Illinois Medicaid & Medicaid Managed Care plans accepted — $0 copay, no annual maximum.
Our dental office participates in Illinois Medicaid and affiliated Medicaid Managed Care Organizations (MCOs), providing comprehensive diagnostic, preventative, restorative, endodontic, periodontal, prosthodontic, and oral surgical services according to Illinois Department of Healthcare and Family Services (HFS) guidelines. Dental benefits across Illinois are administered through designated dental benefit managers: Avesis (CountyCare Health Plan), Envolve Dental, Inc. (Meridian Health Plan), Sun Life DentaQuest (Blue Cross Community Health Plans and Aetna Better Health of Illinois), and SKYGEN USA (Molina Healthcare of Illinois).
Always verify which MCO health plan you are assigned to — your medical MCO identification card does not process dental claims. Every plan below carries a $0 deductible, $0 copay, and no annual benefit maximum.
Children and adolescents ages 0 to 20 are protected under federal and state Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provisions, which mandate comprehensive preventative, restorative, surgical, and orthodontic dental care. Medically necessary services exceeding standard plan frequency limitations may be authorized under EPSDT review.
Adult beneficiaries ages 21 and older are covered under the Illinois Medicaid Adult benefit schedule, which covers regular preventive examinations, cleanings, direct fillings, extractions, palliative pain relief, and complete or partial dentures subject to defined frequency intervals and prior clinical approval.
Prior authorization (PA) is a mandatory clinical review before specialized, elective, or costly procedures. Services rendered without an approved PA cannot be retroactively authorized, and the Medicaid beneficiary cannot be billed for the balance.
These limitations apply across all Illinois Medicaid MCO plans:
Frequency limits by health plan and dental benefit administrator, as published in each plan's Illinois Medicaid dental benefit grid. Child limits apply to members ages 0 to 20; adult limits apply to members age 21 and older. Our team verifies your specific plan before treatment.
| Health Plan Name | Dental Benefit Administrator | Plan & Group Identifier | Administered Network | Member Cost-Sharing & Financial Terms |
|---|---|---|---|---|
| CountyCare Health Plan (Child & Adult) | Avesis Third Party Administrators | CountyCare IL Medicaid Dental Benefit Grid | Avesis Dental Network | $0 Copay / 100% Covered In-Network Deductible: $0.00 · No Annual Maximum |
| Meridian Health Plan of Illinois (All Ages) | Envolve Dental, Inc. – Illinois | Plan: IL-Meridian – Medicaid Group: ENVD IL | Envolve Dental Illinois Network | $0 Copay / 100% Covered (IN & OON) Deductible: $0.00 · No Annual Maximum |
| Blue Cross Community Health Plans (BCCHP) | Sun Life DentaQuest | Child Group: 7003292005 Adult Group: 7003292004 | IL – Blue Cross and Blue Shield – Medicaid | $0 Copay / 100% Covered (IN & OON) Deductible: $0.00 · No Annual Maximum |
| Aetna Better Health of Illinois | Sun Life DentaQuest | Child Group: 6002502057 Adult Group: 6002502055 | IL – Aetna – Medicaid Network | $0 Copay / 100% Covered (IN & OON) Deductible: $0.00 · No Annual Maximum |
| Molina Healthcare of Illinois | SKYGEN USA (Dental Hub) | Plan: Molina IL Medicaid Payer: Molina Healthcare of Illinois | Molina Healthcare of Illinois Network | $0 Copay / 0% Coinsurance (100% Covered) Deductible: $0.00 · No Annual Maximum |
| Service Description | CountyCare (Avesis) | Meridian Health (Envolve Dental) | Blue Cross Community (DentaQuest) | Aetna Better Health (DentaQuest) | Molina Healthcare (SKYGEN USA) |
|---|---|---|---|---|---|
| Periodic oral evaluation | Child: 1 per 6 mos (dental office), 2 per yr (school) Adult: 1 per 6 months | Child: Covered under EPSDT Adult: 1 every 6 months | Child: 1 per 6 months Adult: 2 per 12 months | Child: 1 per 6 months Adult: 1 per 12 months (shared) | Child (0–20): 2 every 6 months Adult (21+): 1 every 6 months |
| Limited oral evaluation – problem focused | Child & Adult: 1 per day per dentist/group (not with palliative) | Child & Adult: 1 every 1 day (shared with palliative) | Child & Adult: 1 per 0 days per business (shared) | Child & Adult: 1 per 0 days per business (shared) | Child & Adult: 1 per day |
| Comprehensive oral evaluation | Child & Adult: 1 per lifetime per dentist or dental group | Child: Covered under EPSDT Adult: 1 per lifetime | Child & Adult: 1 per lifetime per business | Child & Adult: 1 per lifetime per business | Child (0–20): 1 to 2 every 6 mos Adult: 1 every 6 mos (1/lifetime) |
| Comprehensive periodontal evaluation | Child & Adult: Not a plan benefit on grid | Child & Adult: Covered as indicated | Child & Adult: Covered as indicated | Child & Adult: Covered as indicated | Child & Adult: Not covered |
