"What does Denti-Cal cover for adults and children"

One of the most often asked questions about Medi-Cal benefits is this: What Does Medi-Cal Dental Cover? What are the details of the Denti-Cal program? Does coverage include  Dental Checkups, Braces, Dentures, or Dental Implants? We can help.

In this post, we will provide details about Medi-Cal’s dental coverage, who is eligible, and what it covers, plus answer the most frequently asked questions.

"Does Medi-Cal cover Dental Care"

Medi-Cal Dental Coverage

The Medi‑Cal Dental Program offers free or low-cost dental benefits for enrolled Medi‑Cal members.

The program covers dental services that are provided through Denti-Cal – using managed care providers.

If your income is more than the Medi‑Cal limit for your family size, a low-cost monthly premium may be required.

How do I apply for Medi‑Cal dental services?

There are three ways to apply for Medi-Cal to get dental benefits:

  • Online: It takes about 30 minutes to sign up for Medi-Cal online through Covered California.
  • In-person: You can enroll in person at a County Social Services Office. Additionally, California has hundreds of Medi-Cal enrollment centers and thousands of certified enrollers ready to help you apply for Medicaid.
  • Over the phone: You can request a phone call from an enroller to get free advice and apply for Medi-Cal over the phone or call 1‑800‑300‑1506.

For information on how to apply for Medi‑Cal, you can go to www.coveredca.com, view a list of county offices, or call 1‑800‑300‑1506.

What Does Medi-Cal Dental Cover?

​The Medi-Cal Dental Program covers a variety of dental services for Medi-Cal beneficiaries, such as:

  • Diagnostic and preventive dental hygiene (e.g. examinations, x-rays, and teeth cleanings);
  • Emergency services for pain control;
  • Tooth extractions;
  • Fillings;
  • Root canal treatments (anterior/posterior);
  • Crowns (prefabricated/laboratory);
  • Scaling and root planning;
  • Periodontal maintenance;
  • Complete and partial dentures; and
  • Orthodontics for children who qualify.

The following dental benefits are available for adults:

  • Exams and X-rays.
  • Cleanings.
  • Fluoride treatments.
  • Fillings.
  • Anterior root canals (front teeth).
  • Prefabricated crowns.
  • Full dentures.
  • Other medically necessary dental services.

Denti-Cal will only provide up to $1800 in covered services per year.

However, some services are not counted towards the cap, such as dentures, extractions, and emergency
services.

Your dental provider may check with Denti-Cal to find out if you have reached the $1800 cap before treating you.

FAQs about Medi-Cal Dental Coverage

Here are the most frequently asked questions about Denti-Cal coverage:

Does Medi-Cal Dental cover Dental Checkups?

Yes. Dental check-ups are free or low-cost for Medi-Cal members eligible for dental benefits.

Additionally, Adults can have one dental check-up every year, while children can have a check-up every six months.

Does Medi-Cal Dental cover Braces?

Yes, but only in certain circumstances. The Medi-Cal Dental (Denti-Cal) program provides Orthodontic benefits only to children up to age 21 but is only provided for the following medically necessary conditions:

  • Handicapping Malocclusion
  • Cleft Palate/Lip
  • Craniofacial Anomalies

Are Dentures covered under Medi-Cal Dental Plan?

Yes. The Medi-Cal Dental (Denti-Cal) program covers partial dentures, including denture adjustments, repairs, and relines.

Does Medi-Cal cover root canals?

Yes. The Medi-Cal dental program covers both anterior and posterior root canals.

Are Wisdom Teeth removal covered under Medi-Cal Dental?

Yes, Medi-Cal Dental covers tooth removal, including wisdom teeth removal.

Who is Covered by Medi-Cal Dental?

The following low-income groups are covered by Medi-Cal Dental benefits.

