Florida Dental Access Guide

Services Guide for Children

Information about your plans dental services was retrieved from the Medicaid member handbooks: DentaQuest, LIBERTY, and MCNA Dental on June 23rd, 2023. 

You may need a referral from your doctor, dentist, or approval from your dental plan before you go to an appointment or use a service. Services must be medically necessary in order for your plan to pay for them. You may have a $3.00 copayment per day for a non-emergency dental visit in a federally qualified health center.  If there are changes in covered services or other changes that will affect you, the plan will notify you in writing at least 30 days before the effective date of the change. However, it is strongly recommended that you call ahead to member services to confirm the services before your appointment. 

Member services:
DentaQuest
1-888-468-5509
TTY 1-800-466-7566
MCNA Denta
1-855-699-6262
TTY 1-800-955-8771
LIBERTY
1-833-276-0850
TTY 1-877-855-8039
Service
Description
Frequency/specific limitation
Prior Authorization
Dental Exams
A review of your tooth, teeth, or mouth by a dentist
– Complete exams are covered 1 time every 3 years
– Check-up exams are covered 2 times every year
– Emergency exams are covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Dental Screenings
A review of your mouth by a dental hygienist
– Covered 2 times every year
– May be done in a school or Head Start
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Dental X-rays
Internal pictures of teeth with different views
All types of dental x-rays are covered
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Teeth Cleanings
Basic cleanings that may include brushing, flossing, scrubbing, and polishing teeth
– Covered 2 times every year
– May be done in a school or Head Start program
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Fluoride
A medicine put on teeth to make them stronger
Fluoride is covered:
– 4 times every year for children that are 0-5 years old
– 2 times every year for children that are 6-20 years old

May be done in a school or Head Start program
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Sealants
Thin, plastic coatings painted into the grooves of adult chewing surface teeth to help prevent cavities
– We cover sealants 1 time every 3 years for each adult chewing (back) tooth
– May be done in a school or Head Start program
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Oral Health Instructions
Education on how to brush, floss, and keep your teeth healthy
– We cover oral health instructions 2 times every year
– May be done in a school or Head Start program
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Space Maintainers
A way to keep space in the mouth when a tooth is taken out or missing
Covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Fillings and Crowns
A dental service to fix or repair teeth
Covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Root Canals
A dental service to fix the inside part of a tooth (nerve)
Covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Periodontics
Deep cleanings that may involve both your teeth and gums
Covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Prosthodontics
Dentures or other types of objects to replace teeth
– 1 upper, 1 lower, or 1 set of full dentures
– 1 upper, 1 lower, or 1 set of partial dentures
– 1 flipper to replace front teeth
– 1 improvement for denture fit and comfort (reline) for each denture
DentaQuest:
No
MCNA Dental:
Ask for approval before you go to an appointment for these services
LIBERTY:
Ask for approval before you go to an appointment for these services
Orthodontics
Braces or other ways to correct teeth location
Covered as medically necessary
DentaQuest:
No
MCNA Dental:
Ask for approval before you go to an appointment for these services
LIBERTY:
Ask for approval before you go to an appointment for these services
Extractions
Tooth removal
Covered as medically necessary
DentaQuest:
No
MCNA Dental:
Ask for approval before you go to an appointment for these services
LIBERTY:
Ask for approval before you go to an appointment for these services
Sedation
A way to provide dental services where a patient is asleep or partially asleep
Covered as medically necessary
DentaQuest:
No
MCNA Dental:
No
LIBERTY:
No
Ambulatory Surgical Center or Hospital-based Dental Services
Dental services that cannot be done in a dentist office. These are services that need to be provided with different equipment and possibly different providers
Covered as medically necessary for any dental services needed
DentaQuest:
No
MCNA Dental:
Ask for approval before you go to an appointment for these services
LIBERTY:
Ask for approval before you go to an appointment for these services

Prior Authorization:

Prior authorization is a process by which a medical provider (or the patient, in some scenarios) must obtain approval from a patient’s health plan before moving ahead with a particular treatment, procedure, or medication. Different health plans have different rules in terms of when prior authorization is required.

Medically Necessary:

The medical or allied care, goods, or services furnished or ordered must meet the following conditions:
  • Be necessary to protect life, prevent significant illness or significant disability, or alleviate severe pain.
  • Be individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the patient’s needs
  • Be consistent with generally accepted professional medical standards as determined by the Medicaid program, and not experimental or investigational.
  • Be reflective of the level of service that can be safely furnished, and for which no equally effective and more conservative or less costly treatment is available statewide.
  • Be furnished in a manner not primarily intended for the convenience of the recipient, the recipient's caretaker, or the provider.
The fact that a provider has prescribed, recommended, or approved medical or allied care, goods or services does not, in itself, make such care, goods, or services medically necessary or a medical necessity or covered service.

The toolkit is a project of the The Florida Oral Health Alliance.

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