Medicaid Minnesota policy
Dental Authorization Requirement Tables — Restorative
Dental Authorization Requirement Tables — Restorative is a public Medicaid Minnesota policy (effective Mar 12, 2026). It lists 13 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
- Payer
- Medicaid Minnesota
- Effective
- Mar 12, 2026
- Line of business
- Medicaid
- States
- MN
- Source
- www.dhs.state.mn.us
Codes in this policy
The CPT and HCPCS codes the policy names. A policy can name a code it excludes.
| Code | Other Medicaid Minnesota policies |
|---|---|
| D2710 | Policies naming D2710 |
| D2720 | Policies naming D2720 |
| D2721 | Policies naming D2721 |
| D2722 | Policies naming D2722 |
| D2934 | Policies naming D2934 |
| D2952 | Policies naming D2952 |
| D2953 | Policies naming D2953 |
| D2960 | Policies naming D2960 |
| D2961 | Policies naming D2961 |
| D2962 | Policies naming D2962 |
| D2971 | Policies naming D2971 |
| D2975 | Policies naming D2975 |
| D2999 | Policies naming D2999 |