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  3. Dental Benefits for Medicaid Adults

Dental Benefits for Medicaid Adults

Dental treatment for adults is covered under certain circumstances through Virginia's dental program, Smiles For Children.

Adult dental services are limited to medically necessary oral surgery and associated diagnostic services, such as X-rays and surgical extractions.

Preventive, restorative, endodontics, and prosthetic services (e.g. cleanings, fillings, root canals and dentures) are not covered for adults. Dental conditions that may qualify for reimbursement are ones compromising a patient's general health and such conditions must be documented by the dentist or medical provider. Symptoms would include pain and/or infection.

Adult services require prepayment review by DentaQuest and providers have the option of requesting prior authorization.

Adult benefit questions may be answered by contacting DentaQuest's Customer Service Department directly at 1-888-912-3456.

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© Optima Health 2023, PO Box 66189, Virginia Beach, Virginia 23466

Sentara Health Plans and Optima Health are trade names of Sentara Health Plans, Sentara Health Insurance Company, Sentara Health Administration, Inc., and Sentara Behavioral Health Services, Inc. Optima Health Insurance Company is an additional trade name for Sentara Health Insurance Company. Virginia Premier Health Plan is an additional trade name for Sentara Health Plans. Optima Behavioral Health is an additional trade name for Sentara Behavioral Health Services, Inc. Optima Health Maintenance Organization (HMO) products, and Point-of-Service (POS) products, are issued and underwritten by Sentara Health Plans. Optima Preferred Provider Organization (PPO) products are issued and underwritten by Sentara Health Insurance Company. Sentara Health Administration, Inc. provides administrative services to group and individual health plans but does not underwrite benefits. All Optima Health plans have benefit exclusions and limitations and terms under which the policy may be continued in force or discontinued. Medicare products are administered under an agreement with Sentara Health Plans and the Centers for Medicare and Medicaid Services (CMS.) Medicaid and FAMIS products are administered under an agreement with Sentara Health Plans and the Virginia Department of Medical Assistance Services (DMAS.)