section .0300 – services provided

 

10A NCAC 25H .0301       GUIDELINES ON SERVICES

(a)  Each Medicaid recipient may receive two oral

examinations by the same provider in a consecutive 12‑month period.

(b)  A full mouth series is allowed every five years.

(c)  Dental prophylaxis or dental prophylaxis with immediate

fluoride application is limited to two occasions in a consecutive 12‑month

period.  Fluoride treatment is non‑covered for patients 21 years of age

and older.

(d)  Replacement of complete or partial dentures may be made

once every ten years.  Replacement after the expiration of fewer than ten years

may be made with prior approval if failure to replace the dentures will cause

an extreme medical problem (e.g. severe weight loss due to compromised digestive

function) or irreparable harm to oral tissues (e.g. oral sores or TMJ

dysfunction).

(e)  Initial reline of dentures may only be made if six

months have elapsed since receipt of dentures.  Subsequent relines are allowed

only at five year intervals; if failure to reline in fewer than five years will

cause an extreme medical problem or irreparable harm, relines may be made with

prior approval.

(f)  Standard procedures and materials shall be used for

full and partial dentures.  Only those dental materials and procedures accepted

by the American Dental Association (ADA) Council on Dental Therapeutics are

accepted for use in the dental care of Medicaid recipients.  The specific use

of these materials must follow the ADA Council on Dental Therapeutics guidelines

for their use.

 

History Note:        Authority G.S. 108A‑25(b); 108A‑54;

S.L. 1985, c. 479, s. 86;

Eff. February 1, 1976;

Readopted Eff. October 31, 1977;

Amended Eff. October 1, 1992; December 1, 1987; January

1, 1982; February 29, 1980;

Transferred from 10A NCAC 22O .0206 Eff. May 1, 2012.