| Intraoral – comprehensive radiographic series | Child (6–20): 1 per 36 mos (shared with pano) Adult: 1 per 36 mos | Child & Adult: 1 every 36 months (shared with pano/vertical BW) | Child & Adult: 1 per 36 months per patient | Child & Adult: 1 per 36 months per patient | Child (6–20): 1 every 36 mos Adult (21+): 1 every 36 mos |
| Intraoral – periapical first radiographic image | Child & Adult: 1 per day per dentist or dental group | Child & Adult: 1 every 1 day | Child & Adult: 1 per 0 days per business | Child & Adult: 1 per 0 days per business | Child & Adult: 1 per day |
| Intraoral – periapical each additional image | Child & Adult: 1 per tooth per date of service | Child & Adult: Covered; no time limits | Child & Adult: Covered; no time limits | Child & Adult: Covered; no time limits | Child & Adult: Covered as clinically indicated |
| Bitewing radiographs (single, two, or four images) | Child: 1 per 12 mos (2 images age 2+, 4 images age 10+) Adult: 1 per 12 mos | Child & Adult: Single: 1 per 12 mos; Two/Four: 1 every 12 mos (age 2+) | Child & Adult: Two images: 1 per 12 mos; Four images: 1 per 12 mos | Child & Adult: Two images: 1 per 12 mos; Four images: 1 per 12 mos | Child: Two images 1/12 mos (age 2+); Four images 1/12 mos (age 10+) Adult: 1 every 12 mos |
| Vertical bitewings (7 to 8 radiographic images) | Child (6–20): 1 per 36 mos (shared with FMX) Adult: 1 per 36 mos | Child & Adult: 1 every 36 months (shared with FMX/pano) | Child & Adult: 1 per 36 months per patient | Child & Adult: 1 per 36 months per patient | Child (6+): 1 every 36 months Adult: 1 every 36 months |
| Panoramic radiographic image | Child (6–20): 1 per 36 mos (shared with FMX) Adult: 1 per 36 mos | Child & Adult: 1 every 36 months (shared with FMX/vertical BW) | Child & Adult: 1 per 36 months per patient | Child & Adult: 1 per 36 months per patient | Child (6+): 1 every 36 months Adult: 1 every 36 months |
| Caries risk assessment and documentation | Child (0–18): Must submit with school/mobile exam Adult: Not a benefit | Child: Covered under EPSDT Adult: Not standard | Child: Covered under EPSDT Adult: Not standard | Child: Covered under EPSDT Adult: Not standard | Child (0–20): Covered finding of low, moderate, high risk Adult: Not covered |
| Service Description | CountyCare (Avesis) | Meridian Health (Envolve Dental) | Blue Cross Community (DentaQuest) | Aetna Better Health (DentaQuest) | Molina Healthcare (SKYGEN USA) |
|---|---|---|---|---|---|
| Routine dental cleaning (Prophylaxis) | Child (0–20): 1 per 6 mos (dental/school) Adult (21+): 1 per 6 mos | Child: Covered under EPSDT Adult: 1 every 6 months (shared with FMD) | Child (0–20): 1 per 6 mos (shared with FMD) Adult (21+): 1 per 1 year | Child (0–20): 1 per 6 mos (shared with FMD) Adult (21+): 1 per 12 months | Child (0–20): 2 every 6 months Adult (21+): 1 every 6 months |
| Topical application of fluoride (varnish / gel) | Child (0–2): 3 per 12 mos; (3–20): 1 per 6 mos Adult: Not a benefit | Child (0–20): 1 every 180 days (or 3/12 mos) Adult: Not covered | Child (0–20): 1 per 6 mos (or 3 per 12 mos) Adult: Not covered | Child (0–20): 1 per 6 mos (or 3 per 12 mos) Adult: Not covered | Child (0–2): 3 per 12 mos; (4–20): 2 per 6 mos Adult: Not covered |
| Pit and fissure sealants – per tooth | Child (5–17): 1 per 2 yrs per tooth (unrestored molars) Adult: Not a benefit | Child (0–20): Covered primary & perm molars Adult: Not covered | Child: 1 per 2 years, same tooth per patient Adult: Not covered | Child: 1 per 2 years, same tooth per patient Adult: Not covered | Child (0–20): 1 every 2 yrs (perm molars 2, 3, 14, 15, 18, 19, 30, 31) Adult: Not covered |
| Interim caries arresting medicament (SDF) | Child & Adult: 1 per tooth (max 4/day); 2 per tooth/yr, max 6 lifetime | Child & Adult: 6 per lifetime per tooth (all teeth) | Child & Adult: Covered with consent form | Child & Adult: Covered with consent form | Child & Adult: 2 per yr per tooth (max 4/day, max 6 per lifetime) |
| Space maintainers – fixed & removable | Child (0–20): 1 per lifetime per quad/arch Adult: Not a benefit | Child (0–20): 1 every 24 months per quad/arch Adult: Not covered | Child (0–20): 1 per lifetime per quad/arch Adult: Not covered | Child (0–20): 1 per lifetime per quad/arch Adult: Not covered | Child (0–20): 1 per lifetime per quad/arch Adult: Not covered |
| Re-cement or re-bond space maintainer | Child (0–20): 1 per 24 mos per arch/quad Adult: Not a benefit | Child (0–20): Covered as indicated Adult: Not covered | Child (0–20): Covered as indicated Adult: Not covered | Child (0–20): Covered as indicated Adult: Not covered | Child (0–20): 1 every 6 months Adult: Not covered |
| Service Description | CountyCare (Avesis) | Meridian Health (Envolve Dental) | Blue Cross Community (DentaQuest) | Aetna Better Health (DentaQuest) | Molina Healthcare (SKYGEN USA) |
|---|---|---|---|---|---|
