Medicaid covers dental services for children and young adult enrollees under age 21 as part of the Early and Periodic Screening, Diagnostic, and Treatment benefit (EPSDT) . This means that dental services for children and young adults cannot be limited to emergency services and must be comprehensive and at intervals that meet reasonable standards of dental practice. The services must include preventative services such as check-ups, cleanings, x-rays, and sealants, as well as restorative services such as fillings, crowns, root canals, oral surgery, and emergency procedures.
States have the flexibility to determine what dental services are covered for adults, and most states provide at least some dental services for adults, with coverage ranging from only emergency care to comprehensive care. However, coverage for adults is not required by federal law, and states choose whether to provide dental benefits for adults. Fourteen states provide limited Medicaid dental benefits for adults, which means Medicaid covers fewer than 100 diagnostic, preventive, and restorative procedures recognized by the American Dental Association (ADA) .
In Indiana, for example, Medicaid dental coverage includes two oral exams every 12 months, one cleaning every 6 months, two fluoride treatments every 12 months for members through age 20, one complete bitewing x-ray series per member every 12 months, full-mouth radiograph series or panoramic x-rays once every 36 months, periodontal services including scaling and root planing, sealants for members up to age 20 (one per tooth, per lifetime), minor restorative services such as fillings, major restorative services such as crowns, tooth extractions (based on medical necessity), orthodontia for members through age 20 (based on medical necessity), dentures, partials, and repairs (with limits), dental surgery (with limits), and emergency dental services.
It is important to note that some dental services must be approved in advance, including dentures and dental surgery, and a direct dental referral is required for every child in accordance with the periodicity schedule set by the state.
