Dental and Orthodontic Services

Clinical Policy and Programs
Mark W. Casey, DDS, MPH
Dental Director
Phone Number (919) 855-4280
Fax (919) 715-2738

Dental services are defined as diagnostic, preventive or corrective procedures provided by or under the supervision of a dentist.  This includes services to treat disease, maintain oral health, and treat injuries or impairments that may affect a recipient’s oral or general health.  Orthodontics is defined as a corrective procedure for functionally handicapping conditions. 

All services must maintain a high standard of quality and must be provided within the reasonable limits of those that are customarily available and provided to most persons in the community in accordance to Medicaid’s policies and procedures.

Medicaid has adopted procedure codes and descriptions as defined in the most recent edition of Current Dental Terminology (CDT-2005).  CDT-2005 (including procedure codes, descriptions, and other data) is copyrighted by the American Dental Association.

To order ADA Dental Claim Forms, call 1-800-947-4746 or go online to www.adacatalog.org

For service requirements, coverage criteria and limitations, refer to:

• Clinical Coverage Policy #4A - Dental Services
• Clinical Coverage Policy #4B - Orthodontic Services

Additional information is available in the following publications:

• Automated Voice Response (AVR) Instructions for Dental Providers
• Common Dental Claim Denial Correction Instructions
• Frequently Asked Questions

Quick Dental Links

• NC Medicaid Dental Provider List
• Dental Services Fee Schedule

Other Quick Links

• Basic Medicaid Billing Guide
• Proposed Policies
• Provider Forms