Oregon Benefits Description

State Contact: Oregon Health Plan Application Center
Telephone Number: 800-359-9517
E-mail Address: dmap.info@state.or.us   

Medicaid Program

Under the Medicaid State Plan dental benefits are provided to eligible individuals under the age of 21 in compliance with the requirements of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services.

State Program Name: Oregon Health Plan

CHIP Program

CHIP Stand-Alone/Separate Program ONLY
State Program Name: Oregon Health Plan
Dental Services Provided through State-defined benefit package

If providing dental benefits other than as defined by EPSDT, States must complete the following:

Schedule of Services

State EPSDT definition

Preventive Services

Cleanings

a. Recommended frequency: Twice every 12 months

b. Exceptions:

Fluoride treatments

a. Ages:

b. Recommended frequency: Twice every 12 months

c. Also provided by physicians: yes

d. Also provided by hygienists: yes

e. Exceptions: Additional fluoride may be available, up to a total of 4 within 12 months

Sealants

a. Ages: 15 years old and younger

b. Recommended frequency:

c. Exceptions:

Oral hygiene instruction

a. Ages:

b. Recommended frequency:

Space Maintainers

a. Limits:

b. Prior approval required: No 

Diagnostic Services

Dental Examinations by Dentists

a. Recommended age of first visit: At the time of eruption of the first tooth and no later than 12 months of age

b. Recommended frequency: Twice every 12 months

c. Limits:

X-Rays

a. Limits:  Routine radiographs once every 12 months

Treatment Services

Fillings

1. Silver amalgam: Yes

a. Limits:

2. Tooth colored composite: Yes

a. Limits:

Crowns/Tooth Caps

1. Stainless steel crowns: Yes

a. Limits:

b. Prior approval required: No

2. Metal (only) crowns: No

a. Limits:

b. Prior approval required:

3. Metal/Porcelain crowns: Yes

a. Limits: Age 16 and older, only anterior permanent teeth

b. Prior approval required: Yes

4. Porcelain (only): No

a. Limits:

b. Prior approval required:

Root Canals (endodontics)

1. Root canals on baby teeth (Pulpotomies): Yes

a. Limits:

b. Prior approval required: No

2. Root canals on permanent teeth: Yes

a. Limits: Not covered for third molars

b. Prior approval required: 

Gum (periodontal) Therapy

a. Limits:

b. Prior approval required:

Dentures

1. Partial dentures: Yes

a. Prior approval required: Yes

2. Complete dentures: Yes

a. Prior approval required: Yes

Retainers (orthodontic)

a. Limits:

Oral Surgery

1. Simple extractions: Yes

a. Limits:

b. Prior approval required: 

2. Surgical extractions: Yes

a. Limits: Only symptomatic teeth

b. Prior approval required: 

3. Care of abscesses: Yes

a. Limits:

b. Prior approval required: 

4. Cleft palate treatment: No

a. Limits:

b. Prior approval required: 

5. Cancer treatment: No

b. Limits:

c. Prior approval required:

6. Treatment of Fractures: No

a. Limits:

b. Prior approval required:

7. Biopsies: Yes

a. Limits:

b. Prior approval required: No

Braces (Orthodontia)

a. Criteria: Only with diagnosis of cleft palate, with or without cleft lip

b. Prior approval required: Yes

c. Payment if eligibility lost:

In-patient Hospital Services

a. Criteria:

b. Prior approval required: Yes

Special Anesthesia

a. Criteria:

b. Prior approval required: Yes

Excluded Services

1.  Identify services: Some oral surgery and maxillofacial prosthetics are covered under the client’s medical coverage.