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Reimbursement Information

  1. MaineCare (Medicaid) reimburses medical providers for two procedures codes:
    • D1206 – Fluoride Varnish – $12 (twice per calendar year for children under age 3 years; twice per calendar year with at least 150 days between applications for children ages 3 and over. A third application in a calendar year can be reimbursed for children who have a high rate of caries or who have had new dental restorations placed in the previous 18 months. Fluoride varnish can be applied by: MD/DO, PA, NP, nurses and medical assistants (with appropriate supervision).
    • D0145 – Oral Evaluation for patients under 3 years of age – $20 (twice per calendar year) children who have seen a dentist in the past year should not have a D0145 charged/billed from a medical provider. Providers who want to complete an oral evaluation for children ages 3 years and older can do so but they should not be charged/billed for the service.
  1. Some Self-Insured Employers in Maine are covering fluoride varnish (D1206) as a preventive medical benefit at 100% of the lesser of the maximum allowance or the physician’s charge. It covers two applications per year for children up to age 42 months of age when provided by a medical provider or designee.
  1. Additionally, Maine Community Health Options covers Fluoride Varnish as a medical benefit.

Click Here for FTFT PDF billing, coding and periodicity chart.