Tooth decay (also known as caries or cavities) is the most common childhood chronic disease in the United States and disproportionately affects children from low-income families, Black and Hispanic populations, and children with special health care needs1, 2. Cavities are preventable with the use of fluoride varnish, which can prevent about one-third (33%) of cavities in baby teeth.
All members less than 21 years of age must receive a dental screening and an oral health assessment as part of every periodic assessment, with annual dental referrals beginning with the eruption of the member’s first tooth or at 12 months of age, whichever occurs first. Providing or coordinating this service contributes to preventive oral health goals and supports quality improvement efforts under CenCal Health’s Quality Care Incentive Program (QCIP).
Clinical Guidelines
According to The American Academy of Pediatric Dentistry (AAPD), a child should be seen by a dentist starting at 12 months of age and every 6 months thereafter or according to a schedule recommended by the dentist. The care and schedule should be based on the child’s individual needs and susceptibility to disease.
In the absence of a dentist, the child’s Primary Care Practitioner (PCP) or assigned clinical staff should apply topical fluoride varnish to patient’s teeth every 6 months between the ages of 1 and 4. The AAPD recommends that health care professionals use the AAP Oral Health Risk Assessment Tool and continue to perform oral health risk assessments as needed.
Best Practices
- The U.S. Preventive Services Task Force recommends that PCPs apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption.
- Once teeth are present, apply fluoride varnish to all children every 3 to 6 months in the primary care or dental office based on caries risk. See Bright Futures Oral Health Pocket Guide for more information on high-risk criteria.
- The application process takes about three minutes and sets within one minute of contact with saliva. No special dental equipment or training are required.
- Establish reliable referral and follow-up processes to help ensure eligible children receive service if not provided on site.
Billing for Fluoride Varnish
- Application by a physician or other qualified health care professional (in non-dental settings): CPT code 99188.
- DST- specific for dental practices: CDT Code D1206.
- Reimbursable for children through age 5 and includes all materials and supplies needed.
- Once teeth are present, treatment is covered up to 3 times in a 12-month period.
For further best practice guidance, contact the CenCal Health’s Practice Transformation or Population Health teams at: [email protected] or [email protected].
1www.cdc.gov/oral-health/prevention/oral-health-tips-for-children.html
2 www.cdc.gov/oral-health/data-research/facts-stats/index.html