Dental Reimbursement Rate Update

PROVIDER ALERT

The South Carolina Department of Health and Human Services (SCDHHS) has updated the reimbursement rates, effective for dates of service on or after July 1, 2017, for the dental procedure codes listed on the following page.

The updated dental fee schedule will be accessible on the SCDHHS website, scdhhs.gov, July 1, 2017.

For questions regarding this update, 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.

Reimbursement Rate Update for Specific Dental Procedure Categories
Group CDT Code Description Current Rate New Rate
Exam D0120 Periodic oral evaluation  $ 22.00  $  23.00
D0140 Limited oral evaluation  $ 36.04  $  38.50
D0145 Oral evaluation, patient < 3yrs  $ 22.00  $  36.00
D0150 Comprehensive oral evaluation  $ 38.48  $  40.50
Preventive D1110 Dental prophylaxis adult  $ 40.93  $  50.40
D1120 Dental prophylaxis child  $ 28.11  $  34.80
D1206/08 Topical fluoride  $ 15.89  $  16.20
D1351 Dental sealant per tooth  $ 22.61  $  30.00
D1510 Space maintainer fixed unilateral  $  145.40  $  172.80
D1515 Fixed bilateral space maintainer  $  191.83  $  242.40
Oral Surgery D7111 Extraction coronal remnants  $ 51.93  $  66.60
D7140 Extraction erupted tooth  $ 69.03  $  88.80
D7210 Extraction erupted tooth  w/ bone removal/sectioning tooth  $  112.41  $  143.40
D7220 Removal of impacted tooth-soft tissue  $  141.12  $  179.40
D7230 Removal of impacted tooth- partially bony  $  187.55  $  238.80
D7240 Removal of impacted tooth- completely bony  $  219.92  $  280.80
D7241 Removal of impacted tooth- w/complications  $  276.74  $  352.80
D7250 Removal of residual tooth roots  $  118.52  $  151.20
D7270 Tooth re-implantation  $  238.86  $  366.60
D7280 Exposure of an unerupted tooth  $  203.43  $  342.60
D7285 Incisional Biopsy of oral tissue- hard  $  424.58  $  684.60
D7286 Incisional Biopsy of oral tissue - soft  $  191.83  $  293.40
D7510 Incision and drainage of abscess- intraoral soft tissue  $  125.24  $  150.00
D7520 Incision and drainage of abscess- extraoral soft tissue  $  596.24  $  715.80
D7530 Removal of foreign body- mucosa/skin/alveolar tissue  $  215.03  $  258.00
D7550 Partial ostectomy  $  148.45  $  178.20
D7670 Alveolus –closed reduction  $  547.98  $  658.20
D7671 Alveolus- open reduction  $ 1,033.04  $  1,240.80
D7770 Alveolus –open reduction w/ stabilization  $ 1,108.80  $  1,331.40
D7771 Alveolus –closed reduction w/ stabilization  $  855.27  $  1,027.20
D7910 Suture of small wounds up to 5cm  $  190.60  $  229.20
D7911 Complicated  suture wound up to 5 cm  $  476.50  $  572.40
D7912 Complicated suture greater than 5 cm  $  857.71  $  1,030.20
Ancillary D9230 Analgesia/ inhalation of nitrous oxide  $ 24.44  $  32.50
D9243 Intravenous moderate sedation each 15m  $ 62.15  $  74.00
D9420 Hospital/ASC call  $ 70.50  $  87.50
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