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UCare's MSHO Dental Options

Dental benefits for members of UCare's Minnesota Senior Health Options (MSHO) (HMO D-SNP) plan.

In addition to Medicare- and Medical Assistance-covered dental benefits, UCare's MSHO members have additional dental coverage for preventive and restorative dental services. Members must receive these services from a network dentist.

Below is a list of preventive and restorative codes that may be accessed:

  • Additional Oral Evaluation (D0120 or D0150)
    - One additional of either code per calendar year
  • Molar root canal (D3330)
    - One per tooth per lifetime
  • Root canal re-treatment (D3346, D3347, D3348)
    - One re-treat per tooth per lifetime. Covered only if 24 months after original root canal.
  • Full mouth series (x-ray) (D0210)
    - Once per five years
  • Crown (D2740 or D2750)
    - Two per calendar year
    - Porcelain/ceramic or Porcelain fused to high noble metal
  • Re-cement or crown repair (D2920 or D2980)
    - One of either code per year
  • Comprehensive oral evaluation (D0150)
    - One per year
  • Panoramic film (D0330)
    - One additional per year
  • Topical fluoride varnish (D1206)
    - For moderate to high caries risk members.
    - Second varnish per year
  • Gross removal of plaque and calculus (D4355)
    - Additional one per year
  • Tissue conditioning (D5850 and D5851)
    - One treatment per arch per calendar year

Members will be informed of the portion of the cost they will need to pay for non-covered services. Certain limitations apply.

UCare's Dental Connection

A one-stop-shop for all of your dental care coordination needs.

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Contact information


TTY 711
NO ENGLISH 1-800-553-9536