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Dental Services | Midpage
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Indiana Administrative Code
Title 405
5
Rule 14
Dental Services
Office of the Secretary of Family and Social Services
1
Policy
2
Covered services
3
Diagnostic services
4
Topical fluoride
5
Treatment of dental caries
6
Prophylaxis
7
Periodontal root planing and scaling
8
Extractions
9
Space maintenance
11
Analgesia
12
Infection control
13
Emergency treatment of dental pain
14
Office visits
15
General anesthesia and intravenous sedation
16
Periodontics; surgical
17
Oral surgery
18
Hospital admissions for covered dental services or procedures
19
Prior authorization for early and periodic screening, diagnostic, and treatment covered services
20
Dental services provided in a state owned ICF/IID
21
Maxillofacial surgery