North Carolina Medicaid accepted for children, adults and pregnant women — no annual dollar maximum on covered care.
Dentist in Concord participates in North Carolina Medicaid (Title XIX) and provides dental services to eligible Medicaid beneficiaries according to applicable state program guidelines and coverage policies. North Carolina Medicaid dental benefits are administered through the NC Department of Health and Human Services (DHHS) Division of Health Benefits and NCTracks.
Dental benefits vary by Medicaid eligibility category and age group. Common dental benefit groups include:
North Carolina Medicaid adult dental coverage does not enforce a rigid annual dollar cap, but applies procedure-specific frequency limitations, clinical criteria, and category exclusions:
A Medicaid beneficiary may have more than one card depending on their enrollment status:
Please bring the following to your visit so we can verify your eligibility on NCTracks before treatment:
Beneficiaries and dental providers can access enrollment verification, policy manuals, and prior approval processing through official portals:
NCTracks Prior Approval & Claims Portal: www.nctracks.nc.gov | Call Center: 1-800-688-6696
NC Medicaid Division of Health Benefits Portal: medicaid.ncdhhs.gov | Beneficiary Inquiries: 1-888-245-0179
How NC Medicaid covers common dental services for children (under 21) and adults (21 and older), and whether prior authorization (PA) is required. Codes in parentheses are CDT procedure codes, and DOS means date of service. Reading the table: frequency limits are per beneficiary unless noted per provider, per tooth, per quadrant, per arch or per date of service (DOS). Children under 21 may exceed these policy limitations when medically necessary under EPSDT. Adult coverage has no rigid annual dollar cap, but procedure-specific frequency limits, clinical criteria and category exclusions apply.
| Service Description | Child (Under 21) — EPSDT Eligible | Adult (Ages 21+) — Standard Benefit | Prior Auth (PA) — Required? |
|---|---|---|---|
| Annual Dollar Limit | No Annual Maximum | No Annual Maximum (subject to policy limitations) | N/A |
| Service Description | Child (Under 21) — EPSDT Eligible | Adult (Ages 21+) — Standard Benefit | Prior Auth (PA) — Required? |
|---|---|---|---|
| Periodic Oral Evaluation | 1 per 6 calendar months for same provider (D0120) | 1 per 6 calendar months for same provider (D0120) | No |
| Problem-Focused / Emergency Exam | Covered as emergency exam (D0140); follow-up coded as D0170 | Covered as emergency exam (D0140); follow-up coded as D0170 | No |
| Oral Evaluation (< 3 yrs old) | 1 per 6 calendar months (D0145; billed with fluoride varnish D1206) | Not Applicable | No |
| Comprehensive Oral Exam | Initial exam once per provider per beneficiary (D0150) | Initial exam once per provider per beneficiary (D0150) | No |
| Comprehensive FMX Series | 1 time in 5 years; age 6 and older (D0210) | 1 time in 5 years (D0210) | No |
| Periapical / Occlusal Images | D0220 (1/DOS); D0230 addt'l images; D0240 occlusal (max 2/DOS) | D0220 (1/DOS); D0230 addt'l images; D0240 occlusal (max 2/DOS) | No |
| Bitewing Radiographs (1 to 4) | 1 time in 12 calendar months (D0270, D0272; D0273/D0274 age 13+) | 1 time in 12 calendar months (D0270, D0272, D0273, D0274) | No |
| Panoramic Radiograph | 1 time in 5 years; age 6 and older (D0330) | 1 time in 5 years (D0330) | No |
| Service Description | Child (Under 21) — EPSDT Eligible | Adult (Ages 21+) — Standard Benefit | Prior Auth (PA) — Required? |
|---|---|---|---|
| Routine Cleaning (Prophylaxis) | 1 per 6 calendar months (D1120 <13 yrs; D1110 age 13+) | 1 per 6 calendar months (D1110) | No |
| Topical Fluoride (Varnish / Gel) | 1 per 6 calendar months (D1206 varnish / D1208; under 21) | Not Covered (limited to under age 21) | No |
| Dental Sealants (Per Tooth) | Perm molars (<16 yrs); primary molars (<8 yrs); 1 per lifetime (D1351) | Not Covered | No |
