Dental Providers

Medicaid dental services rules can be found under Title 25 Texas Administrative Code Part 1, Chapter 33. All dental providers must comply with the rules and regulations of the Texas State Board of Dental Examiners, including standards for documentation and record maintenance as stated in 22 TAC, Part 5, Chapter 108, Subchapter A, §108.7, Minimum Standard of Care, General, and §108.8, Records of the Dentist. Texas Health Steps (THSteps) dental benefits are administered as Children's Medicaid Dental Services by dental managed care organizations for most Medicaid fee-for-service and managed care clients who are ages 20 and younger. Find more information in the Texas Medicaid Provider Procedures Manual.

Policy Changes

THSteps Dental Preventive Benefits to Change September 1, 2023

Changes to the THSteps Dental Therapeutic Services Policy include the following:

  • Application of caries arresting medicament (procedure code D1354) became a benefit for THSteps for clients ages 6 and younger.
  • Age restrictions and frequency limitations for application of space maintainers are adjusted.
  • Dental sealants became limited to once per tooth and restricted as to provider type.
  • Added language on the frequency of fluoride application and provider type.

THSteps dental checkups are recommended every three to six months, starting at 6 months of age. Below are the different types of dental health services offered for children and young adults who have Medicaid.

Preventive services include:

  • Dental examinations (initial or periodic)
  • Cleaning (prophylaxis)
  • Oral health education
  • Application of topical fluoride
  • Application of sealants to certain teeth
  • Application of caries arresting medicament
  • Maintenance of space

Treatment services include:

  • Restorations (fillings, crowns)
  • Endodontic treatment (pulp therapy, root canals)
  • Periodontic treatment (gum disease)
  • Prosthodontics (full or partial dentures)
  • Oral surgery (extractions)
  • Maxillofacial prosthetics

Emergency dental services include:

  • Procedures necessary to control bleeding, relieve pain, and eliminate acute infection
  • Procedures that are required to prevent imminent loss of teeth
  • Treatment of injuries to the teeth or supporting structures

Orthodontic services include (with prior authorization):

  • Correction of a cleft palate
  • Crossbite therapy
  • Treatment for severe, handicapping malocclusion
  • Treatment for facial accidents involving severe traumatic deviation

Reimbursement for dental services exceeding the benefit limitations may be considered when medically necessary. Providers must submit documentation supporting medical necessity when submitting the claim. The documentation must be kept in the client’s medical record.