Clinical Criteria Documentation (By Procedure)


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.