SECTION 317:30-5-664.7. Dental services provided by Health Centers

(a)   Adults. The Health Center core service benefit to adults is intended to provide services requiring immediate treatment, relief of pain and/or extraction and is not intended to restore teeth. For scope of services for individuals eligible under other program categories, refer to OAC 317:30-5-696. Core services are limited to treatment for conditions such as:

(1)   Acute infection;

(2)   Acute abscesses;

(3)   Severe tooth pain; and

(4)   Tooth re-implantation, when clinically appropriate.

(b)   Children. Medically necessary dental services for children are covered.

(c)   Exclusions and Limitations. Other medically necessary dental services which are not considered core services may be billed by the Health Center utilizing the current SoonerCare fee schedule.

(1)   Smoking and tobacco use cessation is a covered service for adults and children and is separately reimbursable. Refer to OAC 317:30-5-2.

(2)   Refer to OAC 317:30-5-695 for other specific coverage, exclusions and prior authorization requirements.

(d)   Health Centers must submit all claims for SoonerCare reimbursement for dental services on the American Dental Association (ADA) form.

[Source: Added at 23 Ok Reg 3183, eff 6-7-06 (emergency); Added at 24 Ok Reg 2105, eff 6-25-07; Amended at 28 Ok Reg 123, eff 10-14-10 (emergency); Amended at 28 Ok Reg 1443, eff 6-25-11]