What is Covered by Medi-Cal Dental in USA? (Explained 2024)

The Medi-Cal Dental Program helps people with Medi-Cal get various dental services, including:

1. Checkups, X-rays, and teeth cleanings.
2. Emergency services for pain.
3. Removing teeth.
4. Fillings for cavities.
5. Fixing root canals in front and back teeth.
6. Crowns, which can be ready-made or custom-made.
7. Cleaning and planning for root problems.
8. Taking care of gum issues.
9. Full or partial dentures.
10. Braces for kids who qualify.

For adults, the dental benefits cover:

1. Checkups and X-rays.
2. Teeth cleanings.
3. Fluoride treatments.
4. Fillings.
5. Fixing front tooth root canals.
6. Ready-made crowns.
7. Full dentures.
8. Other needed dental services.

Denti-Cal pays for up to $1800 in services each year. But services like dentures, extractions, and emergency care don’t count in this limit. Your dental provider can check with Denti-Cal to see if you reached the $1800 limit before treating you.

Who Qualifies for Dental Coverage under Medi-Cal?

The Medi-Cal Dental Program extends coverage to various low-income groups, offering free or affordable dental services tailored to specific age ranges:

1. Babies (0-4):

• First dental visit
• Dental exams appear (every 6 months; every 3 months from birth to age 3)
• X-rays
• Teeth cleaning (every 6 months)
• Fluoride varnish (every 6 months)
• Fillings
• Tooth removal
• Emergency services
• Outpatient services
• Sedation (if medically necessary)

2. Kids (5-12):

• Dental exams (every 6 months)
• X-rays
• Teeth cleaning (every 6 months)
• Fluoride varnish (every 6 months)
• Molar sealants
• Fillings
• Root canals
• Tooth removal
• Emergency services
• Outpatient services
• Sedation (if medically necessary)

3. Teens (13-17):

• Dental exams (every 6 months)
• X-rays
• Fluoride varnish (every 6 months)
• Molar sealants
• Teeth cleaning (every 6 months)
• Orthodontics (braces) for qualifying cases
• Fillings
• Crowns (on molars or premolars in some cases)
• Root canals
• Partial and full dentures
• Scaling and root planning
• Tooth removal
• Emergency services
• Outpatient services
• Sedation (if medically necessary)

4. Pregnancy:

• Covered during pregnancy and 12 months post-birth
• Dental exams, X-rays, teeth cleaning, scaling and root planing, fluoride varnish, fillings, crowns, root canals, partial/full dentures, denture relines, tooth removal, emergency services
• Coverage every 12 months (or 6 months if under 21 years for certain services)

5. Adults (18-54):

• Medi-Cal covers up to $1,800 in a year for dental services
• No yearly limit if pregnant
• Dental exams, X-rays, teeth cleaning, scaling and root planing, fluoride varnish, fillings, crowns (in some cases), root canals, partial/full dentures, denture relines, tooth removal, emergency services, sedation (if medically necessary)

6. Seniors (55+):

• Up to $1,800 coverage in a year, potential for no yearly limit
• Dental exams, X-rays, teeth cleaning, scaling and root planing, fluoride varnish, fillings, crowns (in some cases), root canals, partial/full dentures, denture relines, tooth removal, emergency services

FAQs

Does Medi-Cal Dental include coverage for dental checkups?

Medi-Cal Dental provides coverage for dental check-ups at no cost or low cost for eligible members with dental benefits. Adults are entitled to one free dental check-up annually, while children can receive a check-up every six months.

Does Medi-Cal Dental include coverage for braces, and if so, under what circumstances?

Medi-Cal Dental (Denti-Cal) covers orthodontic benefits for children up to 21 but only for specific medically necessary conditions like handicapping malocclusion, cleft palate/lip, and craniofacial anomalies. Braces are provided under Medi-Cal Dental when deemed medically necessary for these situations.

Is coverage for dentures included in the Medi-Cal Dental Plan?

Yes, the Medi-Cal Dental (Denti-Cal) program does cover partial dentures, along with services like adjustments, repairs, and relines.

Does Medi-Cal cover both anterior and posterior root canal procedures?

Yes, Medi-Cal provides coverage for root canals, encompassing both anterior and posterior procedures within its dental program.

If you have further questions about Medi-Cal, please contact us.