Age, tooth, diagnosis, service history, provider network status, frequency, annual limits, and authorization can all affect a claim.
Diagnostic and preventive services
Current benefit materials include oral exams, routine cleanings, and covered dental X-rays. Children's benefits can also include fluoride, sealants, and space maintainers when age and clinical rules are met.
Frequency is not identical for every exam or image. A problem-focused exam, periodic exam, full-mouth series, and panoramic image each have separate codes and timing rules.
Treatment categories listed in current summaries
- Restorative: covered silver or tooth-colored fillings and other qualifying restorations
- Major restorative: certain crowns that meet tooth, age, timing, and clinical criteria
- Endodontic: covered pulpal treatment and root-canal services for qualifying teeth
- Periodontal: debridement, maintenance, scaling and root planing, and certain surgery when criteria are met
- Prosthetic: qualifying complete or partial removable dentures, plus certain repairs, relines, or rebases
- Oral surgery: covered simple and surgical extractions
- Anesthesia: certain sedation services when furnished with a covered procedure and program criteria are met
Services that are excluded or tightly limited
The July 2026 adult summary lists fixed bridges, implants, and adult orthodontia as noncovered benefits. It also lists tooth-specific restrictions for crowns and root canals. Children's orthodontia may be covered only for medically necessary cases approved through prior authorization.
Cosmetic goals alone generally do not establish Medicaid medical necessity. Ask for covered alternatives when a proposed material, appliance, or procedure is not payable.
Turn a treatment plan into a coverage check
- 1
Get the diagnosis and proposed codes
Ask which tooth, surface, arch, or quadrant each procedure applies to.
- 2
Check timing and history
A service can be covered in general but unavailable because the frequency period has not elapsed.
- 3
Check the benefit year and program
Adult and Cover All Coloradans annual limits changed July 1, 2026.
- 4
Confirm prior authorization
If required, wait for the written determination before non-emergency care begins.
Open the guide for the service you are researching
Each treatment guide explains the member-group differences, common program limits, and the questions to ask before care.
Primary sources
Verify the details that affect your care
We use official program materials and clearly identify Star Dental pages. Policies and personal benefit status can change.
- DentaQuest adult dental benefit summary
- DentaQuest children's dental benefit summary
- Health First Colorado benefits and services