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Learn about MassHealth dental benefits

Dental care is one of many benefits available to children and adults who are enrolled in MassHealth.

Dental care includes comprehensive services, including dental checkups, preventive services, cleanings, fluoride treatments and dental sealants, as well as pain relief, treatment of infections, fillings, crowns, and root canal treatment. It is important to see a dentist twice per year to maintain good dental health. In general, you are eligible for dental benefits if you are enrolled in one of the following coverage types:

  • MassHealth Standard
  • MassHealth CommonHealth
  • MassHealth Family Assistance, or
  • MassHealth CarePlus

Members enrolled in One Care, Senior Care Options (SCO) or the Program of All-inclusive Care for the Elderly (PACE) should contact their One Care plan, SCO, or PACE organization directly for assistance with dental services.

Individuals with MassHealth Limited or the Children’s Medical Security Plan (CMSP) should review the specific sections below. Please also see information below about benefits provided by the Health Safety Net (HSN).

Table of Contents

Dental services covered by MassHealth

This chart shows the dental services that are covered for children and adults who are enrolled in MassHealth Standard, MassHealth CommonHealth, MassHealth Family Assistance or MassHealth CarePlus. Dental services covered by MassHealth must be deemed medically necessary by your provider.

Service

Is it covered for children? (Members younger than age 21)

Is it covered for adults? (Members age 21 and older)

Is a Prior Authorization  Needed?

Anesthesia (general, nitrous, intravenous & non-intravenous)

YES

YES

NO

Braces

YES

NO

YES- for children

Cavity arresting medicament (silver diamine fluoride)

YES

YES

NO

Cleanings

YES

YES

NO

Crowns/caps

YES

YES

NO

Deep Cleaning

YES

YES

YES- for adults

Dentures/partials/plates

YES

YES

NO

Immediate (temporary) denture

YES

NO

NO

Extractions (tooth-removal)

YES

YES

NO

Fillings

YES

YES

NO

Fluoride

YES

YES

NO

Oral exams

YES

YES

NO

Oral Surgery

YES

YES

NO

Root Canal treatments (not on third molars)

YES

YES

NO

Sealants

YES

NO

NO

Space maintainers

YES

NO

NO

Some periodontal (gum) service

YES

YES

NO

X rays

YES

YES

NO

Other medically necessary dental services

YES

NO

YES

Understanding your benefits

MassHealth contracts with Dental Service of Massachusetts, Inc. (DSM) to manage the MassHealth dental program. DSM and its subcontractor, DentaQuest, referred to as Dental Customer Service, specialize in dental services for MassHealth members.

They can help you understand your dental benefits, find a MassHealth dental provider, and even help you schedule an appointment.

How to contact dental customer service

MassHealth Dental Customer Service
Phone:  Main (800) 207-5019
TTY:  (800) 466-7566
Online:  
member@masshealth-dental.net (member@masshealth-dental.net)

Finding a dentist

MassHealth will pay for covered dental services only if they are provided by dental providers enrolled in MassHealth’s provider network. To help members find a dentist, MassHealth has a list of dentists who participate, called the MassHealth Dental Provider Directory. This directory is updated regularly.

To use the directory online:

Go to the MassHealth dental website (https://www.masshealth-dental.net/). Click on Members, Find a Dentist, and fill in the information requested, such as your zip code, city, or town. You can also search for a dental specialist. A list of MassHealth dental providers and specialists in your area will be displayed. Just review the list and call any one of the providers listed to make an appointment.

OR

Call a Dental Service Representative:

You can call the toll-free Dental Customer Service line at (800) 207-5019 to find out if a dentist is listed in the directory or for help finding a dentist.

Prior authorization

Some services may require prior authorization from MassHealth before a dentist can provide them.

Depending on the type of dental service you need, your provider may need to send a request for prior authorization (PA) to DentaQuest, or, for oral surgeries or other related medical services, directly to MassHealth or your MassHealth health plan.  You can review the chart above to find out which services require a PA.

