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.