Age restrictions for the following procedure codes will change:
|
Procedure Code |
Current Age Restriction |
New Age Restriction |
|
D1120, D1203 |
1 year of age through 12 years of age |
6 months of age through 12 years of age |
|
D1110, D1204 |
13 years of age through 20 years of age |
13 years of age and older |
|
D1206 |
1 year of age or older |
No age limit |
|
D1351, D1510, D1515, D1520, D1525 |
1 year of age through 20 years of age |
1 year of age or older |
|
D1550 |
3 years of age through 12 years of age |
1 year of age or older |
Oral hygiene instruction (procedure code D1330) will be denied when billed on the same date of service by the same provider as procedure code D1203 or D1204.
Dental sealants (procedure code D1351) are a benefit when applied to deciduous (baby or primary) or permanent teeth. Replacement sealants will be limited to one every 3 years, per tooth, for any provider.
Space Maintainers
Space maintainers for use after premature loss of a deciduous/primary first and/or second molar are for clients who are from 1 year of age through 12 years of age. Premature loss is defined as the loss of a tooth before the expected or normal life of the tooth. For a deciduous/primary molar, this occurs before eruption of the comparable bicuspid permanent tooth.
Space maintainers for use after loss of a permanent first molar will be for clients who are 3 years of age or older.
The removal of a space maintainer (procedure code D1555) will not be payable to the provider or dental group practice that originally placed the device. The provider may be reimbursed for removal only if the space maintainer was placed by a different provider.
For more information, call the TMHP-CSHCN Services Program Contact Center at 1‑800-568-2413.