1. (a) Dental services shall be covered for recipients receiving a Kan Be Healthy dental screening.

   1. (1) Both a Kan Be Healthy medical screening and a Kan Be Healthy dental screening shall be required for coverage of limited orthodontia services, with the exception of emergency services.
   2. (2) Prior authorization shall be required for designated services.
   3. (3) Prior authorization shall be required for dental treatment plans estimated to exceed, during a calendar year, the range maximum established by the secretary.

2. (b) Dental services for medicaid recipients not participating in the Kan Be Healthy program shall be limited to the following treatments:

   1. (1) Orcantral fistula closure;
   2. (2) unilateral radical antrotomy;
   3. (3) biopsy of oral tissue;
   4. (4) radical excision of lesion;
   5. (5) excision of tumors;
   6. (6) removal of cysts and neoplasms;
   7. (7) partial ostectomy;
   8. (8) surgical incision and drainage of abscess;
   9. (9) removal of foreign bodies, skin, subcutaneous areolar tissue;
   10. (10) sequestrectomy for osteomyelitis;
   11. (11) maxillary sinusotomy for removal of tooth fragment or foreign body;
   12. (12) treatment of fractures;
   13. (13) closed reduction of dislocation and related injections;
   14. (14) limitation of motion and related injections;
   15. (15) sutures;
   16. (16) oral skin grafts;
   17. (17) frenulectomy;
   18. (18) excision of pericoronal gingiva;
   19. (19) sialalithotomy;
   20. (20) excision of salivary gland;
   21. (21) sialodochoplasty;
   22. (22) closure of salivary fistula;
   23. (23) emergency tracheotomy;
   24. (24) general anesthesia: first 30 minutes;
   25. (25) general anesthesia: each additional 15 minutes;
   26. (26) consultation in the form of diagnostic services provided by a dentist or physician other than the practitioner providing treatment;
   27. (27) house call or extended care facility call;
   28. (28) hospital call; and
   29. (29) prior authorized procedures for medically necessary tooth extractions.
3. (c) This regulation shall be effective on and after January 1, 2002.

(Authorized by and implementing K.S.A. 39-708c; effective May 1, 1981; amended May 1, 1983; amended, T-84-7, May 1, 1983; amended May 1, 1984; amended May 1, 1986; amended, T-87-44, Jan. 1, 1987; amended, T-88-10, May 1, 1987; amended May 1, 1988; amended, T-30-7-29-88, July 29, 1988; amended Sept. 26, 1988; amended Jan. 2, 1989; amended Oct. 1, 1989; amended Aug. 1, 1990; amended Dec. 31, 1992; amended Sept. 27, 1993; amended Jan. 1, 2002.)