First Dental Home

What is First Dental Home?

First Dental Home (FDH) 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 Eligible to Provide this Service?

  • Currently enrolled Texas Health Steps pediatric and general dentists.


Providers must first take a FDH online training course offered by the Texas Health Steps to become certified to bill for this service. All other dental team members are encouraged to attend the training.

Completion of this course does not certify you to bill Medicaid for First Dental Home. If you are a dentist and wish to receive certification to perform this service, you must also submit a certification application to Texas Health Steps.


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 Texas Health Steps dentists who are enrolled in Texas Medicaid to provide a dental home for children from 6 through 35 months of age.

Upon completion of this module, Texas Health Steps pediatric and general dentists can print the CE training certificate and complete a certification application electronically, then fax or email to Texas Health Steps staff to become certified to provide FDH services in their practice. The completed application form and CE certificate should be emailed to Alternatively, the completed form and CE certificate can be faxed to 512-483-3979. Providers must receive an email confirmation from Texas Health Steps that they are certified before they can bill Medicaid.

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 into your account or register for an account.

Please note: providers only have to be certified for FDH one time. You do not have to retake training or submit a new application. However, since the training is updated every 3 years to include policy and clinical changes, providers and staff may wish to retake in this timeframe as well.

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


THSteps Catalog Materials*

*To access the materials below, click on the link and navigate to the section “Browse the THSteps Catalog”, then click on the browse button. This takes you to the Main Menu page; click on “view catalog items” and insert the publication number to pull up the document and download the printable pdf. file.

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.