LAC 50:XXV.501. Adult Denture Services

A. Only the following services are reimbursable under the Adult Denture Program and only in accordance with program policy and guidelines: 1. comprehensive oral examination*; 2. intraoral radiographs, complete series*; 3. complete denture, maxillary*; 4. complete denture, mandibular*; 5. immediate denture, maxillary*; 6. immediate denture, mandibular*; 7. maxillary partial denture, resin base (including clasps)*; 8. mandibular partial denture, resin base (including clasps)*; 9. repair broken complete denture base; 10. replace missing or broken tooth, complete denture, per tooth; 11. repair resin denture base, partial denture; 12. repair or replace broken clasp, partial denture; 13. replace broken teeth, partial denture, per tooth; 14. add tooth to existing partial denture; 15. add clasp to existing partial denture; 16. reline complete maxillary denture (laboratory)*; 17. reline complete mandibular denture (laboratory)*; 18. reline maxillary partial denture (laboratory)*; 19. reline mandibular partial denture (laboratory)*; 20. unspecified removable prosthodontic procedure, by report*.