Okla. Admin. Code § 317:30-5-664.7

Current through Vol. 42, No. 4, November 1, 2024

Section 317:30-5-664.7 - Dental services provided by Health Centers

(a)Adults. The Health Center core service benefit to adults is intended to provide services requiring immediate treatment, relief of pain and/or extraction and is not intended to restore teeth as described in OAC 317:30-5-696. Core services are limited to treatment for conditions such as:

(1) Acute infection;

(2) Acute abscesses;

(3) Severe tooth pain; and

(4) Tooth re-implantation, when clinically appropriate.

(b)Children. Medically necessary dental services for members under twenty-one (21) are covered.

(c)Exclusions and limitations . Other medically necessary dental services which are not considered core services may be billed by the Health Center utilizing the current SoonerCare fee schedule, including but not limited to smoking and tobacco use cessation.

(d)Claims. Health Centers must submit all claims for SoonerCare reimbursement for dental services on the American Dental Association (ADA) form.

(e)Other provisions. For additional coverage, medical necessity criteria, exclusions, billing, and prior authorization requirements, refer to OAC 317:30-5-695 through 317:30-5-705.

Okla. Admin. Code § 317:30-5-664.7

Added at 23 Ok Reg 3183, eff 6-7-06 (emergency); Added at 24 Ok Reg 2105, eff 6-25-07; Amended at 28 Ok Reg 123, eff 10-14-10 (emergency); Amended at 28 Ok Reg 1443, eff 6-25-11

Amended by Oklahoma Register, Volume 38, Issue 23, August 16, 2021, eff. 9/1/2021