Dental

Members with Standard Medicaid benefits are eligible for nearly all medically necessary dental and denturist services. Pregnant members who have been granted Presumptive Eligibility or who have received Notice of Decision may also be eligible for dental benefits.

For full details, please consult your Member Guide.  

Annual Benefit Cap & Limits

  • Adult Members (Standard Medicaid): Subject to an annual dental treatment cap of $1,205.

  • Cap Exemptions: Diagnostic, preventive, covered anesthesia, and denture services do not count toward the $1,205 cap.

  • Exempt Members: Children (ages 0–20) and adults eligible for Aged, Blind, and Disabled (ABD) Medicaid are not subject to the annual limit.

  • Member Responsibility: Adults are responsible for paying for non-covered services and any treatment costs exceeding the annual limit.

  • Periodic service limits apply to all covered services.

Non-Covered Services

  • Dental implants

  • Cosmetic dentistry

  • Qualified Medicare Beneficiary (QMB) services

  • Noble metal crowns, bridges, and orthodontia (Members 21+)

  • Splints and mouthguards (Members 21+)

Summary of Covered Dental Services

Members Aged 20 and Under

Members Aged 21 and Over
  • Can get dental exams and cleanings as often as necessary.
  • Should visit a dentist by their first birthday, and then at least once every six months after the first tooth comes in.
  • During a Well Child Checkup, doctors should do an oral exam, including the application of fluoride varnish if needed.
  • Bridges and tooth-colored crowns are available.
  • Dentures
  • $1,205 annual cap for treatment services.
  • Can have dental exams and cleanings every six months.
  • Partial dentures may be replaced every 5 years.
  • Full dentures may be replaced every 10 years.
  • One lost pair of dentures in a person’s lifetime is covered.

For Provider Manual and Complete List of Covered Dental Services