Coverage Summary
Health First Colorado adult dental benefits, administered by DentaQuest. Revised July 2025.
Cost to You
- Copays: $0
- Deductible: $0
- Out-of-pocket maximum: None needed — there are no member costs
- Annual limit: None (removed July 1, 2023)
All covered services are paid at 100% by Medicaid. You pay nothing for covered services at in-network providers.
Covered Services — Full Breakdown
Diagnostic
| Procedure | Frequency | You Pay |
|---|---|---|
| Periodic oral exam | 2x per year | $0 |
| Comprehensive oral exam | 1x every 3 years per location | $0 |
| Comprehensive periodontal exam | 1x every 3 years | $0 |
| Limited oral exam (problem-focused) | 2x per year per location | $0 |
| Full mouth X-rays | 1x every 5 years | $0 |
| Vertical bitewing X-rays | 1x every 5 years per provider/location | $0 |
| Panoramic X-rays | 1x every 5 years per provider/location | $0 |
Preventive
| Procedure | Frequency | You Pay |
|---|---|---|
| Routine cleaning | 2x per year | $0 |
| Silver diamine fluoride | 2x per year per tooth | $0 |
Restorative
| Procedure | Frequency | You Pay |
|---|---|---|
| Silver fillings | 1x every 3 years per surface per tooth | $0 |
| White fillings | 1x every 3 years per surface per tooth | $0 |
| Stainless steel crowns | 1x every 3 years (permanent teeth only) | $0 |
| Protective restorations | 1x per lifetime per tooth | $0 |
Major Restorative
| Procedure | Frequency | You Pay | Prior Auth? |
|---|---|---|---|
| Crowns | 1x every 7 years per tooth | $0 | Yes |
| Recement crowns | Only 7+ months after placement | $0 | No |
Note: Second molars must meet clinical criteria. Third molars (wisdom teeth) are not covered for crowns.
Endodontics
| Procedure | Frequency | You Pay |
|---|---|---|
| Pulpal debridement | 1x per lifetime per tooth (permanent only) | $0 |
| Root canal treatment | 1x per lifetime per tooth | $0 |
Second molars must meet criteria. Third molars not covered.
Periodontics
| Procedure | Frequency | You Pay | Prior Auth? |
|---|---|---|---|
| Full mouth debridement | 1x every 3 years | $0 | No |
| Periodontal maintenance | 2x per year | $0 | No |
| Scaling/root planing | 1x every 3 years per quadrant | $0 | Yes |
| Periodontal surgery | Must meet clinical criteria | $0 | Yes |
Prosthetics
| Procedure | Frequency | You Pay | Prior Auth? |
|---|---|---|---|
| Complete denture | 1x every 7 years | $0 | Yes |
| Partial denture (removable) | 1x every 7 years | $0 | Yes |
| Rebase/reline denture | 1x every 4 years (7+ months after placement) | $0 | No |
| Repair of denture | 1x per year per denture | $0 | No |
| Fixed partial denture (bridge) | NOT COVERED | N/A | N/A |
| Implants | NOT COVERED | N/A | N/A |
Important: Replacement of lost, stolen, or irreparable dentures is a once per lifetime benefit.
Oral Surgery
| Procedure | Frequency | You Pay |
|---|---|---|
| Simple extractions | 1x per lifetime per tooth | $0 |
| Surgical extractions | 1x per lifetime per tooth | $0 |
Anesthesia
| Procedure | Frequency | You Pay |
|---|---|---|
| Deep sedation / general anesthesia | 1x per day with covered services | $0 |
| IV-conscious sedation | 1x per day with covered services | $0 |
Other
| Procedure | Frequency | You Pay |
|---|---|---|
| Diagnostic consultation | 1x per year per provider/location | $0 |
| House/extended-care facility call | 1x per day per patient | $0 |
| Hospital/ambulatory surgical center | Emergency services only | $0 |
What Is NOT Covered
- Dental implant placement (the fixture/screw itself)
- Fixed bridges
- Orthodontics (for adults; children may qualify)
- Cosmetic procedures (whitening, veneers for appearance only)
- Third molar (wisdom tooth) crowns or root canals
- Full mouth implants / full mouth crowns
Prior Authorization Required For
These services need your dentist to submit a prior auth to DentaQuest before treatment:
- Crowns
- Partial dentures
- Complete dentures
- Periodontal scaling
Treatment started before authorization is approved is at the financial risk of the dental office and may not be covered.
Emergency Care
No limits on emergency visits. No prior authorization needed. If you can't reach your dentist, go to the nearest ER.
See also: Your Treatment Plan | Out-of-Pocket Costs | Procedures/Crowns on Implant Stems