1. A. Only the following services are reimbursable under the Adult Denture Program and only in accordance with program policy and guidelines:

   1. 1. comprehensive oral examination*;
   2. 2. intraoral radiographs, complete series*;
   3. 3. complete denture, maxillary*;
   4. 4. complete denture, mandibular*;
   5. 5. immediate denture, maxillary*;
   6. 6. immediate denture, mandibular*;
   7. 7. maxillary partial denture, resin base (including clasps)*;
   8. 8. mandibular partial denture, resin base (including clasps)*;
   9. 9. repair broken complete denture base;
   10. 10. replace missing or broken tooth, complete denture, per tooth;
   11. 11. repair resin denture base, partial denture;
   12. 12. repair or replace broken clasp, partial denture;
   13. 13. replace broken teeth, partial denture, per tooth;
   14. 14. add tooth to existing partial denture;
   15. 15. add clasp to existing partial denture;
   16. 16. reline complete maxillary denture (laboratory)*;
   17. 17. reline complete mandibular denture (laboratory)*;
   18. 18. reline maxillary partial denture (laboratory)*;
   19. 19. reline mandibular partial denture (laboratory)*;
   20. 20. unspecified removable prosthodontic procedure, by report*.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 31:81 (January 2005), repromulgated LR 31:1589 (July 2005).