Dental and Orthodontic Services

Dental Services Information for Consumers

DMA 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.

As part of an ongoing effort to identify best practices and opportunities for improvement in children’s Medicaid dental programs, CMS conducted eight State Medicaid dental program reviews between December and March of 2010, focusing on practices and program innovations that have successfully increased dental utilization in these states. The report highlights some of the innovations and initiatives found in these eight states including North Carolina.

Summary of Eight State Reports on Innovative State Practices for Improving the Provision of Medicaid Dental Services
Individual state reports can be downloaded from the CMS Medicaid Dental Coverage Website

The Pew Center for the States' Pew Children's Dental Campaign pulished oral health care report cards last year for each state. North Carolina received a "C."

On September 23, 2008, the N.C. Medicaid Program’s Dental Director, Dr. Mark W. Casey, DDS, MPH, presented testimony on Necessary Reforms to Pediatric Dental Care under Medicaid (PDF, 331 KB) to the U.S. House of Representatives Committee on Oversight and Government Reform Domestic Policy Subcommittee Hearing. The testimony highlighted the successful strategy employed to improve oral health for preschool Medicaid recipients in our State.

Medicaid has adopted procedure codes and descriptions as defined in the most recent edition of Current Dental Terminology (CDT 2011-2012). CDT-2011-2012 (including procedure codes, descriptions, and other data) is copyrighted by the American Dental Association.

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

Clinical Coverage Policy 4A, Dental Services (PDF, 794 KB)
Oral Health Periodicity Schedule (PDF, 33KB)
Clinical Coverage Policy 4B, Orthodontic Services (PDF, 457 KB)

Medicaid Bulletins

For changes and updates to coverage criteria, billing information, and other program requirements refer to the N.C. Medicaid general and special bulletins.