I. Budget Proposal Description:
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1 Budget Initiative Fact Sheet Office: MaineCare Services Date: 12/13/2011 Initiative: 7434 Dental Services Account: 0147 I. Budget Proposal Description: This initiative proposes to eliminate dental services (MaineCare Benefits Manual, Section 25) as an optional service for members over age 21. II. Financial Information: General Fund Actual Actual Actual Actual SFY 08 SFY 09 SFY 10 SFY 11 1,606,531 1,554,581 1,667,546 1,663,946 Other Special Revenue Federal Funds 2,673,550 3,438,989 4,406,105 4,006,873 Total 4,280,081 4,993,570 6,073,651 5,670,819 Other sources of funding for program, i.e. FHM? Yes x No III. Total users of service: SFY 2008 Unduplicated Members SFY 2009 Unduplicated Members SFY 2010 Unduplicated Members SFY 2011 Unduplicated Members 18,570 18,978 20,907 20,066 *User data has changed from SFY 10 to SFY 11 due to enrollment and billing under MIMHS. Previously, in SFY 10 there were local codes that distinguished service rendered and where service was delivered. In the transition to MIMHS we are using HIPAA compliant codes and pulling data based on these codes which includes all services provided. IV. Program Eligibility Criteria: MaineCare members age 21 or older, who do not reside in an ICF-MR, are eligible for dental services when it is medically necessary in order to alleviate pain, infection or prevent imminent tooth loss. Services include acute surgical care directly related to an accident where traumatic injury has occurred, oral surgical and related medical procedures, extraction of teeth that are severely decayed and pose a serious threat of infection during a major surgical procedure and full or partial dentures when it is determined to be medically necessary to correct or relieve an underlying medical condition.
2 V. Current Budget Proposal: 1) Appropriation Increase: $ -0- SFY 12 SFY 13 2) Appropriation Decrease: $ 410,611 2,225,611 3) Savings/Reduction Plan: Eliminate dental as an optional service. Services: Acute surgical care directly related to an accident where traumatic injury has occurred (this coverage will only be provided for the first three months after the accident), Oral surgical and related medical procedures not involving the dentition and gingival, extraction of teeth that are severely decayed and pose a serious threat of infection during a major surgical procedure of the cardiovascular system, the skeletal system or during radiation therapy for a malignant tumor, Treatment necessary to relieve pain, eliminate infection or prevent imminent tooth loss and other dental services, including: full and partial dentures, medically necessary to correct or ameliorate an underlying medical condition, if the Department determines that the provision of those services will be costeffective in comparison to the provision of other covered medical services for the treatment of the condition.. 4) Any contracts impacted? Yes x No VI. Legal Requirements: Federal subject to approval of CMS State Plan Amendment. Members and providers must be notified in advance. Medically necessary services for children are required through EPSDT and may not be eliminated. State subject to approval of state rulemaking and changes to statutes 22 MRSA 3174-Q and Title 22, 3174F. VII. Maintenance of Effort Requirements: Yes x No
