The acronyms and definitions within this rule specifically pertain to dental services. This rule does not include an exhaustive list of acronyms and definitions that apply to dental services. All Authority rules are intended to be used in conjunction with the General Rules for Oregon Health Plan (OHP) OAR 410 division 120 and the OAR 410 division 141. Other acronyms and definitions that apply to dental services are found in OARs 410-141-3500, 410-120-0000, 410-200-0015, and Chapter 410, Division 130.

1. (1) “Alveoplasty” is a dental procedure often performed following a tooth extraction, to help recreate the natural contour of the gums and jaw that may have been lost due to bone loss from tooth extraction, or for another reason.
2. (2) “Ancillary Services” has the meaning provided in OAR 410-120-0000.
3. (3) “Anesthesia Services” has the meaning provided in OAR 410-120-0000.

4. (4) “Anterior teeth” are referred to as the front teeth. Permanent (adult) teeth are also referred to by numbers and differentiated by upper and lower:

   1. (a) The upper anterior teeth are indicated by the numbers 6, 7, 8, 9, 10, 11; and
   2. (b) The lower anterior teeth are indicated by the numbers 22, 23, 24, 25, 26, 27.
5. (5) “Apexification” is a dental treatment provided on permanent teeth when the roots of the teeth are incompletely formed, to encourage development and formation of the root.
6. (6) “Apicoectomy” involves the removal of a tooth’s root tip and surrounding tissue.
7. (7) “Billing” definition and requirements are provided in OAR 410-120-1280.
8. (8) “By Report” (BR) has the meaning provided in OAR 410-120-0000.

9. (9) “Canine teeth” are anterior teeth that are pointed. In addition to numbered permanent (adult) teeth, primary (baby) teeth are also referred to by letters and differentiated between upper and lower:

   1. (a) Primary upper canine teeth are indicated by the letters C, H;
   2. (b) Primary lower canine teeth are indicated by the letters M, R;
   3. (c) Permanent upper canine teeth are indicated by the numbers 6, 11; and
   4. (d) Permanent lower canine teeth are indicated by the numbers 22, 27.
10. (10) “Clinically Appropriate” has the meaning provided in OAR 410-120-0000.
11. (11) “Compact Of Free Association (COFA)” Dental Program is a dental-only enrollment type under the Oregon Health Plan (OHP) as defined in OAR 410-200-0445.
12. (12) “Composite restorations” are white, tooth-colored fillings.
13. (13) “Concurrent needs” means simultaneously having a diagnosed need and other characteristics as listed that may affect service delivery.
14. (14) “Coordinated Care Organization (CCO)” has the meaning provided in OAR 410-141-3500.
15. (15) “Covered Services” has the meaning provided in OAR 410-120-0000.
16. (16) “Current Dental Terminology (CDT)” codes are the alphanumeric codes that identify a specific dental procedure, as designated by the federal government, and used by the American Dental Association. Current Dental Terminology, © 2025 American Dental Association. All rights reserved.
17. (17) “Dental” means teeth and supporting structures.
18. (18) “Dental Hygienist” has the meaning provided in OAR 410-120-0000.
19. (19) “Dental Hygienist with an Expanded Practice Dental Hygiene (EPDH) Permit” has the meaning provided in OAR 410-120-0000.
20. (20) “Dental Practitioner (Practitioner)” means an individual licensed pursuant to state law to engage in the provision of dental services within the scope of the practitioner’s license and certification.
21. (21) “Dental Services” means services provided within the scope of practice as defined under state law, by or under the supervision of a dentist or dental hygienist or denture services provider within the scope of practice as defined under state law, by a denturist or dental hygienist with an Expanded Practice Permit (EPP).
22. (22) “Dental Subcontractor” has the meaning provided in OAR 410-120-0000.
23. (23) “Dental Therapist” has the meaning provided in OAR 410-120-0000.
24. (24) “Dentally Appropriate” has the meaning provided in OAR 410-120-0000.
25. (25) “Dentist” has the meaning provided in OAR 410-120-0000.
26. (26) “Denturist” has the meaning provided in OAR 410-120-0000.
27. (27) “Distant Site” means the site where a dentist is being contacted for consultation by the originating site.
28. (28) “Documentation” means dental services documentation which meets the requirements of the Oregon Dental Practice Act statutes, administrative rules for member records, and requirements of OAR 410-120-1360 Requirements for Financial, Clinical and Other Records, and any other documentation as outlined in OAR Chapter 410, Division 123 (Dental/Denturist Services).
29. (29) “Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)” means the program described in OAR 410-151-0000.
30. (30) “EPSDT Beneficiary” has the meaning provided in OAR 410-151-0001.
31. (31) “Eligibility” has the meaning provided in OAR Chapter 410, Division 200.
32. (32) “Emergency Dental Condition” means any incident involving the teeth or gums which may require immediate treatment to stop ongoing tissue bleeding, alleviate severe and sudden pain or infection, treat unusual swelling of the face or gums, or to preserve an avulsed (knocked out) tooth. For additional criteria, refer to “Emergency Medical Condition” provided in 410-120-0000.
33. (33) “Emergency Dental Services” has the same meaning as “Dental Emergency Services” provided in OAR 410-120-0000. This meaning is synonymous with “emergency dental care” and “emergency oral health care.”
34. (34) “Endodontic” means relating to the inner tissues of teeth, otherwise known as the pulp or nerve. Endodontic treatments include pulpal therapy and root canal therapy.
35. (35) “Fee-for-Service Provider” has the meaning provided in OAR 410-120-0000.
36. (36) “First Tooth” is a curriculum aimed to reduce early childhood caries in Oregon.
37. (37) “Fillings” are provided when an area of decay on a tooth is removed by a dental provider, leaving a hole or space that is then filled with a material.
38. (38) “Gingivectomy” is the surgical removal of diseased gum tissue, to prevent damage to the bone.
39. (39) “Gingivoplasty” is the surgical reshaping of gum tissue around the teeth.
40. (40) “Health Care Interpreter (HCI)” Certified or Qualified, has the meaning given to those terms in ORS 413.550.
41. (41) “Hemoglobin A1c (HbA1c) Testing” is a measure of glucose attached to red blood cells and directly relates to average blood glucose levels.
42. (42) “Health Evidence Review Commission (HERC)” has the meaning provided in OAR 410-120-0000.

