The name of a service alone is not enough. The provider must match the proposed code to clinical criteria and the member's treatment history.
Dental fillings
Current adult and children's summaries list covered silver and tooth-colored fillings. The documents apply frequency rules by surface and tooth, so a new cavity, a failed filling, and a cosmetic replacement are not automatically treated the same.
A dentist must determine whether a filling is appropriate or whether the tooth needs a different restoration, root-canal treatment, extraction, or monitoring. Medicaid coverage does not substitute for that clinical decision.
Crowns
The July 2026 adult summary lists crowns once every seven years per tooth, with added criteria for second molars and no adult benefit for crowns on third molars. Children's coverage differs by age and tooth and remains subject to medical necessity.
Prior authorization or supporting records may be required. Ask what covered restoration is recommended, why it is clinically appropriate, and whether the authorization has been decided before the tooth is prepared.
Root-canal treatment
Current summaries list root-canal treatment once per lifetime per qualifying tooth. The adult summary applies additional criteria to second molars and does not list third-molar root canals as covered. Children's rules are based on age, tooth, medical necessity, and EPSDT.
Approval for a root canal does not automatically approve every related service, such as a buildup or crown. Ask the office to verify each part of the treatment sequence.
Before restorative treatment begins
- Ask which teeth and surfaces are involved and request the proposed procedure codes.
- Confirm the office and treating dentist are enrolled for the date and location of service.
- Ask whether a previous filling, crown, or root canal affects the frequency rule.
- Ask whether prior authorization is required and whether the decision is final.
- Ask how the adult or Cover All Coloradans annual limit may affect the plan.
- Seek prompt care for swelling, fever with dental symptoms, facial trauma, or trouble breathing or swallowing.
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