3 VIII. Procedures Performed and Billed to MaineCare by Code Number: Procedure Code Procedure Count of Procedure D2140 Amalgam One Surface Permanen 279 D2150 Amalgam Two Surfaces Permane 437 D2160 Amalgam Three Surfaces Perma 283 D2161 Amalgam 4 or > Surfaces Perm 177 D2330 Resin One Surface-Anterior 1,053 D2331 Resin Two Surfaces-Anterior 1,057 D2332 Resin Three Surfaces-Anterio 947 D2335 Resin 4/> Surf or w Incis An 1,081 D2390 Ant Resin-Based Cmpst Crown 141 D2391 Post 1 Srfc Resinbased Cmpst 1,392 D2392 Post 2 Srfc Resinbased Cmpst 2,110 D2393 Post 3 Srfc Resinbased Cmpst 1,424 D2394 Post >=4srfc Resinbase Cmpst 1,031 D2710 Crown Resin-Based Indirect 60 D2915 Recement Cast or Prefab Post 2 D2920 Dental Recement Crown 81 D2931 Prefab Stnlss Steel Crown Pe 6 D2932 Prefabricated Resin Crown 3 D2940 Dental Sedative Filling 1,007 D2950 Core Build-Up Incl Any Pins 520 D2951 Tooth Pin Retention 179 D2954 Prefab Post/Core + Crown 240
4 D2970 Temp Crown (Fractured Tooth) 10 D3110 Pulp Cap Direct 118 D3120 Pulp Cap Indirect 1,210 D3220 Therapeutic Pulpotomy 89 D3310 End Thxpy, Anterior Tooth 469 D3320 End Thxpy, Bicuspid Tooth 434 D3330 End Thxpy, Molar 282 D3346 Retreat Root Canal Anterior 7 D3347 Retreat Root Canal Bicuspid 3 D3348 Retreat Root Canal Molar 3 D3410 Apicoect/Perirad Surg Anter 10 D3430 Retrograde Filling 2 D3999 Endodontic Procedure 78 D4341 Periodontal Scaling & Root 477 D4355 Full Mouth Debridement 173 D4999 Unspecified Periodontal Proc 32 D5110 Dentures Complete Maxillary 240 D5120 Dentures Complete Mandible 204 D5130 Dentures Immediat Maxillary 9 D5140 Dentures Immediat Mandible 1 D5211 Dentures Maxill Part Resin 10 D5212 Dentures Mand Part Resin 28 D5213 Dentures Maxill Part Metal 7 D5214 Dentures Mandibl Part Metal 2 D5410 Dentures Adjust Cmplt Maxil 285
5 D5411 Dentures Adjust Cmplt Mand 208 D5421 Dentures Adjust Part Maxill 26 D5422 Dentures Adjust Part Mandbl 25 D5510 Dentur Repr Broken Compl Bas 360 D5520 Replace Denture Teeth Complt 977 D5610 Dentures Repair Resin Base 95 D5620 Rep Part Denture Cast Frame 6 D5630 Rep Partial Denture Clasp 14 D5640 Replace Part Denture Teeth 78 D5650 Add Tooth to Partial Denture 505 D5660 Add Clasp to Partial Denture 56 D5710 Dentures Rebase Cmplt Maxil 314 D5711 Dentures Rebase Cmplt Mand 206 D5720 Dentures Rebase Part Maxill 17 D5721 Dentures Rebase Part Mandbl 32 D5730 Denture Reln Cmplt Maxil Ch 39 D5731 Denture Reln Cmplt Mand Chr 48 D5750 Denture Reln Cmplt Max Lab 156 D5751 Denture Reln Cmplt Mand Lab 91 D5982 Surgical Stent 1 D5986 Fluoride Applicator 10 D5999 Maxillofacial Prosthesis 40 D7111 Extraction Coronal Remnants 35 D7140 Extraction Erupted Tooth/Exr 32,804 D7210 Rem Imp Tooth w Mucoper Flp 12,731
