Crowns on Implant Stems

This is your most important coverage question. You have two implant stems (fixtures) already placed and need crowns fabricated and seated on them.

The Coverage Ambiguity

The official Health First Colorado Adult Dental Benefit Summary states:

"Implants — Not a covered benefit"

However, this language is ambiguous. Here's why:

"Implants" in dental terminology can refer to:

1. The implant fixture (the titanium screw surgically placed in the jawbone) — this is the placement surgery
2. The abutment (the connector piece)
3. The implant-supported crown (the visible tooth part that sits on top)

The benefit exclusion almost certainly refers to #1 — the surgical placement of the implant fixture. Your implants are already placed, so that's not what you need.

What you need is #3 — an implant-supported crown, which is a prosthetic/restorative procedure, not an implant surgery.

Evidence That Implant Crowns May Be Covered

The DentaQuest Colorado Medicaid fee schedule lists these implant-related prosthetic codes with assigned fee amounts:

The fact that these codes exist on the fee schedule suggests DentaQuest can process claims for them. However, being on a fee schedule doesn't guarantee coverage for all members — it may only apply to specific populations (e.g., HCBS waiver members with developmental/intellectual disabilities get enhanced dental benefits).

Evidence That They May NOT Be Covered

• The adult benefit summary explicitly says "Implants — Not a covered benefit" without distinguishing between fixture and crown
• The standard adult benefit grid lists "Crowns" with a 7-year frequency, but these may only refer to codes D2740-D2799 (standard crowns), not D6058-D6067 (implant-supported crowns)
• Some fee schedule codes exist for provider reference/billing but may require specific waiver eligibility

What You Must Do

Step 1: Call DentaQuest

855-225-1729 (Mon-Fri 7:30am-5pm MT)

Ask this exact question:

"I am an adult Health First Colorado member. I have two existing dental implant fixtures already in place. I need implant-supported crowns placed on them — CDT codes D6065 or D6058. Are these covered under my adult dental benefit, or does the implant exclusion apply to the prosthetic crown as well?"

Note the representative's name and any reference number.

Step 2: Ask Your Dentist to Submit a Prior Authorization

Even if DentaQuest phone reps say it's not covered, have your dentist submit a prior authorization request anyway. The clinical review team may approve it based on medical necessity, especially since:

• The implants are already placed (sunk cost)
• Leaving exposed implant stems can cause infection or bone loss
• A crown on an existing implant is restorative, not elective

Step 3: If Denied, Appeal

You have the right to appeal any denial. Your dentist can submit supporting documentation. See Resources/Prior Authorization Guide.

Step 4: If Ultimately Not Covered

• Get quotes from Providers/Dental and Implant Centers of Colorado — they specialize in implants
• Ask about payment plans and financing options
• Consider dental schools for reduced-cost care

The HCBS Exception

Members enrolled in Home and Community Based Services (HCBS) waivers for Developmental/Intellectual Disabilities (DIDD) have enhanced dental benefits that explicitly include implant-supported prosthetics. If you qualify for any HCBS waiver, your coverage may be broader. Check at hcpf.colorado.gov/hcbs-dental-services.

See also: Your Treatment Plan | Out-of-Pocket Costs | Coverage Summary | Action Items