| Amalgam restorations (1 to 4+ surfaces) | Child & Adult: 1 restoration per 12 mos per tooth per surface | Child & Adult: 1 every 12 months, same tooth/same surface | Child & Adult: 1 per 12 months, same tooth/same surface | Child & Adult: 1 per 12 months, same tooth/same surface | Child & Adult: 1 every 12 months, same tooth/same surface |
| Resin composite restorations – anterior (1 to 4+) | Child & Adult: 1 restoration per 12 mos per tooth per surface | Child & Adult: 1 every 12 months, same tooth/same surface | Child & Adult: 1 per 12 months, same tooth/same surface | Child & Adult: 1 per 12 months, same tooth/same surface | Child & Adult: 1 every 12 months, same tooth/same surface |
| Resin-based composite crown – anterior | Child: Covered primary/perm anterior Adult: Covered as indicated | Child & Adult: Covered anterior teeth | Child & Adult: Covered anterior teeth | Child & Adult: Covered anterior teeth | Child & Adult: Not covered on standard schedule |
| Resin composite restorations – posterior (1 to 4+) | Child & Adult: 1 restoration per 12 mos per tooth per surface | Child & Adult: 1 every 12 months, same tooth/same surface | Child & Adult: 1 per 12 months, same tooth/same surface | Child & Adult: 1 per 12 months, same tooth/same surface | Child & Adult: 1 every 12 months, same tooth/same surface |
| Inlay & onlay restorations (metallic / porcelain) | Child & Adult: 1 per 60 months per tooth | Child & Adult: 1 every 60 months per tooth | Child & Adult: 1 per 60 months, same tooth | Child & Adult: 1 per 60 months, same tooth | Child & Adult: 1 every 60 months (perm teeth 1–32) |
| Single crowns (porcelain, PFM, full cast metal) | Child & Adult: 1 per 36 months per tooth (except broken functional) | Child & Adult: 1 every 60 months, same tooth | Child & Adult: 1 per 60 months, same tooth | Child & Adult: 1 per 60 months, same tooth | Child & Adult: 1 every 60 months (perm teeth 1–32) |
| Re-cement crown, inlay, onlay, or post/core | Child & Adult: Not payable within 6 mos of delivery to same dentist | Child & Adult: 1 every 6 months | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: Covered (not within 6 mos of placement) |
| Prefabricated stainless steel crowns – primary | Child (A–T): 1 per lifetime per tooth Adult: Not a plan benefit | Child: 1 per lifetime per tooth Adult: Not covered | Child: 1 per lifetime, same tooth Adult: Not covered | Child: 1 per lifetime, same tooth Adult: Not covered | Child (0–20): 1 per lifetime per tooth Adult: Not covered |
| Prefabricated stainless steel crowns – permanent | Child & Adult: 1 per 36 months per tooth | Child & Adult: 1 every 60 months per tooth | Child & Adult: 1 per 60 months, same tooth | Child & Adult: 1 per 60 months, same tooth | Child & Adult: 1 every 60 months (perm teeth 1–32) |
| Prefabricated resin / esthetic coated crowns | Child: 1 per lifetime per tooth (anterior C–H, M–R) Adult: Not a benefit | Child: 1 per lifetime per tooth Adult: Not covered | Child: 1 per lifetime, same tooth Adult: Not covered | Child: 1 per lifetime, same tooth Adult: Not covered | Child (0–20): 1 per lifetime (teeth C–H, M–R) Adult: Not covered |
| Protective restoration (sedative direct) | Child & Adult: 1 per lifetime per tooth (not with other procedures) | Child & Adult: 1 every 6 months | Child & Adult: Covered emergency service | Child & Adult: Covered emergency service | Child & Adult: Covered emergency service |
| Core buildup, including any pins | Child & Adult: 1 per 36 months per tooth | Child & Adult: 1 every 60 months per tooth | Child & Adult: 1 per 60 months, same tooth | Child & Adult: 1 per 60 months, same tooth | Child & Adult: 1 every 60 months (perm teeth 1–32) |
| Pin retention – per tooth, with restoration | Child & Adult: 1 per 60 months per tooth | Child & Adult: 4 every 1 day | Child & Adult: Covered permanent teeth | Child & Adult: Covered permanent teeth | Child & Adult: Covered permanent teeth |
| Prefabricated post and core in addition to crown | Child & Adult: 1 per 36 months per tooth | Child & Adult: 1 every 60 months per tooth | Child & Adult: 1 per 60 months, same tooth | Child & Adult: 1 per 60 months, same tooth | Child & Adult: 1 every 60 months (perm teeth 1–32) |
| Service Description | CountyCare (Avesis) | Meridian Health (Envolve Dental) | Blue Cross Community (DentaQuest) | Aetna Better Health (DentaQuest) | Molina Healthcare (SKYGEN USA) |
|---|---|---|---|---|---|
| Therapeutic pulpotomy – primary teeth | Child (A–T): 1 per lifetime per tooth Adult: Not a plan benefit | Child: Covered primary teeth Adult: Not covered | Child: Covered primary teeth; no time limits Adult: Not covered | Child: Covered primary teeth; no time limits Adult: Not covered | Child (0–20): Covered primary teeth (A–T) Adult: Not covered |
| Partial pulpotomy for apexogenesis | Child (6–11, 22–27): 1 per lifetime (trauma only) Adult: Not a benefit | Child: Covered under EPSDT Adult: Not covered | Child: Covered under EPSDT Adult: Not covered | Child: Covered under EPSDT Adult: Not covered | Child (0–20): 1 per lifetime (perm anterior) Adult: Not covered |