43. (43) “Incisors” are anterior (front) teeth that have single, narrow edges. They are the four front, upper teeth, and the four front lower teeth.

    1. (a) Primary upper incisors are indicated by the letters D, E, F, G;
    2. (b) Primary lower incisors are indicated by the letters N, O, P, Q;
    3. (c) Permanent upper incisors are indicated by the numbers 7, 8, 9, 10; and;
    4. (d) Permanent lower incisors are indicated by the numbers 23, 24, 25, 26.
44. (44) “Malocclusion” is a misalignment or incorrect relation of the upper and lower teeth when the jaw is closed.
45. (45) “Mandibular” refers to the lower jaw and the lower teeth.
46. (46) “Maxillary” refers to the upper jaw and the upper teeth.
47. (47) “Maxillofacial” means relating to the face, head, neck or jaw. Treatments may be necessary due to trauma, disease, or congenital defects.
48. (48) “Medical Practitioner” means an individual licensed pursuant to state law to engage in the provision of medical services within the scope of the practitioner’s license and certification.
49. (49) “Medically Necessary” has the meaning provided in OAR 410-120-0000.
50. (50) “Medicament” means a substance or combination of substances intended to be pharmacologically active, specially prepared to be prescribed, dispensed, or administered to prevent or treat disease.
51. (51) “Oral Health” refers to the health of teeth, gums, lips, tongue, inner cheeks, and the entire oral-facial system that allows us to smile, speak, and chew.
52. (52) “Oral Health Services” refers to services offered to members for their improved oral health. The workforce involved in the services offered includes (but is not limited to) delivery systems staff, educational programs staff, licensed dental providers, dental assistants, and primary care providers such as doctors, nurses, and medical assistants.
53. (53) “Oregon Health Authority (Authority)” means the organization that administers Medicaid in Oregon.
54. (54) “Oregon Health Plan (OHP)” is the Medicaid program in Oregon, and has the meaning provided in OAR 410-120-0000.
55. (55) “Originating Site” means the site where the member is located, and dental care providers are working and performing services in conjunction with a dentist who is not at that site, while using telehealth technology.
56. (56) “Periapical X-rays” capture an image of an entire tooth, from the crown to the root tip.
57. (57) “Periodontal scaling” and “root planing” refer to non-surgical treatments to remove plaque and tartar from teeth roots and gums.
58. (58) “Periodontal” refers to the soft tissues supporting and surrounding teeth.
59. (59) “Permanent teeth”, often referred to as adult teeth, are the second set of teeth people get. There are 32 permanent teeth which include incisors, canines, and premolars, and molars. They are identified by the numbers 1 through 32.

60. (60) “Posterior teeth” are referred to as the back teeth:

    1. (a) Permanent upper posterior teeth are indicated by the numbers 1, 2, 3, 4, 5, 12, 13, 14, 15, 16;
    2. (b) Permanent lower posterior teeth are indicated by the numbers 17, 18, 19, 20, 21, 28, 29, 30, 31, 32;
    3. (c) Primary upper posterior teeth are indicated by the letters A, B, I, J; and
    4. (d) Primary lower posterior teeth are indicated by the letters S, T, K, L.
61. (61) “Practitioner” has the meaning provided in OAR 410-120-0000.

