Codes covered only for members under age 21. This document pertains to services provided on or after January 1, 2020. Copyright Notice: Current Dental Terminology © 2020 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
This dataset has the following 11 columns:
| Column Name | API Column Name | Data Type | Description | Sample Values |
|---|---|---|---|---|
| Code | code | text | Procedure code | D8210 D8698 D8681 D8030 D8701 view top 100 |
| Description | description | text | Brief description of the service covered by the procedure code | Re-cement or re-bond fixed retainer – maxillary limited orthodontic transitional dentition removable appliance therapy Repair of fixed retainer, includes reattachment – maxillary comprehensive orthodontic adolescent dentition view top 100 |
| OHP Plus Benefit Coverage | ohp_plus_benefit_coverage | text | Indicates whether the code is covered for all members, specific benefit groups (e.g., under age 21), or not covered under the OHP Plus benefit package | Covered for under age 21 only Covered for under age 19 only Covered for tongue tie in newborns view top 100 |
| Prioritized List Placement | prioritized_list_placement | url | If applicable, provides the procedure's line placement on the Prioritized List of Health Services, with a link to guidance for that line | view top 100 |
| Guideline Note 1 | guideline_note_1 | url | If applicable, provides the Guideline Note associated with the code's Prioritized List placement, with a link to guidance for that line | view top 100 |
| Guideline Note 2 | guideline_note_2 | url | If applicable, provides additional Guideline Note associated with the code's Prioritized List placement, with a link to guidance for that line | view top 100 |
| Guideline Note 3 | guideline_note_3 | url | If applicable, provides additional Guideline Note associated with the code's Prioritized List placement, with a link to guidance for that line | view top 100 |
| OAR 1 | oar | url | If applicable, provides a link to Dental Services OAR that lists specific limitations for the code | view top 100 |
| Limitations | limitations | text | Coverage limitations for this code (such as age or annual benefit limits) | Not to be paid seperately The Division shal cover fixed and removable space maintainers only for clients under 19 years of age. Covered only for clients under 19 years of age Maxillary labial frenulectomy not covered until age 12 and above Limited to four time per year for clients under 13 years of age. Includes payment for monitoring and Nitrous Oxide. Requires use of multiple agents to receive payment. view top 100 |
| Notes | notes | text | Lists additional notes regarding billing, documentation and deletions | Removal of device is part of the surgery and not billable as a separate service The Division covers endodontics only if the crown-to-root ratio is 50:50 or better and the tooth is restorable without other surgical procedures. For children under 19 years of age, topical fluoride varnish may be applied by a licensed medical practitioner during a medical visit. Topical fluoride treatment from a medical practitioner counts toward the overall maximum number of fluoride treatments. The Division only covers oral exams performed by medical practitioners when the medical practitioner is an oral surgeon The Division may not reimburse if performed on the same date of service as the following codes: D1110 (Prophylaxis — adult); D4210 (Gingivectomy or gingivoplasty — four or more contiguous teeth or bounded teeth spaces per quadrant); D4211 (Gingivectomy or gingivoplasty — one to three contiguous teeth or bounded teeth spaces per quadrant); D4341 (Periodontal scaling and root planning — four or more teeth per quadrant); D4342 (Periodontal scaling and root planning — one to three teeth per quadrant); D4346 (Scaling in presence of generalized moderate to severe inflammation, full mouth after oral evaluation); D4355 (Full mouth debridement to enable comprehensive evaluation and diagnosis); and D4910 (Periodontal maintenance). Additional prophylaxis benefit provisions may be available for persons with high risk oral conditions due to disease process, pregnancy, medications, or other medical treatments or conditions, severe periodontal disease, rampant caries and for persons with disabilities who cannot perform adequate daily oral health care. view top 100 |
| File Date | file_date | calendar_date | The effective date of the file | 2022-01-01T00:00:00.000 2021-01-01T00:00:00.000 view top 100 |