| Pulpal therapy (resorbable filling) – anterior primary | Child (C–H, M–R): 1 per lifetime per tooth Adult: Not a benefit | Child: Covered primary anterior Adult: Not covered | Child: Covered primary anterior Adult: Not covered | Child: Covered primary anterior Adult: Not covered | Child (0–20): Covered primary anterior Adult: Not covered |
| Endodontic therapy (root canal) – anterior tooth | Child & Adult: 1 per lifetime per tooth (teeth 6–11, 22–27) | Child & Adult: 1 per lifetime per tooth | Child & Adult: 1 per lifetime, same tooth | Child & Adult: 1 per lifetime, same tooth | Child & Adult: 1 per lifetime (perm anterior) |
| Endodontic therapy (root canal) – premolar tooth | Child & Adult: 1 per lifetime per tooth (bicuspids) | Child & Adult: Covered permanent teeth | Child & Adult: 1 per lifetime, same tooth | Child & Adult: 1 per lifetime, same tooth | Child (0–20): 1 per lifetime Adult: Not covered |
| Endodontic therapy (root canal) – molar tooth | Child & Adult: 1 per lifetime per tooth (permanent molars) | Child & Adult: Covered permanent teeth | Child & Adult: 1 per lifetime, same tooth | Child & Adult: 1 per lifetime, same tooth | Child (0–20): 1 per lifetime Adult: Not covered |
| Retreatment of previous root canal therapy | Child & Adult: 1 per lifetime per tooth (anterior, premolar, molar) | Child & Adult: Covered as indicated | Child & Adult: Covered as indicated | Child & Adult: Covered as indicated | Child & Adult: Not covered on standard grid |
| Apexification / recalcification (initial, interim, final) | Child & Adult: 1 per lifetime per tooth (teeth 1–32) | Child & Adult: 1 initial, 3 interim, 1 final per lifetime | Child & Adult: Covered permanent teeth | Child & Adult: Covered permanent teeth | Child (0–20): 1 per lifetime per tooth Adult: Not covered |
| Apicoectomy / periradicular surgery – anterior | Child & Adult: 1 per lifetime per tooth (teeth 6–11, 22–27) | Child & Adult: Covered permanent anterior | Child & Adult: Covered permanent anterior | Child & Adult: Covered permanent anterior | Child (0–20): 1 per lifetime Adult: Not covered |
| Service Description | CountyCare (Avesis) | Meridian Health (Envolve Dental) | Blue Cross Community (DentaQuest) | Aetna Better Health (DentaQuest) | Molina Healthcare (SKYGEN USA) |
|---|---|---|---|---|---|
| Gingivectomy or gingivoplasty | Child & Adult: 1 per 24 months per quadrant | Child & Adult: 1 every 24 months per quadrant | Child & Adult: 1 per 24 months per business | Child & Adult: 1 per 24 months per business | Child & Adult: 1 every 24 months per quadrant |
| Gingival flap procedure, including root planing | Child & Adult: 1 per 24 months per quadrant | Child & Adult: 1 every 24 months per quadrant | Child & Adult: 1 per 24 months per business | Child & Adult: 1 per 24 months per business | Child & Adult: 1 every 24 months per quadrant |
| Clinical crown lengthening – hard tissue | Child & Adult: 1 per tooth per lifetime | Child & Adult: 1 per lifetime per tooth | Child & Adult: 1 per lifetime, same tooth | Child & Adult: 1 per lifetime, same tooth | Child & Adult: 1 per lifetime per tooth |
| Osseous surgery (flap entry and closure) | Child & Adult: 1 per 24 months per quadrant | Child & Adult: 1 every 24 months per quadrant | Child & Adult: 1 per 24 months per business | Child & Adult: 1 per 24 months per business | Child & Adult: 1 every 24 months per quadrant |
| Bone replacement grafts & soft tissue grafts | Child (0–20): Not indicated Adult: 1 per 24 mos per tooth/quad | Child & Adult: 1 first site, 3 additional every 24 mos | Child & Adult: Covered; no time limits | Child & Adult: Covered; no time limits | Child & Adult: Covered permanent teeth |
| Periodontal scaling and root planing | Child & Adult: 1 per 24 months per quadrant | Child & Adult: 1 every 24 months per quadrant | Child & Adult: 1 per 24 months per patient | Child & Adult: 1 per 24 months per patient | Child & Adult: 1 every 24 months per quadrant |
| Full mouth debridement | Child & Adult: 1 per 36 months (1 per 6 mos with prophy) | Child: Covered under EPSDT Adult: 1 every 6 months (shared) | Child: 1 per 6 months (shared with child prophy) Adult: Covered | Child: 1 per 6 months (shared with child prophy) Adult: Covered | Child (0–20): 2 every 6 months Adult (21+): 1 every 6 months |
| Periodontal maintenance | Child & Adult: 1 per 12 mos (after active perio therapy) | Child & Adult: 1 every 6 months (shared with adult prophy) | Child: No time limits Adult: 1 per 12 months | Child: No time limits Adult: 1 per 12 months | Child (0–20): Covered Adult (21+): 1 every 12 months |
| Service Description | CountyCare (Avesis) | Meridian Health (Envolve Dental) | Blue Cross Community (DentaQuest) | Aetna Better Health (DentaQuest) | Molina Healthcare (SKYGEN USA) |
|---|---|---|---|---|---|