62. (62) “Premolars” are permanent teeth that are positioned between the canines and molars:

    1. (a) The upper premolar teeth are indicated by the numbers 4, 5, 12, 13; and
    2. (b)The lower premolar teeth are indicated by the numbers 20, 21, 28, 29.
63. (63) “Prescriptions” means services as outlined in OAR 410-121-0144.
64. (64) “Primary Teeth” are also known as baby teeth. These are the first set of teeth that people get. There are 20 primary teeth that shall exfoliate (fall out) as the permanent teeth grow in. Primary teeth are indicated by the letters A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T.
65. (65) “Prior Authorization (PA)” has the meaning provided in OAR 410-120-0000.
66. (66) “Prioritized List of Health Services (Prioritized List)” has the meaning provided in OAR 410-120-0000.
67. (67) “Procedure Codes” means Current Dental Terminology (CDT), unless otherwise noted. Codes listed in this rule and other documents incorporated in rule by reference are subject to change by the American Dental Association (ADA) without notification.
68. (68) “Prophylaxis” is a dental service to thoroughly clean the teeth.
69. (69) “Prosthodontics” refers to the replacement of missing or damaged teeth with artificial devices, most commonly dentures.
70. (70) “Provider” has the meaning provided in OAR 410-120-0000.
71. (71) “Pulpal regeneration” is a dental treatment used to restore the pulp of a diseased or damaged tooth.
72. (72) “Pulpal therapy” involves removing pulp from the crown of a primary tooth and treating it with medicament.
73. (73) “Record retention” means the schedule whereby providers must keep clinical information and financial records on file.
74. (74) “Smiles for Life” is a national oral health curriculum that Oregon Medicaid has adopted to improve oral health access.
75. (75) “Standard of Practice” means what reasonable and prudent practitioners may do in the same or similar circumstances.
76. (76) “Teledentistry” means using electronic and telecommunications technologies, for the distance delivery of dental care services and clinical information designed to improve a member’s health status and to enhance delivery of the health care services and clinical information.
77. (77) “Telehealth” has the meaning provided in OAR 410-120-0000.
78. (78) “Third Party Resources (TPR)” has the meaning provided in OAR 410-120-1280.
79. (79) “Urgent Dental Care” means the management of conditions that require prompt attention to relieve pain and/or risk of infection, and to alleviate the burden on hospital emergency departments. Urgent dental care is distinguished from emergency dental care in that urgent dental care requires prompt but not immediate treatment. Examples include dull toothache, mildly swollen gums, or small chips or cracks in teeth.
80. (80) “Veterans Dental Program” is a dental-only enrollment type under the Oregon Health Plan (OHP) as defined in OAR 410-200-0450.
81. (81) "Young Adults with Special Health Care Needs (YSHCN)” is a benefit eligibility program as defined in OAR 410-200-0455.

Statutory/Other Authority

ORS 413.042 & ORS 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 93-2025, amend filed 12/22/2025, effective 01/01/2026
DMAP 139-2024, amend filed 12/06/2024, effective 01/01/2025
DMAP 59-2024, minor correction filed 02/21/2024, effective 02/21/2024
DMAP 79-2023, amend filed 09/26/2023, effective 10/01/2023
DMAP 89-2022, amend filed 12/16/2022, effective 01/01/2023
DMAP 24-2022, minor correction filed 02/16/2022, effective 02/16/2022
DMAP 50-2021, amend filed 12/24/2021, effective 01/01/2022
DMAP 61-2020, amend filed 12/11/2020, effective 01/01/2021
DMAP 34-2016, f. 6-30-16, cert. ef. 7-1-16
DMAP 36-2014, f. & cert. ef. 6-27-14
DMAP 75-2013(Temp), f. 12-31-13, cert. ef. 1-1-14 thru 6-30-14
DMAP 13-2013, f. 3-27-13, cert. ef. 4-1-13
DMAP 46-2011, f. 12-23-11, cert. ef. 1-1-12
DMAP 41-2011, f. 12-21-11, cert. ef. 1-1-12
DMAP 16-2009, f. 6-12-09, cert. ef. 7-1-09
DMAP 25-2007, f. 12-11-07, cert, ef. 1-1-08
OMAP 49-2004, f. 7-28-04, cert. ef. 8-1-04
OMAP 48-2002, f. & cert. ef. 10-1-02
OMAP 17-2000, f. 9-28-00, cert. ef. 10-1-00
OMAP 23-1999, f. & cert. ef. 4-30-99
OMAP 28-1998, f. & cert. ef. 9-1-98
OMAP 13-1998(Temp), f. & cert. ef. 5-1-98 thru 9-1-98
HR 3-1994, f. & cert. ef. 2-1-94