Department of Health
Inappropriate Medicaid Billings for Dental Sealants Dental sealants are applied to the biting surfaces of back teeth to prevent tooth decay. We examined selected Medicaid payments for dental sealants over a four-year period and identified about $469,300 in potentially inappropriate payments. The payments were potentially inappropriate mainly because it appeared that sealants had been applied to the same teeth more frequently than is allowed by Medicaid regulations. For example, the regulations permit the same teeth to be treated once every three years. However, we identified 354 instances in which a patient received three or more treatments on the same tooth within a three-year period. We recommended that the Department of Health investigate the potential overpayments, recover all actual overpayments, and develop controls to prevent such overpayments in the future.
For a complete copy of Report 2007-S-58 click here.
For a copy of the 90-day response click here.