Promoting and protecting the health and safety of all Idahoans

Dental Services

What are the Idaho Smiles Medicaid Dental Program benefits?

Below is a summary of the Idaho Smiles Medicaid Dental Program benefits. These services must be:

• Medically necessary
• Carried out or handled by an MCNA dentist

Children (under the age of 21)

Description Limitation Review Required
Routine Dental Exams 1 per 6 months No
Dental Cleanings 1 per 6 months No
Fluoride 1 per 6 months No
Dental Sealants Permanent Molars, 1 per 36 months, ages 5-14 No
Bitewing X-rays 1 set per six months No
Full mouth series X-rays or equivalent 1 per 36 months No
Fillings 1 per tooth per 24 months No
Crowns 1 per tooth per 84 months No
Root Canals 1 per tooth per lifetime Yes
Root Planing and Scaling 1 per 24 months per quadrant No
Dentures 1 per 84 months Yes
Extractions 1 per tooth per lifetime Some
Braces Once per lifetime, if medically necessary Yes
Anesthesia If approved as medically necessary Yes

 • Additional services or services in excess of these limitations are covered with prior authorization if medically necessary. (IDAPA 16.03.09.880)

Adults (ages 21 and older)
The following dental benefits are available for adults 21 and older through Idaho’s Medicaid program. Please note, coverage is not available for root canals or crowns.

Questions? Call Idaho Smiles, 1-855-233-6262.

Adult Medicaid (Pregnant Women, Adult Basic and Enhanced)

Description Limitation Review Required
Routine Dental Exams 1 per year No
Dental Cleanings 1 per 6 months No
Bitewing X-rays 1 set per 12 months No
Full mouth series X-rays or equivalent 1 per 36 months No
Fillings 1 per tooth per 24 months No
Dentures 1 per 84 months Yes
Extractions 1 tooth per lifetime Some
Anesthesia If approved, as medically necessary Some
House, Hospital, Extended Facility Call 1 per day No
Behavior Management 2 per year No

What dental services are NOT covered?

• Services that are not medically necessary to the participant’s dental health
• Dental care for cosmetic reasons
• Experimental procedures
• Services which are eligible for reimbursement by insurance or covered under any other insurance or medical health plan
• Dental expenses related to any dental services: Started after the participant’s coverage ended
• Services received before the participant became eligible for these services
• Services that are not specifically listed as a covered benefit
• Malignancies
• Prescriptions or drugs