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
- 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.
Dental Care Coordination Team
NO ENGLISH 1-800-553-9536
Call Delta Dental
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