First Dental Home

What is First Dental Home?

First Dental Home is a package of dental services aimed at improving the oral health of children 6-35 months of age. It provides simple, consistent messages to parents/caregivers of very young children. Materials have been collaboratively developed by pediatric and general dentists.


Who is Being Trained to Provide a First Dental Home?

  • Currently enrolled Texas Health Steps pediatric and general dentists.
  • Dentists who have submitted a Texas Health Steps dental provider enrollment application.
  • Dental team members are encouraged to participate in FDH trainings.


Take free Continuing Education courses through the Texas Health Steps Online Provider Education website. The First Dental Home course was developed by the Texas Health Steps Dental program. The goal of the FDH module is to train and certify Texas Health Steps dentists who are enrolled in Texas Medicaid to provide a dental home for children from 6 through 35 months of age.

To take the online training, visit Texas Health Steps Online Provider Education website and click on "Courses". In the Course Finder, select "Oral Health" in the topic menu, then click FIND. Click on First Dental Home for more information and enrollment. Please note, to enroll for a course you must first sign in to your account or register for an account.

Please email Texas Health Steps if you have questions concerning training for FDH.

What is Included in a First Dental Home Visit?

  • Caries risk assessment.
  • Dental prophylaxis.
  • Oral hygiene instructions with primary caregiver.
  • Application of topical fluoride varnish.
  • Dental anticipatory guidance.
  • Establishment of recall schedule.

Why Complete a Caries Risk Assessment?

Determine potential for development of severe early childhood caries by identifying the:

  • Oral health status of the child/patient.
  • Oral health status of primary caregiver and other family members.
  • Potential bacterial transmission sources.
  • Direct dental anticipatory guidance content.
  • Determine an appropriate recall periodicity schedule for the child.

What is "Dental Anticipatory Guidance"?

Age appropriate information/education for parents/caregivers based on:

  • Questionnaire responses.
  • Parent/caregiver interview.
  • Caries risk assessment.
  • Multi-topic overview of oral health environmental influences.
  • Directed at increasing the parents/caregivers' understanding about the importance of good oral health.

What Documentation is Required?

  • Date of FDH visit.
  • Name of primary caregiver present during FDH visit.
  • Document what took place during visit (11 Components).
    1. Completion of oral health questionnaire by the dentist or a member of the dentist's staff.
    2. The dental risk assessment questionnaire by the parent/guardian.
    3. Review of the child's health history.
    4. Review of the dental history for the:
      • Child/patient.
      • Primary caregiver.
      • Any siblings.
    5. An initial comprehensive oral evaluation performed by the FDH trained dentist.
    6. Caries risk assessment performed by the FDH trained dentist.
    7. Toothbrush prophylaxis (rubber cup prophylaxis if indicated due to stain, etc.).
    8. Topical fluoride varnish application (on all erupted teeth).
    9. Dental anticipatory guidance provided to the parent/guardian:
      • Oral hygiene instructions.
      • Nutritional guidance.
      • Oral developmental milestones for the child.
    10. Establishment of a dental recall schedule.
    11. Any necessary referral to dental specialists.

Document all incomplete required procedures and the reason that they were not completed.

How is this Service Billed to Texas Medicaid?

Upon completion of the training, dental providers are eligible to bill D0145 and receive enhanced reimbursement. Though the dentist must attend training, all dental team members are encouraged to attend.

  • D0145 – Oral evaluation for a patient younger than 3 years old and counseling with the parent/caregiver.
  • D0145 – all-inclusive for First Dental Home visit (bundled code).
  • Do not bill any other exam, prophy, or fluoride codes with this visit.