Dental Check Program

Rewards for Quality Care^SM

Join us in reducing risks related to poor dental hygiene and associated risks for dental caries for our members.

Dental Check integrates the goals and values of providing high-quality and cost-effective preventive dental care for AmeriHealth Caritas Pennsylvania members ages 0-20, while incenting our dental providers with supplemental payments for partnering with us to improve clinical outcomes.

Goals

Provide our dental providers with a unique opportunity to improve clinical outcomes and compensate them for their efforts.
Address health care disparities to ensure our members with cultural and linguistic needs have access to the best possible dental care and services. We encourage you to take free cultural competency training for oral health providers. You may earn up to 6 CE credits.

Join us

Give oral health information on the date of prophylaxis.
Provide members with a caries risk assessment and corresponding documentation on the date of prophylaxis.
Submit claims with CAT results using the appropriate risk stratification CDT procedure codes.
Provide an additional prophylaxis and/fluoride treatment visit for eligible members identified as high-risk. These additional services can be provided at a 90-day interval, after the date of initial prophylaxis, without additional authorization from AmeriHealth Caritas Pennsylvania. Reimbursement will be in accordance with the terms of your participation agreement.

Supplemental payments

AmeriHealth Caritas Pennsylvania will make supplemental payments in accordance with the fee schedule below for oral hygiene instructions provided to and/or caries risk assessments completed for eligible members. Service is limited to one member per 180 days.

Code D1330: Oral hygiene instructions, $5
Code D0601: Caries risk assessment with a finding of low risk, $10
Code D0602: Caries risk assessment with a finding of moderate risk, $10
Code D0603: Caries risk assessment with a finding of high risk, $10

Note: Current benefit guidelines and age limitations apply.