Dental Care

Healthy Indiana Plan (HIP)

• HIP Basic

  Age 19-64

• Limited Accidental Dental Injury Benefits
• Other Services (EPSDT- eligible members age 19-20 only)

Healthy Indiana Plan (HIP)

• HIP Plus

  Age 19-64 

• Two oral exams every 12 months (at least six months apart) 
• Two cleanings every 12 months (at least six months apart)
  
• Four bitewing X-rays every 12 months
• Full-mouth radiograph series (D0210 includes bitewings) or panoramic x-rays (D0330) once every 60 months
• Minor Restorative services (fillings) and extractions (combined four per calendar year)
• Prefabricated crowns (one every calendar year)
• Emergency dental services 

Healthy Indiana Plan (HIP)

• State Plan Basic
• State Plan Plus
• State Plan Plus Copay
• Maternity

Age 19-64

Hoosier Care Connect (HCC)

• Full
• Package A

Age 0+

Hoosier Healthwise

(HHW)

• Package A
• Package C - CHIP

Age 0+, Package A

Age 0-18, CHIP

• Two oral exams every 12 months (at least six months apart)
• Two cleanings every 12 months (at least six months apart)*
• Two fluoride treatments every 12 months for members(at least six months apart)
• Full-mouth radiograph series (D0210 includes bitewings) or panoramic
• Periodontal services including scaling and root planing
• Minor restorative services, such as fillings
• Major restorative services, such as prefabricated crowns
• Orthodontia for members through age 20 (based on medical
• Dentures, partials, and repairs (with limits)
• Emergency dental services