Dentists
Reimbursing Procedure Codes D0145 and D1206
Dental procedure code D0145 is an oral evaluation for a patient under three years of age and includes counseling with the primary caregiver. Oral evaluation is a diagnostic and preventive service which should be provided preferably within the first six months of the eruption of the first primary tooth. The evaluation should include recording the child’s oral health history, caries susceptibility, development of an appropriate preventive oral health regimen, and communication with and counseling of the child’s parent, legal guardian or caregiver. Medicaid reimburses $16.00 for procedure code D0145.Procedure code D1206 is for the application of topical fluoride varnish and is a therapeutic application for moderate to high caries risk patients. Application of topical fluoride varnish should be delivered in a single dose involving the entire oral cavity. Fluoride varnish is not to be used for desensitization. Medicaid reimburses $11.00 for procedure code D1206.
For children under three years of age, procedure codes D0145 and D1206 must be billed together. D0145 and D1206 may not be billed with any other type of evaluation or fluoride treatment on the same date of service..
Fluoride varnish may be applied to any child age 0 to 20. The oral evaluation (D0145) may be provided to children 0 to three years of age.
Reminder to Dental ProvidersThe Medicaid Child Health Check- Up Program (EPSDT) recommends that children under the age of 21 have a dental check-up beginning at age 3 or earlier, if medically necessary. Subsequent dental visits should be provided every 6 months or earlier, if medically indicated.