405 IAC 5-14-5
405 IAC 5-14-5 Treatment of dental caries
Cite as Ind. Admin. Code tit. 405, r. 5-14-5
Sec. 5. Treatment of dental caries with amalgam, composites, or resin restorations or stainless steel crowns is covered. The use of pit
sealants on permanent molars and premolars only is a covered service for members under twenty-one (21) years of age. There is a limit of one (1)
treatment per tooth, per lifetime. Margination of restorations and occlusal adjustments are not covered.