UCare's MSHO Dental Options

Dental benefits for members of UCare's Minnesota Senior Health Options (MSHO) plan.

In addition to Medicare- and Medicaid-covered dental benefits, MSHO members have additional dental coverage for preventive and restorative dental services that are not covered by Medical Assistance (Medicaid). Members must receive these services from a network dentist.

Below is a list of preventive and restorative codes that may be accessed:

  • Scaling and root planing (D4341 and D4342)
    - Once every two years and only in an office setting. The member must have pocket depths of 4 mm or greater and documented bone loss visible on x-rays.
  • Additional dental exam (D0120)
    - One additional per calendar year
  • Molar root canal (D3330)
    - One per tooth per lifetime
  • Root canal re-treatment (D3346, D3347, D3348)
    - Rule: One re-treat per tooth per lifetime. Covered only if billed 24 months after original root canal.
  • Full mouth series (x-ray) (D0210)
    - Rule: Once per five years
  • Periodontal maintenance (D4910)
    - Four times per calendar year
    - Porcelain-Fused-to-Metal
  • PFM crown (D2750)
    - One per calendar year

Members will be informed of the portion of the cost they will need to pay for non-network services. Certain limitations apply.

New in 2020

Additional dental coverage:
Two crowns per year
Tissue conditioning for dentures
New electric toothbrush every three years

Members may call the Customer Services number on their UCare member identification (ID) card for more information.

UCare's Dental Connection

A one-stop-shop for all of your dental care coordination needs.

Contact information

Members

Delta Dental Customer Services
651-768-1415
1-855-648-1415
TTY 711
NO ENGLISH 1-800-553-9536

County Staff

Call Delta Dental
Government Programs Access Unity
651-994-5198
1-866-303-8138

H2456_3953_092019 approved
September 2019