Colorado Medicaid Billing Reference
Fee-for-Service Reimbursement
Billing Ages 0-2
| Code | Encounter |
|---|---|
| D0145 | Oral Evaluation |
| D1206 | Topical Fluoride Varnish |
| Z13.84 Screening for Dental Disorders (ESPSDT ICD 10- Diagnosis codes) | Pair with Well Child Visit and submit on electronic claim 837P. Document formal Caries Risk Assessment in patient chart. Reimbursable twice per year; two additional per year for high caries risk children |
Billing Ages 3-4
| Code | Encounter |
|---|---|
| D0190 | Dental Screening |
| D1206 | Topical Fluoride Varnish |
| Z13.84 Screening for Dental Disorders (ESPSDT ICD 10- Diagnosis codes) | Pair with Well Child Visit and submit on electronic claim 837P. Document formal Caries Risk Assessment in patient chart. Reimbursable twice per year; two additional per year for high caries risk children. |
Billing Ages 5-20
| Code | Encounter |
|---|---|
| D0190 | Dental Screening |
| D1206 | Topical Fluoride Varnish |
| Z13.84 Screening for Dental Disorders (EPSDT ICD Diagnosis codes) | Reimbursable a maximum three times, regardless of risk. Not required to pair with well child; submit on electronic claim 837P. |
Caries Risk Assessment
Documentation of risk using a Pediatric Oral Health Screening form must be part of the child member’s medical and/or dental record.
Required Certification Training for Primary Care Providers
Ages 0-12 years
- Complete Cavity Free at Three Training. Visit CoOralHealth.org for upcoming certification trainings or to request a training.
OR
- Complete Smiles for Life national curriculum online SmilesForLifeOralHealth.org
- Complete Child Oral Health course and Caries Risk Assessment, Fluoride Varnish, and Counseling Course.
Ages 12-20 years
- Complete Smiles for Life national curriculum online SmilesForLifeOralHealth.org
- Complete Adult Oral Health Course and Caries Risk Assessment, Fluoride Varnish, and Counseling Course.
- Qualified Medical Personnel include Physicians (MDs), Osteopaths (DOs), Nurse Practitioners (NPs) and Physicians Assistants (PAs) with a focus on primary care, general practice, internal medicine or pediatrics and who have completed training.
- Qualified Medical Personnel who complete this training must provide documentation of this training when requested….