HEDIS Training and Tips

Let's Partner to Improve the Oral Health of Children

Centene Dental Services is committed to improving the health of our community by helping members live healthier lives. Oral health is a vital part of a child's tooth and gum development and overall well-being.

We are asking for your help to ensure our pediatric and adolescent members receive both preventative and ongoing quality dental care.

For 2023, the Annual Dental Visit (ADV) Measure is being retired, and two new Dental Measures have been created. In previous years, the ADV measure tracked general dental visits for Medicaid members under 21 years of age. Beginning in 2023, the below HEDIS measures will be implemented:

Oral Evaluation, Dental Services (OED) - Medicaid members under 21 years of age who received a comprehensive or periodic oral evaluation with a dental provider.

Good oral health is a vital component of a child’s overall health, and oral examinations are important to prevent disease, reverse disease processes, prevent progression of caries, and reduce incidence of future lesions. This measure will allow health plans to understand if their pediatric members are receiving dental care and to work towards improving access and utilization of dental evaluations.

Applicable Measure Codes:

  • Oral Evaluation: CDT D0120
  • Oral Evaluation: CDT D0145
  • Oral Evaluation: CDT D0150

Topical Fluoride for Children (TFC) - Medicaid members 1-4 years of age who received at least two fluoride varnish applications within the measurement year

Dental caries is the most common chronic disease in children in the United States. Topical fluoride plays an important role in preventing tooth decay. This measure will allow health plans to understand if their pediatric members are receiving fluoride varnish applications and to promote fluoride varnish treatments for their younger members.

Applicable Measure Codes:

  • Application of Fluoride Varnish: CDT D1206
  • Application of Fluoride Varnish: CPT 99188 (only applicable to a physician or other qualified health care professional when performed in a non-dental clinic or facility setting)

Please visit envolvedental.com/logon to verify member benefits and eligibility, check treatment history, and submit claims and authorizations.  For questions please contact our Customer Service.

Dental Code Search: https://dentalbenefits.envolvehealth.com/DentalCodeSearch