Medicaid Minnesota policy
Dental Services — Covered Services
Dental Services — Covered Services is a public Medicaid Minnesota policy (effective Feb 24, 2025). It lists 26 CPT or HCPCS codes. Not a coverage decision; the payer's own document governs.
- Payer
- Medicaid Minnesota
- Effective
- Feb 24, 2025
- 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 |
|---|---|
| 41820 | Policies naming 41820 |
| 41828 | Policies naming 41828 |
| 41872 | Policies naming 41872 |
| 41874 | Policies naming 41874 |
| 41899 | Policies naming 41899 |
| D0120 | Policies naming D0120 |
| D0140 | Policies naming D0140 |
| D0145 | Policies naming D0145 |
| D0150 | Policies naming D0150 |
| D0210 | Policies naming D0210 |
| D0220 | Policies naming D0220 |
| D0230 | Policies naming D0230 |
| D0240 | Policies naming D0240 |
| D0270 | Policies naming D0270 |
| D0272 | Policies naming D0272 |
| D0273 | Policies naming D0273 |
| D0274 | Policies naming D0274 |
| D0330 | Policies naming D0330 |
| D0604 | Policies naming D0604 |
| D0605 | Policies naming D0605 |
| D0606 | Policies naming D0606 |
| D1310 | Policies naming D1310 |
| D1321 | Policies naming D1321 |
| D1330 | Policies naming D1330 |
| D9310 | Policies naming D9310 |
| E0486 | Policies naming E0486 |