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TennCare Dental

TennCare dental benefits are handled by DentaQuest,the dental part of TennCare Kids, which is a full program of checkups and healthcare services for children who have TennCare.

DentaQuest services are available to help your children keep their teeth and gums healthy. Children should see their dentist every six months for a FREE exam beginning at age 1 or earlier, if needed.

If you have any questions about what you read here or about DentaQuest in general, call 855-418-1622 or go to dentaquest.com.

Who is eligible for DentaQuest services?

Only children under age 21 who have TennCare.

What services are covered?

DentaQuest covers preventive services for the mouth and teeth—healthy checkups to help your dentist find and treat problems early. Preventive services include teeth cleanings, fluoride treatment and sealants. These services are free. You don’t have to pay a copay fee for preventive care.

DentaQuest also covers some dental treatments that are medically necessary—meaning the child’s teeth would be damaged if they did not get treatment. DentaQuest covers these services when they are medically necessary:*

• Oral exams

• Sealants for some teeth

• Root canals (with prior approval)

• X-rays

• Space maintainers

• Tooth pulling

• Teeth cleaning

• Filling of cavities

• Braces (with prior approval)

• Fluoride treatment

• Crowns (with prior approval)

• Other services when medically necessary

What does “with prior approval” mean?

For services that say “with prior approval,” your dentist, DentaQuest and TennCare all have to agree you need them. If you have questions about what dental services you can have, call DentaQuest at 855-418-1622.

Is there any charge for other services?

A few DentaQuest members—those in the TennCare Standard category—may be required to pay part of the cost for services that are not preventive. This is the copay, or the amount that DentaQuest does not pay. For example, if you are a TennCare Standard member and you go to the dentist for a filling, you might have to pay a copay during your visit. DentaQuest will pay the rest. However, most qualifying DentaQuest members will not have a copay.

Are braces covered?

Braces are covered only when they are medically necessary. The DentaQuest dentist can tell you if you meet the rules to have braces. To be covered for that cost, you must get approval from DentaQuest before getting braces.

Can DentaQuest help me find a dentist?

Yes! To locate a dentist near you, call 855-418-1622 or go to the Find a Dentist page on the DentaQuest website.

*To be medically necessary, a medical item or service must satisfy each of the following criteria:

(a) It must be recommended by a licensed physician who is treating the enrollee or other licensed healthcare provider practicing within the scope of his or her license who is treating the enrollee;

(b) It must be required in order to diagnose or treat an enrollee’s medical condition; MEDICAL NECESSITY CHAPTER 1200-13-16 (Rule 1200-13-16-.05, continued) November, 2011 (Revised) 8

(c) It must be safe and effective;

(d) It must not be experimental or investigational; and

(e) It must be the least costly alternative course of diagnosis or treatment that is adequate for the enrollee’s medical condition.