Dental Program

When completing and submitting a paper ADA Dental Claim form, dental providers should complete Field 23 with the participant’s MO HealthNet number exactly as shown on the participant's ID card. Anything other than the participant’s DCN, or leaving the field blank, will cause the claim to deny.

Fluoride Varnish During Well Child Check

Fluoride varnish is a covered service for participants age five and under, when the need is identified through an Early Periodic Screening, Diagnostic, and Treatment (EPSDT) visit. Fluoride varnish may be applied by physicians and nurse practitioners along with other medical professionals (RN, LPN, Physician Assistant) working in a physician’s office or clinic.Fluoride treatment is limited to 1 application of stannous fluoride, acid-phosphate fluoride or fluoride varnish per participant, 2 times per rolling year, per provider.

Dental Billing Tips

Dental Examination:

  • D0120 – Periodic Oral Evaluation
    • Not included in the Adult Dental Limited Package
    • Would require a letter of medical necessity from the patient’s primary care provider The medical necessity must meet MO HealthNet policy in Section 13 of the Dental Manual.
  • D0140 – Limited Oral Evaluation Problem Focused
    •  Code could be used with appropriate documentation of the problem.
  • D0150 - Compr

B. Ray Storm, DDS, MBA, MO HealthNet Dental Director

Dr. Ray Storm is currently the State Dental Director for Missouri, a position just recently re-established at the Department of Health and Senior Services through the efforts of the Missouri Coalition for Oral Health, Delta Dental of Missouri, Missouri Foundation for Health, the REACH Healthcare Foundation, and many other stakeholders committed to improving oral health for all Missourians. Dr. Storm will also be working with MO HealthNet in this role. Prior to his appointment to that position he practiced general dentistry for 32 years in his private practice in St. Peters, Missouri.

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