Current through Register Vol. 30, No. 38, September 20, 2024
A. The
Administration or a contractor shall cover dental services for a member less
than 21 years of age under R9-22-213.
B. For individuals age 21 years of age or
older, the Administration or a contractor shall cover medical and surgical
services furnished by a dentist only to the extent such services may be
performed under state law either by a physician or by a dentist and such
services would be considered a physician service if furnished by a physician.
1. Except as specified in subsection (C),
such services must be related to the treatment of a medical condition such as
acute pain, infection, or fracture of the jaw. Covered dental services include
examination of the oral cavity, radiographs, complex oral surgical procedures
such as treatment of maxillofacial fractures, administration of an appropriate
level of anesthesia and the prescription of pain medication and
antibiotics.
2. Such services do
not include services that physicians are not generally competent to perform
such as dental cleanings, routine dental examinations, dental restorations
including crowns and fillings, extractions, pulpotomies, root canals, and the
construction or delivery of complete or partial dentures. Diagnosis and
treatment of temporomandibular joint dysfunction are not covered except for the
reduction of trauma.
C.
For the purposes of this subsection, simple restorations means silver amalgam
or composite resin fillings, stainless steel crowns or preformed crowns. In
addition, dental services for an individual 21 years of age or older include:
1. The elimination of oral infections and the
treatment of oral disease, which includes dental cleanings, treatment of
periodontal disease, medically necessary extractions and the provision of
simple restorations as a medically necessary pre-requisite to covered
transplantation; and
2.
Prophylactic extraction of teeth in preparation for covered radiation treatment
of cancer of the jaw, neck or head.
