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1501 Cherry Street, 
Philadelphia, PA 19102 

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COVERED AND NO

APPROVAL NEEDED

  • Check-ups and cleaning once every 180 days

  • Diagnostic, restorative, and surgical dental procedures, prosthodontics and sedation.

  • Orthodontics (correcting malpositioned teeth)

  • Complete and partial dentures

  • Surgical extractions

  • Placement of device to facilitate eruption of impacted tooth

REQUIRES DOCUMENTATION

OF NEED

  • Additional exam & cleaning (more than one per 180 days)

  • Additional dentures (Medicaid routinely covers 1 set per lifetime)

  • Crowns and adjunctive services

  • Periodontics (gums & bones)

  • Endodontic services (inside the tooth – i.e. root canal)

COVERED, BUT REQUIRES

AUTHORIZATION

To contain costs, Pennsylvania has reduced the dental care it covers for those on Medicaid and has created a system that requires patients to jump through significant hoops to get needed dental care.

This matters because oral health has a significant impact on overall health.  People with poor oral health face higher risk of heart disease, stroke, complications in pregnancy and childbirth, and other conditions.  People with untreated dental problems also often have difficulty finding jobs, which lowers employment.

We can also reduce the cost of oral health by stopping problems before they start. This helps people avoid serious problems like gum disease that are expensive to treat and catch potentially serious problems like cancer before they progress.

Want more detailed information on dental benefits in Pennsylvania and filing for a Benefit Limits Exception?  Watch our webinar below:

What Benefits Are Covered?

So What's the Problem?

Need help figuring out your dental benefits?

Call the PHAN Helpline at 877-570-3642 or fill out this form.