Section R9-22-207. Dental Services

A.      The Administration or a contractor shall cover dental services for a member less than 21 years of age under R9-22-213.

B.       For individuals age 21 years of age or older, the Administra- tion or a contractor shall cover medical and surgical services furnished by a dentist only to the extent such services may be performed under state law either by a physician or by a dentist and such services would be considered a physician service if furnished by a physician.

1.        Except as specified in subsection (C), such services must be related to the treatment of a medical condition such as acute pain, infection, or fracture of the jaw. Covered den- tal services include examination of the oral cavity, radio- graphs, complex oral surgical procedures such as treatment of maxillofacial fractures, administration of an appropriate level of anesthesia and the prescription of pain medication and antibiotics.

2.        Such services do not include services that physicians are not generally competent to perform such as dental clean- ings, routine dental examinations, dental restorations including crowns and fillings, extractions, pulpotomies, root canals, and the construction or delivery of complete or partial dentures. Diagnosis and treatment of temporo- mandibular joint dysfunction are not covered except for the reduction of trauma.

C.      For the purposes of this subsection, simple restorations means silver amalgam or composite resin fillings, stainless steel crowns or preformed crowns. In addition, dental services for an individual 21 years of age or older include:

1.        The elimination of oral infections and the treatment of oral disease, which includes dental cleanings, treatment of periodontal disease, medically necessary extractions and the provision of simple restorations as a medically necessary pre-requisite to covered transplantation; and

2.        Prophylactic extraction of teeth in preparation for cov- ered radiation treatment of cancer of the jaw, neck or head.

Historical Note

Adopted as an emergency effective May 20, 1982 pursu- ant to A.R.S. § 41-1003, valid for only 90 days (Supp. 82- 3). Former Section R9-22-207 adopted as an emergency

now adopted and amended as a permanent rule effective August 30, 1982 (Supp. 82-4). Former Section R9-22- 207 repealed, new Section R9-22-207 adopted effective October 1, 1985 (Supp. 85-5). Section repealed, new Sec-

tion adopted effective September 22, 1997 (Supp. 97-3). Amended by final rulemaking at 8 A.A.R. 2325, effective May 9, 2002 (Supp. 02-2). Amended by exempt rulemak-

ing at 16 A.A.R. 1638, effective October 1, 2010 (Supp.

10-3).