Dental Care

Dental Benefits

MHS Indiana Plans	Dental Benefit Summary (may include additional benfits) *Review clinical policy guidelines on our website (centenedental.com/policies) prior to providing services
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	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

MHS Indiana Plans

Dental Benefit Summary (may include additional benfits) *Review clinical policy guidelines on our website (centenedental.com/policies) prior to providing services

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

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

*VALUE-ADDED BENEFIT: ADDITIONAL ADULT CLEANING

_{MHS offers a value-added dental benefit for HIP State Plan, HIP Maternity, HHW, and HCC adults aged 21 and up. Non-institutionalized adult MHS members in these plans may receive an additional adult cleaning (D1110) in a 12-month period. As with other eligible members, dental cleaning servicesshould be spaced six months apart.}

POWER Up To HIP Plus!

Don’t have dental, vision and chiropractic benefits? Take charge of your health next year and POWER Up to HIP Plus. Make sure you keep paying your POWER Account contributions to keep HIP Plus benefits.

Last Updated: 11/07/2025