If you or your provider have questions about prior authorizations, contact DentaQuest or your MassHealth health plan. The Frequently Asked Questions (FAQ) section below has additional information that may be helpful.

Dental coverage for MassHealth Limited members

MassHealth Limited covers emergency dental services. These are conditions that could result in placing your health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.  For more information about dental services covered by MassHealth Limited, please contact MassHealth Dental Customer Service.

Dental coverage through Children’s Medical Security Plan (CMSP)

MassHealth members enrolled in the Children’s Medical Security Plan (CMSP) can receive coverage for dental care up to $750 per year, including preventative and restorative services. Services such as routine cleanings, plaque or stain removal, topical fluoride treatments, sealants, and fillings. Coverage does not include cosmetic or orthodontic services (such as braces).

For more information about dental services covered in CMSP, contact MassHealth Dental Customer Service.

Dental coverage through Health Safety Net (HSN)

The Health Safety is available to uninsured and underinsured Massachusetts residents whose family income is under a certain percentage of the Federal Poverty Level (FPL). HSN will only pay for certain dental care services, and you will need to receive your dental care services from a Community Health Center, hospital-licensed health center, or a hospital satellite clinic. Please see the HSN website (https://www.mass.gov/service-details/health-safety-net-for-patients) for more information.

To find a provider, call MassHealth Dental Customer Service.

Frequently asked questions about dental services

Are dental implants and bone grafts covered by MassHealth?

Dental implants are not covered by MassHealth. Bone grafts may be covered as a medical service with prior authorization under your MassHealth health plan or by MassHealth directly. If you have questions about bone grafts, or other medical services, contact your MassHealth health plan.

If you do not have a MassHealth health plan, contact MassHealth Customer Service at

(800) 841-2900

TTY:

(800) 497-4648

My dentist referred me to an oral surgeon, is oral surgery covered by MassHealth?

If your dentist refers you to an oral surgeon for oral surgery or other related care, these services are typically covered by your MassHealth health plan or by MassHealth directly. If you or your provider have questions about which services are covered by which program or who to bill for services, start by calling Dental Customer Service.

Can I receive transportation to a dental appointment?

Transportation services are provided to members to and from appointments for MassHealth- covered services, if you are eligible for MassHealth Standard, MassHealth CommonHealth, or MassHealth CarePlus. For more information about transportation services, visit Learn about non-emergency medical transportation for MassHealth members (https://www.mass.gov/info-details/learn-about-non-emergency-medical-transportation-for-masshealth-members).

Commonly used dental terms

Anesthesia: A type of medication that results in partial or complete elimination of pain sensation; numbing a tooth is an example of local anesthesia; general anesthesia produces partial or complete unconsciousness.

Bridge: A prosthesis replacing one or several adjacent teeth (not covered by MassHealth).

Cavity: Also called tooth decay; caused by bacteria in the mouth and sugary foods resulting in destruction of tooth structure.

Cleaning: The removal of plaque and calculus (tartar) from teeth, generally above the gum line.

Crown: A prosthetic covering for a tooth.

Denture: A removable appliance (prosthesis) that replaces all of the missing teeth in either the upper or lower jaw. Usually made of plastic or a combination of plastic and metal.

Enamel: The hard covering on the exposed part of a tooth.

Extraction: A removal of a tooth from its socket.

Molar: A back tooth having a broad surface used for grinding one's food.

Orthodontics: A specialty of dentistry concerned with correcting misalignment of teeth.

Periodontics: The study of supporting structures of teethgums, alveolar bone, cementum, and the periodontal ligamentand diseases and conditions that affect them.

Root Canal: The hollow part of the root of a tooth containing the nerve and blood vessels.

Additional Resources

Contact

Phone

For people with partial or total hearing loss

Phone

Self-service available 24 hrs/day in English and Spanish. Other services available Monday-Friday 8 a.m.–5 p.m. Interpreter service available.

Self-service available 24 hrs/day in English and Spanish. Other services available Monday-Friday 8 a.m.–5 p.m. Interpreter service available.

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