Oral Evaluation and Fluoride Varnish in the Medical Home

What is Oral Evaluation and Fluoride Varnish in the Medical Home?

Oral Evaluation and Fluoride Varnish (OEFV) in the Medical Home offers limited services aimed at improving the oral health of children from 6 through 35 months of age.

Who is Eligible to Provide this Service?

Texas Health Steps enrolled physicians, physician assistants, and advanced practice registered nurses.


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

Completion of this course does not certify you to bill Medicaid for oral evaluations and fluoride varnish. If you are a Physician, Physician's Assistant, or Advanced Practice Nurse and wish to receive certification to perform this service and bill Medicaid, you must also submit a certification application to Texas Health Steps.

Please email Texas Health Steps if you have questions.


Take free Continuing Education (CE) courses through the Texas Health Steps Online Provider Education website. The OEFV course was developed by the Texas Health Steps Dental Program. The goal of the module is to introduce Texas Health Steps medical providers and other interested healthcare professionals to best practices for promoting oral health in children from 6 through 35 months of age.

Upon completion of this module, Texas Health Steps physicians, physician assistants and advanced practice registered nurses 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 OEFV 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 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 "Find a Course", scroll down to Oral Health, and then click on Oral Evaluation and Fluoride Varnish for more information and enrollment.

Please note: Providers only have to be certified for OEFV 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.

What is Included in this Visit?

  • Intermediate oral evaluation.
  • Fluoride varnish application.
  • Dental Anticipatory guidance.
  • Referral to a dental home.

The services listed above must be performed in conjunction with a Texas Health Steps medical checkup.

How is this Service Billed to Texas Medicaid?

In conjunction with a Texas Health Steps medical checkup, utilize CPT code 99429 with U5 modifier.

Must be billed with one of the following medical checkup codes:

  • 99381
  • 99382
  • 99391
  • 99392

Federally qualified health centers and Rural Health Centers do not receive additional encounter reimbursement.

What Documentation is Needed?

  • Must document all components of OEFV on the documentation form provided during the training.
  • Keep record of the referral to a dental home.

Forms and Materials

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.


The following PDFs are available for download only. They are not available for online ordering.