Ohio Medicaid and Next Generation MyCare clinical criteria:
Preventive services
(D1354–D1355) Clinical criteria for caries arresting and preventative medicaments
(D1510–D1575): Clinical criteria for space maintenance
Restorative services
(D2140–D2394): Clinical criteria for direct restorations
(D2710–D2794): Clinical criteria for single crowns
(D2928–D2934): Clinical criteria for prefabricated crowns
(D2950, D2952–D2957): Clinical criteria for restorative substructures
(D2991): Clinical criteria for hydroxyapatite regeneration
Endodontic services
(D3310–D3333): Clinical criteria for endodontic therapy
Periodontal services
(D4210–D4212): Clinical criteria for gingivectomy
(D4240–D4241): Clinical criteria for the gingival flap procedure
(D4260–D4261): Clinical criteria for periodontal osseous surgery
(D4263–D4267): Clinical criteria for periodontal regenerative treatment
(D4341–D4342): Clinical criteria for periodontal scaling and root planing
(D4910): Clinical criteria for periodontal maintenance
Removable Prosthodontic services
(D5211–D5286): Clinical criteria for removable partial dentures
(D5110–D5140, D5511–D5520, D5710, D5711, D5730, D5731, D5750): Clinical criteria for complete dentures
Fixed Prosthodontic services
(D6205–D6999): Clinical criteria for fixed partial dentures
Oral and maxillofacial services
(D7111–D7250): Clinical criteria for extraction of teeth
(D7251): Clinical criteria for coronectomy
(D7310–D7321): Clinical criteria for alveoloplasty
(D7961–D7963): Clinical criteria for frenectomy
Orthodontic services
(D8010–D8090, D8210–D8670, D8680): Clinical criteria for orthodontic treatment
Adjunctive general services
(D9222–D9223, D9239–D9243): Clinical criteria for anesthesia and intravenous sedation
(D9920): Clinical criteria for behavioral management
Other criteria
(D0120-D9999)*: Clinical criteria for appropriateness of care
*These criteria apply to any dental procedure deemed to have been provided in a clinically inappropriate manner.