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Adult Dental Benefit Changes for January 1, 2020

The Agency of Human Services (AHS) is making the following changes to the Medicaid adult dental benefit effective January 1, 2020.

  •  Increasing the annual maximum dollar limit on adult dental services from $510 to $1,000.
  • Allowing up to two visits for preventive services per calendar year that do not count towards the $1000 annual maximum dollar limit and removing copayments from preventive dental services listed below, including D0120 Periodic Oral Exam.

These changes are a result of Act 72 enacted during the 2019 legislative session. The changes are intended to expand adult Medicaid beneficiaries’ access to dental care and encourage the utilization of preventive dental care. These changes apply to Medicaid beneficiaries age 21 and older, who are not pregnant or in the postpartum period.
Codes for preventive services outside of the annual maximum dollar amount include:

Preventive Services
D1110 Prophylaxis – Adult “cleaning”
D1206 Topical Fluoride Varnish
D1208 Topical Application of Fluoride
D1320 Tobacco Counseling for the Control and Prevention of Oral Disease
Office Visit
D0120 Periodic Oral Exam

For additional language, please see the Dental Page.