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Dental Services for Children – Inappropriate Billing

Dental services are required for most Medicaid-eligible individuals under age 21 as a component of the Early and Periodic Screening, Diagnostic, and Treatment services benefit (SSA §§ 1905(a)(4)(B) and 1905(r)). Federal regulations define “dental services” as diagnostic, preventative, or corrective procedures provided by or under the supervision of a dentist (42 CFR § 440.100). Services include the treatment of teeth and the associated structure of the oral cavity and disease, injury, or impairment that may affect the oral cavity or general health of the recipient. Previous OIG work indicated that some dental providers may be inappropriately billing for services. We will review Medicaid payments by States for dental services to determine whether States have properly claimed Federal reimbursement.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services Dental Services for Children – Inappropriate Billing Office of Audit Services W-00-17-31135 2018

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