| Caries Arresting Medicament (SDF) | 1 every 6 calendar months per tooth; max 4 applications/tooth (D1354) | 1 every 6 calendar months per tooth; max 4 applications/tooth (D1354) | No |
| Space Maintainers (Uni / Bilateral) | Covered for primary molars/canines & perm 1st molars (D1510–D1575) | Not Covered | No |
| Service Description | Child (Under 21) — EPSDT Eligible | Adult (Ages 21+) — Standard Benefit | Prior Auth (PA) — Required? |
|---|---|---|---|
| Amalgam (Silver) Fillings | 1 per surface/tooth/DOS; multi-surface fee capped at D2161 | 1 per surface/tooth/DOS; multi-surface fee capped at D2161 | No |
| Composite (Tooth-Colored) Fillings | Covered into dentin (D2330–D2335 anterior; D2391–D2394 posterior) | Covered into dentin (D2330–D2335 anterior; D2391–D2394 perm posterior) | No |
| Prefabricated Stainless Steel Crowns | Covered (<21 yrs; max 6 crowns/DOS; D2930 primary, D2931 perm) | Not Covered | No |
| Prefabricated Resin / Esthetic Crowns | Covered (<21 yrs; D2932 anterior, D2933/D2934 primary, D2390 anterior) | Not Covered | No |
| Core Buildup / Post & Pin Retention | Core buildup (D2950) / Pin retention (D2951) covered | D2950 / D2951 covered; Foundation for crown (D2949, age 16+) requires PA | D2950/D2951: No D2949: Yes |
| Protective Restoration | 1 per tooth to relieve pain/promote healing (D2940) | 1 per tooth to relieve pain/promote healing (D2940) | No |
| Service Description | Child (Under 21) — EPSDT Eligible | Adult (Ages 21+) — Standard Benefit | Prior Auth (PA) — Required? |
|---|---|---|---|
| Pulpotomy / Pulpal Therapy | D3220 (max 6/DOS); D3222 apexogenesis; D3230 anterior; D3240 posterior | D3220 therapeutic pulpotomy covered (max 6 per DOS) | No |
| Root Canal Therapy (Anterior) | Permanent anterior teeth only (D3310) | Permanent anterior teeth only (D3310) | No |
| Root Canal Therapy (Premolar / Molar) | Premolar (D3320) & Molar (D3330) covered for permanent teeth | Not Covered (premolar & molar endodontics limited to under age 21) | No |
| Apexification / Recalcification | Covered for permanent teeth (D3351 initial, D3352, D3353 final) | Limited to permanent anterior teeth only (D3351–D3353) | No |
| Service Description | Child (Under 21) — EPSDT Eligible | Adult (Ages 21+) — Standard Benefit | Prior Auth (PA) — Required? |
|---|---|---|---|
| Periodontal Scaling & Root Planing | 1 per quadrant per 24 months (D4341 / D4342; max 2 quads per DOS) | 1 per quadrant per 24 months (D4341 / D4342; max 2 quads per DOS) | Yes (PA Required) |
| Full Mouth Debridement / Gingival Scaling | D4346 full mouth (age 13+; 1/6 mos); D4355 debridement (1/12 mos) | D4346 full mouth (1/6 mos); D4355 debridement (1/12 mos) | No |
| Periodontal Maintenance | Allowed 2 times per year following surgical perio (D4910) | Allowed 2 times per year following surgical perio (D4910) | No |
| Service Description | Child (Under 21) — EPSDT Eligible | Adult (Ages 21+) — Standard Benefit | Prior Auth (PA) — Required? |
|---|---|---|---|
| Complete Dentures (Upper / Lower) | 1 per arch every 10 years (D5110, D5120; immediate D5130, D5140) | 1 per arch every 10 years (D5110, D5120; immediate D5130, D5140) | Yes (PA Required) |
| Partial Dentures – Resin Base | 1 per arch every 8 years (D5211, D5212; specific tooth criteria apply) | 1 per arch every 8 years (D5211, D5212; specific tooth criteria apply) | Yes (PA Required) |
| Denture Adjustments & Repairs | Adjustments covered after 6 mos; repairs (D5511–D5660) covered | Adjustments covered after 6 mos; repairs (D5511–D5660) covered | No |
| Denture Relines (Direct / Indirect) | 1 reline every 5 years; initial reline allowed 6 mos post-delivery | 1 reline every 5 years; initial reline allowed 6 mos post-delivery | Yes (PA Required) |
| Service Description | Child (Under 21) — EPSDT Eligible | Adult (Ages 21+) — Standard Benefit | Prior Auth (PA) — Required? |
|---|---|---|---|
| Simple Extractions | Covered as clinically needed (D7111 coronal remnants, D7140 erupted) | Covered as clinically needed (D7111 coronal remnants, D7140 erupted) | No |
