| Is the Benefit Covered? |
Copayment Requirement |
Prior Approval Requirement |
Coverage Limitations |
Reimbursement Methodology |
Populations Covered |
|
|
Alabama
|
|
No
|
|
|
|
|
|
|
Alaska
|
|
Yes
|
|
Yes
|
Coverage of dentures is included in $1,150 annual limit and limited to 1 denture/5 years
|
Fee for service
|
CN
|
|
Arizona
|
|
Yes
|
|
Yes
|
Must be medically necessary to alleviate a health problem
|
Fee for service
|
CN & MN
|
|
Arkansas
|
|
No
|
|
|
|
|
|
|
California
|
|
Yes
|
|
Yes
|
1 denture/5 years, 1 reline/year
|
Fee for service
|
CN & MN
|
|
Colorado
|
|
No
|
|
|
|
|
|
|
Connecticut
|
|
Yes
|
|
|
1 full upper and/or lower denture or 1 partial denture/5 years, 1 reline/2 years
|
Fee for service
|
CN & MN
|
|
Delaware
|
|
No
|
|
|
|
|
|
|
District of Columbia
|
|
Yes
|
|
|
|
|
|
|
Florida
|
|
Yes
|
5% of payment for dentures and specified related services
|
Partial dentures and replacement full dentures
|
1 full upper and/or lower partial or full denture/lifetime
|
Fee for service
|
CN & MN
|
|
Georgia
|
|
No
|
|
|
|
|
|
|
Hawaii
|
|
Yes
|
|
|
1 full or partial denture up to $1,000/year
|
Fee for service
|
CN & MN
|
|
Idaho
|
|
Yes
|
|
|
1 full upper and/or lower denture or 1 partial denture/5 years
|
Fee for service for Enhanced Plan, capitated payment for Basic Plan
|
CN
|
|
Illinois
|
|
Yes
|
|
Yes
|
1 full upper and/or lower denture/5 years, partial dentures not covered but may be adjusted
|
Fee for service through contracted intermediary
|
CN & MN
|
|
Indiana
|
|
Yes
|
|
Yes
|
$600 maximum benefit/year included with dental services
|
Fee for service
|
CN
|
|
Iowa
|
|
Yes
|
|
Fixed partial dentures, posterior partial dentures
|
1reline/year, 2 repairs/year
|
Fee for service
|
CN & MN
|
|
Kansas
|
|
No
|
|
|
|
|
|
|
Kentucky
|
|
No
|
|
|
|
|
|
|
Louisiana
|
|
Yes
|
|
All services other than repairs
|
1 full upper and lower denture and 1 reline/7years, or 2 relines on existing denture/7 years, partial lower denture only allowed to balance occlusion with full upper denture, repairs covered only if denture would then be fully serviceable
|
Fee for service
|
CN & MN - See state-specific FN
|
|
Maine
|
|
Yes
|
|
Yes
|
1 full upper and/or lower denture or 1 partial denture/5 years
|
Fee for service
|
CN and MN
|
|
Maryland
|
|
No
|
|
|
|
|
|
|
Massachusetts
|
|
Yes
|
|
Yes
|
1 full upper and/or lower denture or 1 partial/7 years, 1 upper and/or lower rebase or reline/3 years, immediate dentures not covered
|
Fee for service
|
CN & MN
|
|
Michigan
|
|
Yes
|
$3/denture
|
Yes
|
1 full upper and/or lower denture or 1 partial/5 years
|
Fee for service, Public Dental Clinics paid average commercial rate
|
CN & MN
|
|
Minnesota
|
|
Yes
|
|
|
1 full upper and/or lower denture or 1 partial denture/3 years
|
Fee for service
|
A & B - See state-specific FN
|
|
Mississippi
|
|
No
|
|
|
|
|
|
|
Missouri
|
|
Yes
|
5% of payment for denture and related services
|
Yes
|
1 full upper and/or lower denture or 1 partial denture/lifetime, reline after 1 year, adult coverage limited to those who are pregnant, blind or residing in nursing facilities
|
Fee for service
|
