Dental caries and fluoride varnish: not just for dentists

Dental caries and fluoride varnish: not just for dentists

Dental caries remains the most common chronic disease of childhood in the United States.  In fact, dental caries affects more than half of Texas children. Primary care providers play a key role in the prevention of dental caries. To help ensure dental health, all children 6 months of age and older should be referred to a dental home. Additionally, periodic oral evaluations and application of fluoride varnish in the medical home during well child or THSteps exams can help combat this widespread problem.  In 2014, the American Academy of Pediatrics and the USPSTF recommended fluoride varnish at least once every 6 months – starting at tooth eruption. Fluoride applied during primary medical care visits can reduce decay rates by one-third.

Dental Fluoride Varnish is a covered benefit for CHIP and Medicaid members who are 6 to 35 months of age. This quick and effective procedure is reimbursed to the primary care provider in addition to the THSteps checkup reimbursement. Oral Evaluation and Fluoride Varnish in the Medical Home is coded utilizing CPT code 99429 with U5 modifier in conjunction with an appropriate CPT code for a Texas Health Steps medical checkup. The documentation of the visit should include:

  • Intermediate oral evaluation.
  • Fluoride varnish application.
  • Dental Anticipatory guidance.
  • Referral to a dental home.

To bill for oral evaluations and fluoride varnish, physicians, advanced practice registered nurses and physician assistants must be certified through the Department of State Health Services (DSHS) by completing training. The training is a free one-hour course provided online. You can access it at

Once trained, the THSteps medical provider can delegate the fluoride varnish application to nurses and medical assistants.

Please contact your Provider Relations representative if you have questions.

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