Implementing Fluoride Varnish in Your Office 

1. Complete the MassHealth-approved fluoride varnish training. 


2. Take the post-test (if required) and e-mail it to the address provided on the training Web site, or at the 
instructor-led training. File the certificate of training you receive in your office. Report your CME hours. 


3. Hold a meeting in your office with other clinicians, nurses, medical assistants, administrative staff, and 
office manager to explain what a fluoride varnish program is and how using fluoride varnish in your 
practice will be beneficial to a child’s oral health. Explain ease of use and that this is now a MassHealth 
reimbursable service. Encourage everyone who will be directly involved to take one of the trainings. 


4. Choose an “oral health office champion” who will keep supplies, handouts, etc, up to date. 


5. Have the “champion:” 

 a. Download the Fluoride Varnish Training for Massachusetts Health Care Providers Manual. 

 b. Customize the Fluoride Varnish Progress Note form with your office logo and make copies easily 
available (see below). 

 c. If you have an Electronic Health Record (EHR), you can use the sample patient stamp information 
on page 6 as a guide to create a progress note template. 

 d. Make copies of the Fluoride Varnish Handout or add it to your EHR. 

 e. Print and laminate the Fluoride Varnish Application Facts form. Keep it near where varnish 

 application occurs. 

 f. Optional: Print the Fluoride Varnish Application Consent form. (A written consent for varnish is not 

 required by MassHealth.) 

 g. Review the Fluoride Varnish Ordering Information form. Identify a local distributor and place your 

 order. 

 h. Confirm appropriate CDT Service Code D1206 for billing as noted on page 8 and add to the 
encounter/billing forms. 

 i. In Massachusetts, note that varnish can be applied by an MD, DO, PA, NP, RN, LPN or equivalent. 

 j. Create a portable fluoride varnish application basket containing: 

• Laminated Fluoride Varnish 
Application Facts document 


• Handouts 


• Applicators 


• Light source (head lamp) 


• Mouth Mirror (optional) 


• Progress Notes 


• Gloves 


• Gauze 


• Stickers 


6. Consider dividing the fluoride varnish process, e.g., medical assistant reviews risk assessment and gets 
materials ready, nurse applies varnish, physician reviews handouts, prevention advice, and does billing. 


7. Do a few test cases to assess your flow, billing, patient satisfaction, and nursing satisfaction: have a 
meeting to get input from all players. 


8. Advertise in your waiting room, office newsletters, and Web site that you are providing this service. 


9. Create a list of local dentists that accept MassHealth (call 1-800-207-5019 or visit MassHealth Dental 
Information for Members for a list, or go to www.mass.gov/masshealth, select “Information for 
MassHealth Members,” then select “Dental Benefits and Choosing a Dentist.”