Section 140.420  Dental Services

a)         Payment for dental services shall be made only to enrolled licensed dentists.  Payment for comprehensive orthodontic care shall be made only to a dentist licensed for provision of such services.

b)         Except for the "services not covered" specified in subsection (c) of this Section , payment shall be made for dental services that are:

1)         Necessary to relieve pain or infection, preserve teeth, or restore adequate dental function;

2)         Diagnostic, preventive, or restorative services, endodontics, prosthodontics, orthodontics or oral surgery included in the Department's Schedule of Dental Procedures (see Table D of this Part); and

3)         Performed by the dentist or under the direct supervision of the dentist.

c)         Services for which payment shall not be made include:

1)         Routine or periodic examinations other than clinical oral examinations (see Table D(a)(1));

2)         Experimental dental care;

3)         Procedures performed only for cosmetic reasons;

4)         Dental prophylaxis for individuals 21 years and older;

5)         Topical fluoride treatment and sealants for individuals age 21 years and older;

6)         Space maintainers for individuals age 21 years and older;

7)         Acrylic crown;

8)         Prefabricated stainless steel crown for primary tooth for individuals age 21 years and older;

9)         Therapeutic pulpotomy for individuals age 21 years and older;

10)         Bicuspid and molar root canals, apexification, and apicoectomy procedures for anterior teeth, bicuspids, and permanent first molars for individuals age 21 years and older;

11)        Periodontics for individuals age 21 years and older;

12)        Partial dentures for adults age 21 years and older;

13)        All dentures placed prior to five year expiration (see Section 140.421(c));

14)        Bridgework for individuals age 21 years and older;

15)        Surgical exposure to aid eruption for individuals age 21 years and older;

16)        Alveoloplasty for individuals age 21 years and older;

17)        Frenulectomy for individuals age 21 years and older; and

18)        Orthodontics for individuals age 21 years and older.

(Source:  Amended at 27 Ill. Reg. 14799, effective September 5, 2003)