Benefits

Medicaid
The Dental Benefits Guide is a basic dental benefits summary for Medicaid clients.

Traditional Medicaid: aged, blind, disabled, non-pregnant adults twenty-one years of age and older.
• X-rays
• Fillings
• Simple tooth extractions
• Root canal treatment for permanent teeth (excluding second and third molars)

Traditional Medicaid: children birth through twenty years of age and pregnant women of any age.
• Two dental examinations a year with x-rays and cleaning
• Topical fluoride applications and sealants
• Fillings
• Root canal treatment (excludes second and third molars for pregnant women)
• Orthodontia in cases of severe malocclusion (prior approval required)
• General anesthesia (prior approval required)

Non-Traditional Medicaid: non-pregnant adults nineteen through sixty-four years of age
Not covered.

Comparison of Adult Medicaid Programs

For information about dentists and dental clinics providing services for
Medicaid clients or information about enrolling in Medicaid, call 801-538-6155 or 1-800-662-9651 or visit Medicaid online.

Primary Care Network (PCN)
See the PCN Member Guide for Covered Services.

There are three ways to apply for PCN during an open enrollment period:
• Apply online
• Download & print an application, then mail it.
• Stop by your local eligibility office

For more information call 1-888-222-2542 or visit the webpage www.health.utah.gov/pcn/Providers.htm to find a PCN dentist near you.

Children's Health Insurance Plan (CHIP)
CHIP Dental Benefits and Co-Pay Schedule
For more information about CHIP dental benefits and dentists, call Public Employees Dental Program (PEDP) at 801-366-7555 or toll-free 1-800-765-7347.

For more information about enrolling in the CHIP Program, call toll-free, 1-888-222-2542. Or during Open Enrollment, apply for CHIP online, by mailing an application, or by visiting a Utah Department of Health eligibility office.