Standard dental plan risk criteria
The ODS standard dental plan will cover fluoride for members 19 and over if the member is at high risk of decay due to the following medical reasons:
- Genetic abnormality of teeth
- Chemotherapy
- Radiation therapy
- Patients in active orthodontic treatment
- Xerostomia
- Suboptimal fluoride exposure
- History of three or more smooth surface caries within the last three years
- History of three or more root caries within the last three years
- History of three or more fillings within the last three years
If you have a patient that meets the specified criteria above, document the reason in the chart notes and indicate “high risk for decay” in the Remarks section of your claim form to ensure consideration for payment.
For questions about this benefit change, please review our Summer 2010 Dental Office Update newsletter or contact our Dental Customer Service department at 800-452-1058.