Pediatric Oral Health

Tooth decay (also known as caries or cavities) is the most common chronic disease of childhood in the United States, according to the Centers for Disease Control (CDC).

Poor oral health leads to pain, school absenteeism, lower grades, and an overall negative effect on children’s general physical health. Tooth decay disproportionately affects low-income, young, Black and Hispanic populations, and children with special healthcare needs. Cavities are preventable with the use of fluoride varnish, which can prevent about one-third (33%) of cavities in baby teeth.

All members under 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.

New Measure for the Quality Care Incentive Program (QCIP)

CenCal Health added “Topical Fluoride for Children” to QCIP to improve the percentage of CenCal Health children 1-4 years of age who received at least two fluoride varnish applications. Services rendered beginning July 2024 will be used to calculate QCIP incentive payments when Topical Fluoride for Children transitions to a priority measure in July 2025, with the first incentive distribution in Q3 2025.

Clinical Guidelines

The American Academy of Pediatrics (AAP) recognizes that pediatricians are uniquely positioned to provide guidance regarding oral health and apply fluoride varnish to prevent tooth decay. The AAP recommends that pediatricians:

• Perform oral health risk assessments on all children at every routine well-child visit beginning at 6 months of age.
• Recommend the use of fluoridated toothpaste starting at the eruption of the first tooth: a smear for children younger than 3 years and a pea-sized amount starting at age 3 years.
• Apply fluoride varnish according to the AAP’s Recommendations for Preventive Pediatric Health Care. Fluoride varnish is proven to help prevent early childhood caries.
• Counsel families about nutrition and how to care for their children’s teeth; refer to a dentist.
• Advocate for water fluoridation in the community; know the concentration of fluoride in the primary water supply to determine the need for supplements.

Topical application of fluoride varnish is a covered benefit for pediatric CenCal Health members.

The application process takes about three minutes and sets within one minute of contact with saliva. No special dental equipment or training are required.

Billing for Fluoride Varnish

• Use CPT code 99188
• 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.
• Fluoride Varnish may be applied by:

• Medical Professionals
• Any trained person with signed guardian permission and under a doctor/dentist prescription or protocol
• In a community setting, such as a school/health fair or government program

For questions or to schedule a collaborative call, please contact the Population Health Team at populationhealth@cencalhealth.org.

Health Education and Resources

American Academy of Pediatrics:

• Bright Futures/AAP Periodicity Schedule PDF
• Bright Futures/AAP Health Promotion: Promoting Oral Health PDF
• Fluoride Remains Powerful Tool to Prevent Tooth Decay Webpage
• American Academy of Pediatric Dentistry Oral Health Risk Assessment Tool PDF
• Fluoride Use in Caries Prevention in the Primary Care Setting Webpage

Center of Disease Control and Prevention: Oral Health Tips for Children Webpage

DHCS All Plan Letter 19-010: Requirements for Coverage of Early and Periodic Screening, Diagnostic, and Treatment Services for Medi-Cal Members Under the Age of 21 PDF