| Surgical & Impacted Extractions | Covered (D7210 surgical, D7220 soft tissue, D7230/D7240/D7241 bony) | Covered (D7210 surgical, D7220 soft tissue, D7230/D7240/D7241 bony) | No |
| Service Description | Child (Under 21) — EPSDT Eligible | Adult (Ages 21+) — Standard Benefit | Prior Auth (PA) — Required? |
|---|---|---|---|
| Emergency Palliative Pain Relief | Covered per visit for minor emergency treatment of dental pain (D9110) | Covered per visit for minor emergency treatment of dental pain (D9110) | No |
| IV Moderate Sedation / Deep Sedation | Covered in office (D9222/D9223 deep; D9239/D9243 IV sedation; D9230) | Covered in office (D9222/D9223 deep; D9239/D9243 IV sedation; D9230) | No |
Important Coverage Disclaimer: Medicaid dental benefits vary by member eligibility category and may change. Coverage depends on current eligibility, benefit category, age, frequency limitations, clinical criteria, documentation, authorization requirements, and applicable benefit guidelines. This page is provided for general patient education and administrative reference and does not guarantee eligibility, coverage, payment, or approval of any service. Patients should confirm current eligibility and benefits before treatment. Official NC Medicaid Clinical Coverage Policy No. 4A and NCTracks guidelines control if they differ from this summary.
Everything you need to know before your first visit. Have another question?
Call (704) 707-3620 →No. North Carolina Medicaid has no annual dollar maximum for children or adults. Adult coverage is instead subject to procedure-specific frequency limitations, clinical criteria and category exclusions, and children under 21 may exceed policy limitations when medically necessary under EPSDT.
Adult beneficiaries age 21 and older pay a $4.00 co-payment per dental visit. Beneficiaries under 21, pregnant women covered under Medicaid for Pregnant Women (MPW), emergency hospital visits and nursing home residents are exempt. If a service isn't covered, we explain any cost before treatment.
For adults 21 and older, root canal therapy is covered only on permanent anterior (front) teeth (D3310). Premolar (D3320) and molar (D3330) root canals are covered for beneficiaries under 21 but are not covered for adults.
Yes, with prior approval. Complete dentures are limited to one per arch every 10 years and resin-base partial dentures (D5211/D5212) to one per arch every 8 years; cast metal partials are not covered. Partials also require documented missing-teeth criteria. Adjustments are covered after 6 months, repairs are covered, and one reline is allowed every 5 years.
Periodontal scaling and root planing, complete dentures, resin partial dentures, denture relines and foundation-for-crown (D2949) services require prior approval through NCTracks. Exams, X-rays, cleanings, fillings, extractions and emergency palliative care do not.
Periodic exams and routine cleanings are covered once every 6 calendar months, bitewing X-rays once every 12 calendar months, and a full-mouth series or panoramic X-ray once every 5 years (age 6 and older for children). Fluoride varnish is covered every 6 months for beneficiaries under 21.
Bring both your NC Medicaid card and your health plan card. Most dental services under NC Medicaid continue to be administered and reimbursed through NC Medicaid Direct (Fee-for-Service) via NCTracks, and we verify your dental eligibility on NCTracks before treatment.
MPW dental coverage extends through the last day of the month in which the twelfth month postpartum period ends. MPW beneficiaries are also exempt from the $4.00 co-payment.
We review your benefits up front and lay out every option in plain language — so cost is never the reason care gets delayed.
We work with most major providers, plus Medicaid and Medicare for adults and children.
View all insurance options →In-house payment plans and third-party financing so treatment fits your budget, not the other way around.
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2460 Wonder Drive Northeast C, Kannapolis, NC 28083, United States
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