| Complete dentures (maxillary & mandibular) | Child & Adult: 1 per 60 months per arch | Child & Adult: 1 every 60 months per arch | Child & Adult: 1 per 60 months per patient | Child & Adult: 1 per 60 months per patient | Child & Adult: 1 every 60 months per arch |
| Immediate dentures (maxillary & mandibular) | Child & Adult: 1 per 60 months per arch | Child & Adult: 1 per lifetime per arch | Child & Adult: 1 per lifetime per patient | Child & Adult: 1 per lifetime per patient | Child & Adult: 1 every 60 months (or 1/lifetime) |
| Partial dentures (resin base, cast metal framework) | Child & Adult: 1 per 60 months per arch | Child & Adult: 1 every 60 months per arch | Child & Adult: 1 per 60 months per patient | Child & Adult: 1 per 60 months per patient | Child (0–20): 1 every 60 mos Adult (21+): Covered select |
| Denture repairs, tooth replacements & clasp additions | Child & Adult: Not payable within 6 mos of denture delivery | Child & Adult: 2 every 12 mos (base); 1 every 12 mos (teeth/clasps) | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: Covered service |
| Denture relines (chairside & laboratory) | Child & Adult: 1 per 24 months per arch (after 6 mos) | Child & Adult: 1 every 24 months per arch | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: 1 every 24 months per arch |
| Maxillofacial prosthetics (obturators, guidance, resection) | Child & Adult: Covered with medical necessity narrative | Child & Adult: Covered by report | Child & Adult: Covered with documentation | Child & Adult: Covered with documentation | Child & Adult: Covered with documentation |
| Fixed bridge pontics & retainer crowns | Child (0–20): 1 per 60 mos (anterior 6–11, 22–27) Adult: Not a benefit | Child (0–20): Covered anterior Adult: Not a benefit | Child (0–20): 1 per 60 mos (anterior) Adult: Not a benefit | Child (0–20): 1 per 60 mos (anterior) Adult: Not a benefit | Child (0–20): 1 every 60 mos (anterior 6–11, 22–27) Adult: Not covered |
| Re-cement or re-bond fixed partial denture (bridge) | Child & Adult: Not payable within 6 mos to delivering dentist | Child & Adult: 1 every 6 months | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: Covered service |
| Service Description | CountyCare (Avesis) | Meridian Health (Envolve Dental) | Blue Cross Community (DentaQuest) | Aetna Better Health (DentaQuest) | Molina Healthcare (SKYGEN USA) |
|---|---|---|---|---|---|
| Simple extraction (erupted tooth or exposed root) | Child & Adult: 1 per lifetime per tooth | Child & Adult: 1 per lifetime per tooth | Child & Adult: Covered; no time limits | Child & Adult: Covered; no time limits | Child & Adult: Covered service |
| Surgical extraction (bone removal and/or sectioning) | Child & Adult: 1 per lifetime per tooth | Child & Adult: 1 per lifetime per tooth | Child & Adult: Covered; no time limits | Child & Adult: Covered; no time limits | Child & Adult: Covered service |
| Removal of impacted tooth (soft tissue) | Child & Adult: 1 per lifetime per tooth | Child & Adult: 1 per lifetime per tooth | Child & Adult: Covered; no time limits | Child & Adult: Covered; no time limits | Child & Adult: Covered service |
| Removal of impacted tooth (partially bony) | Child & Adult: 1 per lifetime per tooth | Child & Adult: 1 per lifetime per tooth | Child & Adult: Covered; no time limits | Child & Adult: Covered; no time limits | Child & Adult: Covered service |
| Removal of impacted tooth (completely bony) | Child & Adult: 1 per lifetime per tooth | Child & Adult: 1 per lifetime per tooth | Child & Adult: Covered; no time limits | Child & Adult: Covered; no time limits | Child & Adult: Covered service |
| Removal of residual tooth roots (cutting procedure) | Child & Adult: 1 per lifetime per tooth | Child & Adult: 1 per lifetime per tooth | Child & Adult: Covered; no time limits | Child & Adult: Covered; no time limits | Child & Adult: Covered service |
| Tooth reimplantation and stabilization | Child & Adult: 1 per lifetime per tooth (trauma) | Child & Adult: 1 per lifetime per tooth | Child & Adult: Covered permanent teeth | Child & Adult: Covered permanent teeth | Child & Adult: Covered permanent teeth |
| Surgical access of an unerupted tooth & device placement | Child (0–20): Approved ortho only Adult: Not a plan benefit | Child (0–20): 1 per lifetime Adult: Covered as indicated | Child (0–20): 1 per lifetime Adult: Covered as indicated | Child (0–20): 1 per lifetime Adult: Covered as indicated | Child (0–20): 1 per lifetime Adult: Not covered |
| Biopsy of oral tissue (soft tissue, hard bone, salivary) | Child & Adult: Covered with pathology report | Child & Adult: 1 every 1 day | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: Covered service |
| Alveoloplasty (with or without extractions) | Child & Adult: 1 per lifetime per quadrant | Child & Adult: 1 per lifetime per quadrant | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: 1 per lifetime per quadrant |
