EPSDT and Coding – Oral Health

Ty Bullington, CPNP, examines Makala (age 10) at Sewanee Pediatrics, Sewanee, TN.

Despite major efforts in recent years, oral health disease still poses a significant health threat to many children. Because pediatricians and other child health professionals are more likely to encounter new parents and infants, it is essential that they be aware of early childhood dental caries risk and preventive strategies to make appropriate decisions about timely and effective intervention.

Many of the eligible children in Tennessee are not accessing dental services as needed. Physicians have a unique opportunity to help increase services.

Current Recommendations

Types of training assistance include:

  • Dental risk assessments and referrals are recommended for every child in accordance with the periodicity schedule.
  • Risk assessment performed at 6 and 9 months.
  • Referral to a dental home 6 months after the eruption of the first tooth or no later than 12 months, if available. Otherwise assess at 12, 18, 24 and 30 months.
  • If the primary water source is deficient in fluoride, consider oral fluoride supplementation.
  • Referral to dental home if one has not been established at 3 and 6 years.
  • If medically necessary, a child may be referred at any age.
  • Documentation of dental inspection, referral and education must be documented in the medical record.
  • Dental Risk Assessment Questionnaire

TennCare Dental Screening and Fluoride Varnish Program - DentaQuest

For questions on the Dental Screening and Fluoride Varnish Program, contact DentaQuest at 1-800-233-1468 or visit the DentaQuest website.

Locating a TennCare Dentist

Dental Benefits for TennCare are provided by DentaQuest. To locate a TennCare dentist members or providers may call DentaQuest:

  • Customer Line: 1-855-418-1622
  • Provider Line: 1-855-418-1623
  • A formal referral is not necessary.

EPSDT and Coding Contact Information

Janet Sutton, CPC, RHIT
AHIMA Approved ICD-10-CM Trainer
Coding Educator
Phone: 615-447-3264
Fax: 615-383-7170
Email: janet.sutton@tnaap.org