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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:

  • Scaling and root planing (D4341 and D4342)
    - Once every two years and only in an office setting. The member must have pocket depths of 4 mm or greater and documented bone loss visible on x-rays.
  • Additional dental exam (D0120)
    - One additional per calendar year
  • Molar root canal (D3330)
    - One per tooth per lifetime
  • Root canal re-treatment (D3346, D3347, D3348)
    - Rule: One re-treat per tooth per lifetime. Covered only if billed 24 months after original root canal.
  • Full mouth series (x-ray) (D0210)
    - Rule: Once per five years
  • PFM crown (D2750 , D6245, D6740)
    - Two per calendar year
    - Porcelain-Fused-to-Metal
  • 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

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.

Learn more

Contact information


Dental Care Coordination Team
TTY 711
NO ENGLISH 1-800-553-9536

County Staff
Call Delta Dental
Government Programs Access Unity