6 D7220 Impact Tooth Remov Soft Tiss 381 D7230 Impact Tooth Remov Part Bony 1,036 D7240 Impact Tooth Remov Comp Bony 1,285 D7241 Impact Tooth Rem Bony w Comp 65 D7250 Tooth Root Removal 7,159 D7260 Oral Antral Fistula Closure 10 D7261 Primary Closure Sinus Perf 685 D7270 Tooth Reimplantation 4 D7285 Biopsy of Oral Tissue Hard 108 D7286 Biopsy of Oral Tissue Soft 356 D7310 Alveoplasty w Extraction 1,805 D7320 Alveoplasty wo Extraction 65 D7321 Alveoloplasty Not w Extracts 4 D7410 Rad Exc Lesion Up to 1.25 Cm 47 D7411 Excision Benign Lesion>1.25c 13 D7412 Excision Benign Lesion Compl 7 D7441 Malig Tumor > 1.25 Cm 1 D7450 Rem Odontogen Cyst to 1.25cm 748 D7451 Rem Odontogen Cyst > 1.25 Cm 333 D7460 Rem Nonodonto Cyst to 1.25cm 8 D7461 Rem Nonodonto Cyst > 1.25 Cm 1 D7465 Lesion Destruction 1 D7471 Rem Exostosis Any Site 61 D7472 Removal of Torus Palatinus 7 D7473 Remove Torus Mandibularis 70
7 D7510 I&d Absc Intraoral Soft Tiss 2,501 D7511 Incision/Drain Abscess Intra 2 D7520 I&d Abscess Extraoral 6 D7521 Incision/Drain Abscess Extra 3 D7530 Removal FB Skin/Areolar Tiss 79 D7540 Removal of FB Reaction 9 D7550 Removal of Sloughed Off Bone 20 D7610 Maxilla Open Reduct Simple 3 D7630 Open Red Simpl Mandible Fx 1 D7640 Clsd Red Simpl Mandible Fx 2 D7720 Clsd Reduct Compd Maxilla Fx 1 D7730 Open Reduct Compd Mandble Fx 1 D7740 Clsd Reduct Compd Mandble Fx 1 D7780 Reduct Compnd Facial Bone Fx 3 D7880 Occlusal Orthotic Appliance 111 D7910 Dent Sutur Recent Wnd to 5cm 11 D7911 Dental Suture Wound to 5 Cm 939 D7912 Suture Complicate Wnd > 5 Cm 20 D7950 Mandible Graft 1 D7953 Bone Replacement Graft 8 D7955 Repair Maxillofacial Defects 1,439 D7960 Frenulectomy/Frenulotomy 6 D7970 Excision Hyperplastic Tissue 7 D7997 Appliance Removal 3 D7999 Oral Surgery Procedure 12
8 D9110 Tx Dental Pain Minor Proc 2,529 D9220 General Anesthesia 6,187 D9221 General Anesthesia Ea Ad 15m 1,809 D9230 Analgesia 239 D9241 Intravenous Sedation 200 D9242 IV Sedation Ea Ad 30 M 148 D9310 Dental Consultation 185 D9410 Dental House Call 303 D9420 Hospital Call 9 D9430 Office Visit During Hours 80 D9440 Office Visit After Hours 22 D9610 Dent Therapeutic Drug Inject 766 D9612 Thera Par Drugs 2 or > Admin 73 D9630 Other Drugs/Medicaments 12 D9930 Treatment of Complications 354 D9940 Dental Occlusal Guard 109 D9999 Adjunctive Procedure 4 Grand Total 99,045
9 IX. Demographic Information: (2010 Data) COUNTY COUNT(DISTINCTPERSON_ID) Androscoggin 2,190 Aroostook 1,579 County Unidentified 617 Cumberland 3,079 Franklin 622 Hancock 559 Kennebec 2,528 Knox 506 Lincoln 499 Oxford 1,268 Penobscot 2,328 Piscataquis 348 Sagadahoc 438 Somerset 1,267 Waldo 579 Washington 556 York 1,944 Gender Female Male 7914 Unidentified 2 Between Age Average Age 40 Median Age 37 Marital Status Divorced 3065 Married 5690 Single 9151 Widowed 519 Separated 1294 Unidentified 1188 Income Earnings 5693 Pension/Retirement 311 Unemployment 675 Workers Comp 68
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Please note a few important reminders to help expedite the process of dental claims/estimates:
To: Valued Members and Providers From: Member Services Date: January 2019 RE: Attached is the for all members. Note: The Plan Pays amount on the fee schedule already has the percentages factored in. The
TABLE OF DENTAL PROCEDURES PLATINUM PLAN PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS.
