Dental Benefits
| Health Plan | Benefits |
|---|
Healthy Indiana Plan (HIP)
*age 19-20 years
| - Two oral exams every 12 months
- One cleaning every 6 months
- Emergency oral exams
- One complete bitewing x-ray series per member every 12 months
- Full-mouth radiograph series or panoramic x-rays once every 3 years
|
Healthy Indiana Plan (HIP)
*age 21-64 years
|
|
Healthy Indiana Plan (HIP)
*age 19-64 years
| - Two oral exams every 12 months
- One cleaning every 6 months
- Emergency oral exams
- One complete bitewing x-ray series per member every 12 months
- Full-mouth radiograph series (D0210 includes bitewings) or panoramic x-rays (D0330) once every 5 years
- Restorative services (fillings) and extractions (four total per benefit year)
- Crowns (one per benefit year)
|
Healthy Indiana Plan (HIP)
- HIP State Plan Basic
- HIP State Plan Plus
- HIP State Plan Plus Copay
- HIP Maternity
*age 19-64 years
| - Two oral exams every 12 months
- One cleaning every 6 months
- Emergency oral exams
- Two fluoride treatments every 12 months for members through age 20
- One complete bitewing x-ray series per member every 12 months
- Full-mouth radiograph series (D0210 includes bitewings) or panoramic x-rays (D0330) once every 3 years
- Periodontal services including scaling and root planing
- Minor restorative services, such as fillings
- Major restorative services, such as crowns
- Simple and surgical tooth extractions (based on medical necessity)
- Orthodontia for members through age 20 (based on medical necessity)
- Dentures, partials, and repairs (with limits)
- Dental surgery (with limits)
|
Find a Network Dentist
Use our Find a Provider tool or call MHS Member Services at 1-877-647-4848.
