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 ages 6-35 months. It provides simple, consistent messages to parents and 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 (THSteps) pediatric and general dentists.


Providers must first take a FDH online training course offered by the THSteps 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 THSteps.


Take free Continuing Education (CE) courses through the THSteps Online Provider Education website. The FDH course was developed by the THSteps Dental program. The goal of the FDH module is to train THSteps dentists who are enrolled in Texas Medicaid to provide a dental home for children ages 6-35 months.

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

To take the online training, visit THSteps Online Provider Education website and click on "Courses." Select "Oral Health" in the topic menu, and a list of courses will pop up. Click on “First Dental Home” for more information and enrollment. You must first sign into your account or register for an account to enroll for a course.

Note: providers only have to be certified once for FDH. Retaking a training session or submitting a new application isn’t required. However, since the training is updated every three years to include policy and clinical changes, providers and staff may wish to retake in this timeframe as well. 

Email THSteps if you have questions concerning training for FDH.


The Oral Health Questionnaire and the Dental Risk Assessment Questionnaire, available in English and Spanish, are optional tools provided by the THSteps dental program. Dental providers may opt to use similar questionnaires in their practice.

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 at top left to pull up the document and download the printable PDF.

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?

A caries risk assessment determines the potential for developing 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.
  • Appropriate recall periodicity schedule for the child.

What is "Dental Anticipatory Guidance"?

Age-appropriate information and education for parents and caregivers is based on:

  • Questionnaire responses.
  • A parent or caregiver interview.
  • A caries risk assessment.
  • A multi-topic overview of oral health environmental influences.
  • Increasing the parents or 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.
  • Documents in 11 components explaining what took place during the visit.
    1. Completion of an oral health questionnaire by the dentist or a member of the dentist's staff.
    2. The dental risk assessment questionnaire by the parent or 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 or 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 they were not completed.

How is this Service Billed to Texas Medicaid?

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

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