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NDB Nevada Kids Silver In-Network Schedule of Benefits
NDB Nevada Kids Silver Diagnostic D0120 Periodic Oral Evaluation Established Patient (1 per 6 months)... No Charge D0140 Limited Oral Evaluation Problem Focused (3 per 6 months)... No Charge D0145 Oral
our promise to State of Florida 2008
our promise to State of Florida 2008 TABLE OF DENTAL PROCEDURES PLEASE READ THE FOLLOWING INFORMATION CAREFULLY FOR YOUR PROCEDURE FREQUENCIES AND PROVISIONS. The attached is a list of dental procedures
PLEASE READ IMPORTANT PLAN INFORMATION AT THE END OF THIS SCHEDULE
Careington Corporation Care POS Schedule CI-4 Please Call 800-290-0523 for Customer Service ***Discount plans are not insurance*** This schedule applies to services provided by a participating General
The. Dental Plan. Underwritten by: DENTA-CHEK of Maryland, Inc. A Not-for-Profit Corporation
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COPAY SCHEDULE SCHEDULE OF COPAYMENTS SPECIALIST DENTIST
INFORMATION Lab fees are included in Network General Dentist Copay unless indicated by specific code. Services not listed are not covered. Services listed in the Limitations and Exclusions section of the
COPAY SCHEDULE SCHEDULE OF COPAYMENTS SPECIALIST DENTIST
INFORMATION Lab fees are included in Network General Dentist Copay unless indicated by specific code. Services not listed are not covered. Services listed in the Limitations and Exclusions section of the
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COPAY SCHEDULE AZ400 - SCHEDULE OF COPAYMENTS SPECIALIST DENTIST
INFORMATION Lab fees are included in Network General Dentist Copay unless indicated by specific code. Services not listed are not covered. Services listed in the Limitations and Exclusions section of the
COPAY SCHEDULE AZ100 - SCHEDULE OF COPAYMENTS SPECIALIST DENTIST
INFORMATION Lab fees are included in Network General Dentist Copay unless indicated by specific code. Services not listed are not covered. Services listed in the Limitations and Exclusions section of the
COPAY SCHEDULE AZ500 - SCHEDULE OF COPAYMENTS SPECIALIST DENTIST
INFORMATION Lab fees are included in Network General Dentist Copay unless indicated by specific code. Services not listed are not covered. Services listed in the Limitations and Exclusions section of the
TYPE 1 PROCEDURES PAYMENT BASIS - Maximum Covered Expense BENEFIT PERIOD - Calendar Year For Additional Limitations - See Limitations
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SECURECARE DENTAL COPAY PLAN AZ100 - SCHEDULE OF DENTIST COPAYMENTS
The Copay Plan is a fee-for-service dental plan designed with convenient copays. If the treating dentist is a General Dentist, the patient is responsible for the Genteral Dentist Copay(s) for services
NC Medicaid Dental Reimbursement Rates General Dentist, Oral Surgeon, Pediatric Dentist, Periodontist, & Orthodontist Effective Date: January 1, 2014
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NDB Nevada Kids Silver In-Network Schedule of Benefits
Diagnostic D0120 Periodic Oral Evaluation - Established Patient (1 Per 6 No Charge D0140 Limited Oral Evaluation - Problem Focused (As Necessary) (3 Per 6 No Charge D0145 Oral Evaluation for a Patient
S:\Rates\2014\F12-02-DentalProvider-FeeSchedule Rev
120 PERIODIC ORAL EVALUATION ESTABLISHED PATIENT 49.00 59.00 59.00 71.00 140 LIMITED ORAL EVALUATION - PROBLEM FOCUSED 71.00 85.00 99.00 119.00 145 ORAL EVAL PT UND 3 YR AGE CNSL W/PRIM CAREGIVER 71.00
2019 CDT HCPCS Updates
DECEMBER 2018 KMAP DENTAL BULLETIN 18248 2019 CDT HCPCS Updates Effective with dates of service on and after, the following dental codes will be covered under certain benefit plans for the (KMAP) for some