SPECIAL BULLETIN COVID-19 #87: Additional Dental Clinical Coverage Policy Provisions

Monday, May 11, 2020

In response to the recent recommendations by the Centers for Disease Control (CDC) regarding the delay of aerosolizing dental treatment during the onset of the COVID-19 pandemic, NC Medicaid is implementing temporary clinical policy revisions that will allow dentists to provide additional services to Medicaid and NC Health Choice beneficiaries. These temporary policy changes were applied in the NCTracks system with a retroactive effective date of March 10, 2020. These policy revisions will end the earlier of the cancellation of the North Carolina state of emergency declaration or when the policy is rescinded.

Changes include:

  • Allow the topical application of fluoride varnish (D1206) for all ages.
  • Allow the topical application of fluoride varnish (D1206) once per three calendar month period (approximately every 90 days) for patients at high risk for caries (active disease or previous caries related treatment).
  • Allow the application of silver diamine fluoride (D1354 interim caries arresting medicament application per tooth) for all ages.
  • Allow the application of silver diamine fluoride (D1354 interim caries arresting medicament application per tooth) for all primary teeth (A-T) and permanent teeth (01-32).

Note: The application of silver diamine fluoride (D1354 interim caries arresting medicament application per tooth) will continue to be limited to once every six calendar months per tooth and a total of four applications per tooth.

Contact 

NC Medicaid Contact Center: 888-245-0179