Treatment Plan Overview

This note maps common dental procedures to their Medicaid coverage status under Health First Colorado.

Common Procedures and Coverage

1. Crowns on Implant Stems

Status: UNCERTAIN — Requires Direct Verification

This is a complex coverage question for members who already have implant stems (fixtures) placed and need crowns fabricated and seated on existing abutments/stems. See Procedures/Crowns on Implant Stems for the full analysis.

The situation: The official benefit summary says "Implants: Not a covered benefit." However, this language is ambiguous — it likely refers to the placement of the implant fixture itself, not necessarily the prosthetic crown that goes on top.

What to know:

  • The DentaQuest fee schedule does list implant-supported crown codes (D6058-D6067, D6082, D6086) with assigned fee amounts
  • The fee schedule also lists D6092 (re-cement implant/abutment supported crown)
  • The benefit summary only covers standard "Crowns" (once every 7 years per tooth)
  • Implant-supported crowns use different CDT codes than standard crowns

What members should do: Call DentaQuest at 855-225-1729 and ask specifically:

"Are implant-supported crowns (codes D6065 or D6058) covered under Health First Colorado adult dental benefit when the implant fixture is already in place? Or does the 'implants not covered' exclusion apply to the crown portion as well?"

Likely out-of-pocket if NOT covered: $900-$1,500+ per crown (see Out-of-Pocket Costs)

2. Extraction(s)

Status: COVERED

See Procedures/Extractions.

  • Simple extractions: covered, 1x per lifetime per tooth, $0
  • Surgical extractions: covered, 1x per lifetime per tooth, $0
  • No prior authorization needed
  • Sedation available if needed (covered 1x/day)

3. Cleaning

Status: COVERED

See Procedures/Cleanings and Exams.

  • Routine cleaning: 2x per year, $0
  • Members who haven't seen a dentist recently may need a "full mouth debridement" first (covered 1x every 3 years, $0)
  • Periodontal maintenance: 2x per year for members with gum disease, $0

4. Flipper (Temporary Removable Partial Denture)

Status: LIKELY COVERED — With Caveats

See Procedures/Flipper (Removable Partial Denture).

  • Removable partial dentures are covered (1x every 7 years, $0)
  • A "flipper" is a type of removable partial denture (usually acrylic)
  • Requires prior authorization
  • DentaQuest may approve the most cost-effective option, which could be a standard partial rather than a flipper specifically
  • Frequency limit matters: receiving a flipper may make a member ineligible for another partial denture for 7 years

Ask the dentist: Whether DentaQuest will authorize a flipper specifically, or if they'll only approve a standard partial denture.

5. Crown Replacement (Non-Implant)

Status: COVERED

See Procedures/Crown Replacement.

  • Standard crowns: covered 1x every 7 years per tooth, $0
  • Requires prior authorization
  • If an existing crown is less than 7 years old, it likely won't be approved for replacement unless there's documented clinical necessity

Suggested Priority Order

  1. Call DentaQuest to verify implant crown coverage (this determines cost expectations)
  2. Schedule a comprehensive exam at a Medicaid-accepting dentist to get a full treatment plan
  3. Dentist submits prior authorizations for crowns, flipper, and any other services needing approval
  4. Get cleaning during the first or second visit
  5. Extraction(s) as determined by the dentist
  6. Flipper fabricated after extractions heal
  7. Implant crowns — depending on coverage determination

See also: Coverage Summary | Out-of-Pocket Costs | Action Items | Providers/Finding a Provider via DentaQuest