| Removal of benign cyst or tumor | Child & Adult: Covered with pathology report | Child & Adult: 1 per lifetime | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: Covered service |
| Removal of lateral exostosis & torus palatinus / mand. | Child & Adult: Covered service | Child & Adult: 4 exostosis / 1 torus / lifetime | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: Covered service |
| Incision and drainage of abscess (intraoral soft tissue) | Child & Adult: 1 per day per tooth (not with extraction) | Child & Adult: 1 every 1 day | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: 1 per day |
| Reduction of dislocation & facial bone fractures | Child & Adult: Covered emergency surgery | Child & Adult: 1 every 1 day | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: Covered service |
| Frenectomy (buccal, labial, lingual) & frenuloplasty | Child (0–20): Buccal 6/life, Lingual 1/life Adult: Not a benefit | Child & Adult: Buccal 2/life, Lingual 1/life | Child & Adult: Covered service | Child & Adult: Covered service | Child (0–20): 1 per lifetime Adult: Not covered |
| Excision of hyperplastic tissue – per arch | Child & Adult: Covered service | Child & Adult: 1 every 36 months | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: Not covered on standard grid |
| Service Description | CountyCare (Avesis) | Meridian Health (Envolve Dental) | Blue Cross Community (DentaQuest) | Aetna Better Health (DentaQuest) | Molina Healthcare (SKYGEN USA) |
|---|---|---|---|---|---|
| Comprehensive orthodontic treatment – adolescent | Child (0–20): 1 per lifetime (HLD criteria) Adult: Not a plan benefit | Child (0–20): Covered under EPSDT Adult: Not covered | Child (0–20): Covered under EPSDT Adult: Not covered | Child (0–20): Covered under EPSDT Adult: Not covered | Child (0–20): 1 per lifetime Adult: Not covered |
| Pre-orthodontic treatment visit | Child (0–20): 1 per lifetime Adult: Not a plan benefit | Child (0–20): Covered under EPSDT Adult: Not covered | Child (0–20): Covered under EPSDT Adult: Not covered | Child (0–20): Covered under EPSDT Adult: Not covered | Child (0–20): 1 per lifetime Adult: Not covered |
| Periodic orthodontic treatment visit | Child (0–20): 1 per 45 days (max 11 visits) Adult: Not a plan benefit | Child (0–20): Covered under contract Adult: Not covered | Child (0–20): Covered under contract Adult: Not covered | Child (0–20): Covered under contract Adult: Not covered | Child (0–20): 1 every 45 days (11/life) Adult: Not covered |
| Orthodontic retention (retainer construction & delivery) | Child (0–20): 1 per lifetime Adult: Not a plan benefit | Child (0–20): Covered under contract Adult: Not covered | Child (0–20): Covered under contract Adult: Not covered | Child (0–20): Covered under contract Adult: Not covered | Child (0–20): 1 per lifetime Adult: Not covered |
| Service Description | CountyCare (Avesis) | Meridian Health (Envolve Dental) | Blue Cross Community (DentaQuest) | Aetna Better Health (DentaQuest) | Molina Healthcare (SKYGEN USA) |
|---|---|---|---|---|---|
| Emergency palliative treatment of dental pain | Child & Adult: 1 per day (not payable with limited exam) | Child & Adult: 1 every 1 day (shared with limited exam) | Child & Adult: 1 per 0 days per business (shared) | Child & Adult: 1 per 0 days per business (shared) | Child & Adult: 1 per day |
| Deep sedation & general anesthesia (first 15m & subs) | Child & Adult: 1 initial unit per day; subs payable with initial | Child & Adult: 1 initial / 4 subs per day | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: 1 initial / subs per day |
| General anesthesia with advanced airway | Child & Adult: 1 initial unit per day; subs payable with initial | Child & Adult: 1 initial / 4 subs per day | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: 1 initial / subs per day |
| Inhalation of nitrous oxide / analgesia | Child & Adult: Covered per date of service | Child & Adult: 1 every 1 day | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: Covered service |
| Intravenous moderate conscious sedation | Child & Adult: 1 initial unit per day; subs payable with initial | Child & Adult: 1 initial / 4 subs per day | Child & Adult: 1 per 0 days per business | Child & Adult: 1 per 0 days per business | Child & Adult: 1 initial / subs per day |
| Enteral & non-intravenous parenteral sedation | Child & Adult: 1 unit per date of service | Child & Adult: 1 every 1 day | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: 1 per day |
| Consultation – diagnostic service | Child & Adult: Payable only to non-treating consulting dentist | Child & Adult: 1 every 1 day | Child & Adult: Covered; no time limits | Child & Adult: Covered; no time limits | Child & Adult: Covered service |
| Therapeutic parenteral drug administration | Child & Adult: Covered (name and dosage required) | Child & Adult: 1 every 1 day | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: Covered service |
