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.
NO ENGLISH 1-800-553-9536