CN & MN
|
|
Montana
|
|
Yes
|
$5/denture-related visit
|
Yes
|
A - 1 full upper and/or lower denture or 1 partial denture/10 years, 1 partial denture/5 years, 1 replacement per lifetime (for lost denture)
B - Limited to services essential for employment
|
Fee for service
|
A & B - See state-specific FN
|
|
Nebraska
|
|
Yes
|
$3/specified services
|
Replacement dentures
|
Replacement covered only if existing denture cannot be made wearable by reline or repair, $1,000 maximum benefit/year included with dental services
|
Fee for service
|
CN & MN
|
|
Nevada
|
|
Yes
|
|
Yes
|
1 full upper and/or lower denture or 1 partial upper and/or lower denture/5 years
|
Fee for service
|
CN
|
|
New Hampshire
|
|
No
|
|
|
|
|
|
|
New Jersey
|
|
Yes
|
|
Yes
|
Dentures covered if specified occlusal criteria met, 1 full upper and/or lower denture/7.5 years
|
Fee for service
|
CN & MN
|
|
New Mexico
|
|
Yes
|
|
Yes
|
|
Fee for service
|
CN
|
|
New York
|
|
Yes
|
|
Yes
|
|
Fee for service
|
CN & MN
|
|
North Carolina
|
|
Yes
|
$3/episode of treatment
|
Yes
|
1 full upper and/or lower denture or 1 partial upper and/or lower denture/10 years, 1 upper and/or lower reline/5 years
|
Fee for service
|
CN & MN
|
|
North Dakota
|
|
Yes
|
|
|
1 full upper and/or lower denture or 1 partial denture/5 years if not repairable, 1 reline/2 years
|
Fee for service
|
CN & MN
|
|
Ohio
|
|
Yes
|
|
Yes
|
1 full upper and/or lower denture or 1 partial denture/8 years if not repairable, 1 reline/4 years
|
Fee for service
|
CN
|
|
Oklahoma
|
|
No
|
|
|
|
|
|
|
Oregon
|
|
Yes
|
|
|
|
Fee for service
|
A - See state-specific FN
|
|
Pennsylvania
|
|
Yes
|
|
Yes
|
1 full upper and/or lower denture or 1 partial denture/5 years
|
Fee for service
|
CN
|
|
Rhode Island
|
|
Yes
|
|
Yes
|
|
Fee for service
|
CN & MN - see state-specific FN
|
|
South Carolina
|
|
No
|
|
|
|
|
|
|
South Dakota
|
|
Yes
|
$3/denture or reline
|
Yes
|
1 full upper and/or lower denture or 1 partial denture or reline/5 years
|
Fee for service, or percentage of charge for unlisted services
|
CN
|
|
Tennessee
|
|
No
|
|
|
|
|
|
|
Texas
|
|
Yes
|
|
Specified services
|
Adult coverage limited to ICF/MR residents
|
Fee for service
|
CN & MN
|
|
Utah
|
|
Yes
|
|
Yes
|
Adult coverage limited to pregnant women
|
Fee for service
|
A - See state-specific FN
|
|
Vermont
|
|
No
|
|
|
|
|
|
|
Virginia
|
|
No
|
|
|
|
|
|
|
Washington
|
|
Yes
|
|
Yes
|
1 full upper and 1 full lower denture/10 years, 1 partial upper and 1 partial lower denture/10 years
|
Fee for service
|
CN & MN
|
|
West Virginia
|
|
No
|
|
|
|
|
|
|
Wisconsin
|
|
Yes
|
|
Yes
|
|
Fee for service
|
CN & MN
|
|
Wyoming
|
|
Yes
|
|
|
1 denture/lifetime
|
Fee for service
|
CN
|
|
American Samoa
|
|
Yes
|
|
|
|
|
See territory-specific FN
|
|
Guam
|
|
Yes
|
|
|
Limited to post-trauma only
|
Fee for service
|
CN
|
|
Northern Mariana Islands
|
|
Yes
|
|
|
Limited to dentures delivered by government-operated facility
|
|
CN & MN - See territory-specific FN
|
|
Puerto Rico
|
|
No
|
|
|
|
|
|
|
Virgin Islands
|
|
Yes
|
|
Yes
|
Strict criteria of medical necessity must be met
|
Fee for service
|
CN
|
