Changes to Age Limitations for Certain Dental Procedures

Tagged: 

Effective for all claims submitted on or after Aug. 1, 2016, the South Carolina Department of Health and Human Services (SCDHHS) will lower the age limitation for the codes listed in the table below. This change is to adhere to best practice guidelines.

CDT  Code

Benefit Description

Age Limitation

Teeth Covered

Benefit Limitations

D0330

Panoramic Radiographic Image

6-20

 

Dentists are allowed one D0210 or D0330 per patient within a 36 month period.

Oral surgeons are allowed one D0210 and one D0330 per patient within a 36 month period.

D1351

Sealant – per tooth

5-14

Teeth 2, 3, 14, 15, 18, 19,

30, 31

Dentists and oral surgeons are allowed one D1351 per patient per tooth within a 36 month period.

 

The application of sealants to patients under the age of 5 will continue to be allowed under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) regulations, but a prior authorization is required. Proof of tooth eruption will need to be provided for prior approval by DentaQuest. See Section 3.04 of the Office Reference Manual (ORM) for additional information.

If you have any questions or concerns regarding this bulletin, please contact the DentaQuest Provider Service Center at (888) 307-6553. Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

Report Fraud