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
(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
(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
(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.