Ready, Set, Know: Enhanced Dental & Medical Benefits



Medical doctor behind a windwo, blurred, hand is pointing to modern medical icons. Blue overcast to the image.

Did you know that all clients of the Developmental Disabilities Administration (DDA) can receive some enhanced medical benefits, such as annual physical exams and dental cleanings up to three times a year? Including individuals on DDA’s No Paid Services Caseload?

These enhanced benefits are in addition to other covered services offered to all Apple Health recipients. You don’t need approval from DDA to request these services, just go directly to your provider.

Dental Blue and green line graphic of a tooth.

Enhanced Frequency of Benefits for DDA Clients:

  • Periodic oral exam once every 4 months
  • Prophylaxis once every 4 months (includes
    (SRP or periodontal maintenance—see below)
  • Topical fluoride treatment once every 4 months
  • Scaling and Root Planing (SRP) once per quadrant every 12 months
  • Periodontal Maintenance once every 6 months (must be 6 months after SRP)
  • Sealants every 2 years

In addition, clients of DDA can get stainless steel crowns (on back teeth) and general anesthesia with prior authorization.

Dental Coverage for Adult Apple Health Recipients Includes:

  • 1 Initial Comprehensive Exam
  • 1 Periodic Exam
  • 1 Prophylaxis (cleaning)
  • Limited Exam (as needed)
  • 1 filling per tooth every 2 years
  • 1 Complete X-Ray Series every 3 years
  • 4 Bitewing X-Rays every 12 months
  • Root canal for upper and lower anterior (front) teeth only
  • Complete and Partial Dentures, with Prior Authorization (other restrictions may
    apply)
  • Simple extractions, Surgical extractions, Biopsies, Incise and Drain

Medical blue and green line graphic of a heartbeat, heart and stethoscope.

In addition to other medical coverage provided to all Apple Health recipients, adult clients with developmental disabilities are able to receive one preventive yearly physical.

Learn More

For more information about your benefits contact the Health Care Authority at 1-800-562-3022. Be sure to identify yourself or your family member as a client of DDA for information related to enhanced benefits for people with developmental disabilities.

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Find a Medical or Dental Care Provider Who Accepts Apple Health

 

Enhanced Dental and Medical Benefits (pdf)

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2019

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