Utah Medicaid is participating in the Centers for Medicare and Medicaid Services’ (CMS) Oral Health Initiative Learning Collaborative (OHI). OHI seeks to improve the use of preventive dental services by children enrolled in Medicaid or CHIP by achieving the following aims:
- Increase the proportion of children ages 1-20 who receive a preventive dental service.
- Increase the proportion of children ages 6-9 who receive a dental sealant on a permanent molar tooth.
- Increase the proportion of children ages 1-4 who receive fluoride varnish applications as part of a well-child visit.
Oral health is an important part of a child’s overall wellbeing. Through this initiative dentists, physicians, and other providers now have an even greater opportunity to participate in improving a child’s oral health. Medicaid and CHIP cover evaluations, prophylaxis, sealants and application of fluoride varnish for eligible members. Follow the links below to find detailed billing information for various provider types.
Dental Providers: See the covered CPT codes here.
Medical Providers (e.g. Pediatrician, Primary Care Physician, etc.): See the covered CPT codes here.
Medical providers are encouraged to view a short video about administering the fluoride varnish to patients.
Any questions or comments about the Oral Health Initiative Program may be directed to: medicaidOHI@utah.gov.
Medical and dental providers must ensure claims adhere to Medicaid and CHIP policy through the review of current manuals and coverage guidelines for all specific codes prior to services being provided. If the member is enrolled in a dental plan, please follow the plan’s guidelines for coverage, utilization, and prior authorization.