| Teledentistry (synchronous & asynchronous) | Child & Adult: 1 per day (billed with limited exam) | Child & Adult: 1 every 1 day | Child & Adult: Covered service | Child & Adult: Covered service | Child & Adult: Covered service |
| Treatment or Procedure | Review Type | What Must Be Documented |
|---|---|---|
| Comprehensive single crowns & onlays on permanent teeth | Prior authorization | Porcelain, porcelain-fused-to-metal, and full cast restorations require full-arch radiographs, intraoral photographs demonstrating extensive breakdown where direct fillings cannot restore functional integrity, and documentation that the tooth exhibits sound periodontal support with no active untreated pathosis. |
| Core buildup and post/core foundations | Prior authorization | Advance prior authorization is required. |
| Complete and partial removable dentures | Prior authorization | Initial fabrication and any replacement prosthesis requested after the statutory 5-year (60-month) waiting period. Requires documentation that all active decay is restored, necessary extractions are completed, and partial denture abutments demonstrate at least 50% bone support without active periodontal disease. |
| Denture relines and adjustments | Prior authorization | Required following the initial post-delivery period. |
| Surgical periodontal procedures | Prior authorization | Gingivectomy, gingival flap procedures, osseous surgery, crown lengthening, and bone/tissue grafts require twelve-month periodontal charting showing pocket depths greater than 4mm with documented alveolar bone loss. On specific plans they must be preceded by scaling and root planing in the same quadrant within the previous 24 months. |
| Periodontal scaling and root planing | Prior authorization | Requires full-mouth periodontal charting and radiographs exhibiting noticeable bone loss and radicular calculus. |
| Surgical tooth exposures and device placements | Prior authorization | Required for exposures and device placements to facilitate orthodontic eruption. |
| Comprehensive adolescent orthodontics | Prior authorization | Limited to children under age 21 meeting severe handicapping malocclusion thresholds. Requires a validated Handicapping Labio-Lingual Deviation (HLD) index score sheet, cephalometric analysis tracings, diagnostic study casts, external facial photographs, and intraoral images. |
| Deep sedation and general anesthesia | Prior authorization | Requires an extensive medical necessity narrative documenting severe cognitive, physical, or behavioral conditions that preclude in-office local treatment. |
| Fixed bridgework pontics and retainer crowns | Prior authorization | Strictly restricted to adolescents under age 21 for replacing missing permanent anterior teeth where all other restorative care is verified complete. |
| EPSDT requests beyond standard limits (under age 21) | Prior authorization | Requests are marked with EPSDT indicators and accompanied by a comprehensive clinical justification, supporting diagnostic imaging, and physician or specialist documentation confirming that the service is vital to prevent deterioration of the child's oral health. |
| All oral tissue biopsies (incisional, excisional, soft tissue, and hard bone) | Pre-payment review | Official diagnostic pathology laboratory report submitted with the claim. |
| Surgical removal of impacted teeth (soft tissue, partially bony, and completely bony) | Pre-payment review | Diagnostic pre-treatment radiographs submitted with the claim. |
| Surgical removal of residual tooth roots | Pre-payment review | Reimbursement held pending clinical audit of the attachments submitted with the claim. |
| Traumatic tooth reimplantation and stabilization | Pre-payment review | Immediate post-operative radiographs submitted with the claim. |
| Incision and drainage of acute facial abscesses | Pre-payment review | Emergency clinical narrative submitted with the claim. |
| Emergency reduction of jaw dislocations or alveolar fractures | Pre-payment review | Reimbursement held pending clinical audit of the attachments submitted with the claim. |
| Unlisted or unspecified dental procedures | Pre-payment review | Billed by report. |
Important Coverage Disclaimer: Medicaid dental benefits vary by member eligibility category, age bracket, and clinical necessity. Benefit coverage is contingent upon active member eligibility on the exact date of service, provider network participation, verified procedure code frequency limitations, and prior authorization approval where mandated by Illinois Department of Healthcare and Family Services (HFS) policy. Children under 21 have broader protections under federal EPSDT guidelines when medically necessary. This page is an administrative reference for dental office billing and patient education, and does not guarantee payment or service approval. Official claims determinations by the respective dental plan administrators supersede this summary.
