048.0037.26.10
Ch. 26, § 10. Dental Services
Cite as Medicaid Rules, Ch. 26, § 10
(a) Covered services for clients under the age of twenty-one (21):
(i) Preventive visits;
(ii) Restorative fillings, crowns, and tooth replacement;
(iii) Extractions;
(iv) Partial or complete dentures;
(v) Root canal therapy;
(vi) Periodontal treatment;
(vii) Oral and maxillofacial surgery;
(viii) Orthodontic treatment for severe malocclusions; and
(ix) Palliative treatment.
(b) Covered services for clients age twenty-one (21) and older:
(i) Preventive visits;
(ii) Extractions;
(iii) Palliative treatment; and
(iv) Oral and maxillofacial surgery.