What Dental Services Does Medicaid Cover in New York?

Good dental care is an important part of your overall health. New York Medicaid covers a range of medically necessary dental services to help members prevent dental problems, treat tooth decay, relieve pain, and maintain healthy teeth and gums.

Fidelis Care Medicaid Managed Care members receive dental coverage as part of their plan. Dental benefits are provided through DentaQuest.

Covered dental services may include preventive check-ups, cleanings, X-rays, fillings, dentures, crowns, root canals, implants, and other medically necessary dental care. Coverage for some services depends on your individual dental needs and may require prior approval.

What Dental Services Does New York Medicaid Cover?

New York Medicaid provides coverage for medically necessary dental care. For Fidelis Care Medicaid Managed Care members, covered dental services include:

Preventive dental check-ups
Dental cleanings
X-rays
Fillings

In certain circumstances, additional dental services may be covered, including:

Dentures
Dental implants
Crowns
Root canals

New York Medicaid also covers other medically necessary dental services, including extractions. Your dental provider will recommend treatment based on your individual dental needs and request prior approval when necessary.

For additional information about New York Medicaid dental benefits, visit the New York State Medicaid Member Dental Benefits page.

Does Medicaid Cover Dental Cleanings and Check-Ups in New York?

Yes. Fidelis Care Medicaid Managed Care covers preventive dental services, including dental check-ups, cleanings, and X-rays.

Regular dental visits can help your dentist find cavities and other oral health problems early. Preventive dental care can also help keep your teeth and gums healthy and prevent dental problems from becoming more serious.

Visit our Dental Resources page for information about dental care and tips for maintaining good oral health.

Does Medicaid Cover Fillings in New York?

Yes. Fillings are among the dental services covered for Fidelis Care Medicaid Managed Care members.

Your dentist can examine your teeth and recommend appropriate treatment based on your individual dental needs.

Does Medicaid Cover Root Canals in New York?

Root canals may be covered by New York Medicaid in certain circumstances when medically necessary.

New York Medicaid expanded its clinical criteria for root canal coverage beginning January 31, 2024. These changes were designed to help members keep more of their natural teeth when clinically appropriate.

Your dentist will determine whether a root canal is appropriate for your dental needs and request prior approval when necessary.

Does Medicaid Cover Crowns in New York?

Crowns may be covered by New York Medicaid in certain circumstances when medically necessary.

Coverage criteria for crowns were expanded beginning January 31, 2024 to help preserve a member's natural teeth when clinically appropriate.

Your dentist can determine whether a crown is appropriate for your individual dental needs and whether prior approval is required.

Does Medicaid Cover Dentures in New York?

Yes. Dentures are among the medically necessary dental services that may be covered by New York Medicaid.

New York Medicaid expanded access to replacement dentures beginning January 31, 2024. Your dentist will evaluate your dental needs and determine whether replacement dentures are necessary.

Coverage requirements can depend on your individual circumstances. Talk with your dentist about the treatment options that may be appropriate for you.

Does Medicaid Cover Dental Implants in New York?

Dental implants may be covered by New York Medicaid in certain circumstances when medically necessary.

New York Medicaid expanded its dental implant coverage criteria beginning January 31, 2024. Your dentist will evaluate your individual dental needs and determine whether an implant may be appropriate.

Prior approval may be required for dental implant services.

Does Medicaid Cover Emergency Dental Care in New York?

Yes. New York Medicaid covers medically necessary dental care, including services that may be needed to address urgent dental problems.

Depending on your dental needs, covered services may include examinations, X-rays, extractions, root canals, crowns, and other medically necessary treatment. Coverage for some services depends on your individual circumstances and may require prior approval.

If you are experiencing a dental problem, contact a participating dentist to discuss the care you may need.

Does Medicaid Cover Braces in New York?

Fidelis Care Medicaid Managed Care covers braces for children up to age 21 who have a severe dental problem that qualifies for orthodontic treatment.

Examples may include severe dental problems that make it difficult to chew, as well as certain conditions such as cleft palate or cleft lip.

A dental provider can evaluate your child's needs and determine whether orthodontic treatment may qualify for coverage.

Do I Need a Referral to See a Dentist?

No. Fidelis Care Medicaid Managed Care members do not need a referral from their primary care provider (PCP) to see a dentist.

You can receive dental care from a participating dental provider. You can also receive dental services from a dental clinic operated by an academic dental center without a referral.

How to Find a Dentist That Accepts Fidelis Care Medicaid

Fidelis Care provides dental benefits through DentaQuest. If you need to find a participating dentist or change your dentist, DentaQuest can help.

Visit our Dental Resources page to get started and find dental care resources.

You can also call DentaQuest at 1-800-516-9615 for help finding or changing your dentist.

When you visit your dentist, show your Fidelis Care Member ID card to access your dental benefits. You will not receive a separate dental ID card.