Everything you need to know before your first visit. Have another question?
Call 6306861328 →No. Every Illinois Medicaid dental plan we accept — CountyCare, Meridian, Blue Cross Community, Aetna Better Health, and Molina Healthcare — has no annual benefit maximum, a $0 deductible, and a $0 copay (100% covered). Coverage is governed instead by per-service frequency limits, age brackets, and prior authorization requirements.
Covered services are paid at 100% with a $0 copay. As a participating network provider, we are strictly prohibited from balance billing Medicaid members or offering private fee upgrades when Medicaid provides a standard covered benefit. If a service requiring prior authorization is rendered without an approved authorization, the denial is the provider's financial liability and you cannot be billed for the balance.
Bring your State of Illinois Healthcare and Family Services (HFS) Medical Card or active MCO insurance card (CountyCare, Meridian, Blue Cross Community, Aetna Better Health, or Molina Healthcare); a valid government-issued photo ID for the adult member, parent, or legal guardian; a comprehensive list of current prescription medications and your primary care physician's details (required for surgical and sedation reviews); and signed Silver Diamine Fluoride (SDF) informed consent documentation if you are receiving interim caries arresting medicament therapy.
Dental benefits are handled by a designated dental benefit manager, not your medical MCO card. CountyCare Health Plan: Avesis Third Party Administrators, www.avesis.com, 1-800-327-4462. Meridian Health Plan of Illinois: Envolve Dental, Inc., dental.envolvehealth.com, 1-844-464-5632. Blue Cross Community Health Plans (BCBS IL) and Aetna Better Health of Illinois: Sun Life DentaQuest, providers.dentaquest.com, 1-800-896-2374. Molina Healthcare of Illinois: SKYGEN USA (Dental Hub), app.dentalhub.com, 1-855-202-0729. All dental authorization forms, claim submissions, and clinical appeals are routed directly to the designated dental benefit manager.
Yes. Emergency palliative treatment of dental pain is covered 1 per day on all plans (not payable with a limited exam on the same date), along with limited problem-focused evaluations, incision and drainage of abscesses, and emergency reduction of dislocations and facial bone fractures. Emergency palliative pain relief and simple extractions do not require prior authorization; certain emergency surgical claims are subject to pre-payment review with the required attachments.
It may be. Under federal and state EPSDT provisions, children and adolescents under age 21 have statutory protections guaranteeing access to all medically necessary dental care required to correct, ameliorate, or maintain physical, dental, and developmental health, even if the requested service exceeds standard plan frequency limitations or is excluded from standard adult coverage. We submit a prior authorization request marked with EPSDT indicators, accompanied by a comprehensive clinical justification, supporting diagnostic imaging, and physician or specialist documentation.
For children and adolescents under age 21 only. Comprehensive orthodontic treatment is covered 1 per lifetime under EPSDT for severe handicapping malocclusion meeting HLD index thresholds, with prior authorization and full diagnostic records. Orthodontic treatments, appliance therapy, and retainers are excluded benefits for adults age 21 and older across all Illinois Medicaid MCO plans.
Removable complete and partial dentures are limited to one per arch every 5 years (60 months) across all Illinois plans, and both initial fabrication and replacement require prior authorization. Replacement prior to 5 years is strictly non-payable unless catastrophic structural failure or severe tissue alteration is clinically documented and approved. Denture relines are covered 1 per 24 months per arch.
No. Standard surgical placement of dental implants, implant abutments, and implant-supported crowns are non-covered benefits for routine care. Limited coverage is available exclusively on select plans for peri-implantitis maintenance (debridement and screw retorquing) on pre-existing implants.
No. This page is an administrative reference for patient education and does not guarantee payment or service approval. Benefits vary by member eligibility category, age bracket, and clinical necessity, and coverage is contingent upon active eligibility on the exact date of service, provider network participation, verified procedure code frequency limitations, and prior authorization approval where mandated by Illinois HFS policy. Official claims determinations by the respective dental plan administrators supersede this summary.
We review your benefits up front and lay out every option in plain language — so cost is never the reason care gets delayed.
We work with most major providers, plus Medicaid and Medicare for adults and children.
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366 W Army Trail Rd #310a, Bloomingdale, IL 60108, United States
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