Babies (0-4)

The Medi‑Cal Dental Program provides the following free or low-cost services for babies:

  • Baby’s first dental visit
  • Baby’s first dental exam
  • Dental exams (every 6 months; every 3 months from birth to age 3)
  • X-rays
  • Teeth cleaning (every 6 months)
  • Fluoride varnish (every 6 months)
  • Fillings
  • Tooth removal
  • Emergency services
  • Outpatient services
  • Sedation (if medically necessary)

Kids (5-12)

The Medi-Cal Dental Program provides the following free or low-cost services for kids:

  • Dental exams (every 6 months)
  • X-rays
  • Teeth cleaning (every 6 months)
  • Fluoride varnish (every 6 months)
  • Molar sealants
  • Fillings
  • Root canals
  • Tooth removal
  • Emergency services
  • Outpatient services
  • Sedation (if medically necessary)

Teens (13-17(

The Medi‑Cal Dental Program provides the following free or low-cost services for teens:

  • Dental exams (every 6 months)
  • X-rays
  • Fluoride varnish (every 6 months)
  • Molar sealants
  • Teeth cleaning (every 6 months)
  • Orthodontics (braces) for those who qualify
  • Fillings
  • Crowns*
  • Root canals
  • Partial and full dentures
  • Scaling and root planing
  • Tooth removal
  • Emergency services
  • Outpatient services
  • Sedation (if medically necessary)

*Crowns on molars or premolars (back teeth) may be covered in some cases.

Pregnancy

As a Medi-Cal member, you are covered during your pregnancy and 12 months after the birth of your baby.

Regardless of the type of Medi- Cal you have, you are able to receive all covered dental procedures as long as you meet all criteria and requirements for the procedures.

Medi‑Cal will pay up to $1,800 in a year for covered dental services.

You may qualify for more than the $1,800 yearly limit, if you have a medical need.

The Medi‑Cal Dental Program provides the following free or low-cost services during pregnancy:

  • Dental exams *
  • X-rays
  • Teeth cleaning *
  • Scaling and root planing
  • Fluoride varnish *
  • Fillings
  • Crowns**
  • Root canals
  • Partial and full dentures
  • Denture relines
  • Tooth removal
  • Emergency services

* Every 12 months if over 21 years of age or every 6 months if under 21 years of age.
**Crowns on molars or premolars (back teeth) may be covered in some cases.

Adults (18-54)

Medi‑Cal will pay up to $1,800 in a year for covered dental services.

You may qualify for no yearly limit if you are pregnant. Dental services may go over the $1,800 limit if shown to be medically needed.

The Medi‑Cal Dental Program provides the following free or low-cost services for adults:

  • Dental exams (every 12 months)
  • X-rays
  • Teeth cleaning (every 12 months)
  • Scaling and root planing
  • Fluoride varnish (every 12 months)
  • Fillings
  • Crowns*
  • Root canals
  • Partial and full dentures
  • Denture relines
  • Tooth removal
  • Emergency services
  • Sedation (if medically necessary)

*Crowns on molars or premolars (back teeth) may be covered in some cases.

Seniors (55+)

Medi‑Cal will pay up to $1,800 in a year for covered dental services. You may qualify for no yearly limit.

The Medi‑Cal Dental Program provides the following free or low-cost services for seniors:

  • Dental exams (every 12 months)
  • X-rays
  • Teeth cleaning (every 12 months)
  • Scaling and root planing
  • Fluoride varnish (every 12 months)
  • Fillings
  • Crowns*
  • Root canals
  • Partial and full dentures
  • Denture relines
  • Tooth removal
  • Emergency services

*Crowns on molars or premolars (back teeth) may be covered in some cases.

What Does Medi-Cal Dental Cover? – Summary

We hope this post on “What Does Medi-Cal Dental Cover?” – was helpful.

Questions?

If you have further questions about Medi-Cal, please let us know in the comments section below.

Be sure to check out our other articles about Medi-Cal and California Medicaid program, including:

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