Oral Health

The American Academy of Pediatrics is committed to helping pediatricians and other health providers learn how to identify oral disease, provide caries prevention services, and when to refer a to a dentist.

Pediatricians and other medical providers can play an important role in children’s oral health outcomes and improve the overall health of children. Children who may not have the opportunity to see a dentist are well served by pediatricians who are knowledgeable about oral health.

The American Academy of Pediatrics’ new Bright Futures Recommendations for Preventive Pediatric Health Care indicates that an oral health risk assessment be done at ages 6 and 9 months. A referral to a dental home (if available) should be made at 12, 18, 24 and 30 months. If a dental home is not available at those ages, an oral health risk assessment should be done.

Promoting Oral Health

The American Academy of Pediatrics’ new Bright Futures Recommendations for Preventive Pediatric Health Care indicates that an oral health risk assessment be done at ages 6 and 9 months. A referral to a dental home (if available) should be made at 12, 18, 24 and 30 months. If a dental home is not available at those ages, an oral health risk assessment should be done.  Also, if the primary water source for the child is not fluoridated, consider oral fluoride supplementation. Click here to view the new periodicity chart. Click here for a summary of changes to the periodicity schedule.

Locate a Pediatric Dentist

Click here to locate a pediatric dentist at Georgia Academy of Pediatric Denistry

Georgia Medicaid and Oral Health

Since 2002, Georgia’s Medicaid EPSDT program, HealthCheck has required the following: Children must be referred to a dentist for routine dental care for members as early as 12 months of age. However, if indicated, a dental referral may be made at any age. An inspection of the mouth must be a part of each screen. If HealthCheck provider identifies any spot during oral exam, refer the member to a dentist immediately. Discuss the importance of good oral hygiene with member/caregiver.

The Georgia Department of Community Health (DCH), Georgia Medicaid program provides reimbursement for the application of fluoride varnish by physicians in the Medicaid Fee for Service (FFS) Program. The three Medicaid CMOs were notified of this new coverage benefit and it is our current understanding that all 3 will follow Medicaid FFS and begin paying for this service. This service can billed using CPT D1206 and can be billed on the form 1500. The service is billable under the following Categories of Service: 430 (Physician Services), 431 (Physician’s Assistant Services), and 740 (Nurse Practitioners). When done in a physician’s office, the procedure can be delegated to appropriate clinical staff. The reimbursement amount is $17.59. The service can be provided for children aged one month through 13 years, 11 months of age, twice annually. The code is already open and further details will be included in the July 1 version of the Medicaid Health Check manual, available on the Georgia Health Partnership web portal.