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KMAP BULLETIN: Coverage of Periodontal Maintenance

Date: 06/01/22

KMAP DENTAL BULLETIN 22030 (PDF)

Effective with dates of service on and after July 1, 2022, dental code D4910 will be covered for Children’s Health Insurance Program (CHIP) members ages 0 – 18, and Title XIX members ages 0 – 20, after the utilization of D4341 or D4342.

Dental code D4910 will be covered for the following provider types/provider specialties:

  • 08/080 (Clinic/Federally Qualified Health Clinic)
  • 27/270 (Dentist/Endodontist)
  • 27/271 (Dentist/General Dentistry Practitioner)
  • 27/272 (Dentist/Oral Surgeon)
  • 27/273 (Dentist/Orthodontist)
  • 27/274 (Dentist/Pediatric Dentist)
  • 27/275 (Dentist/Periodontist)
  • 31/351 (Physician/Indian Health Services) 

Note: The effective date of the policy is July 1, 2022. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.