Discuss Oral Hygiene as Part of Preventive Care for Children with Medicaid 

Sept. 23, 2026

October is National Dental Hygiene Month and a great time to remind members that a child’s oral care begins before they’re old enough to go to the dentist. For children enrolled in Medicaid, oral health screening is required as part of the Early and Periodic Screening, Diagnostic and Treatment program. The program also includes requirements for vision, hearing and other services.

EPSDT requirements for providers: EPSDT requirements for oral health screenings and related care follow recommendations from the American Academy of Pediatrics, the American Dental Association and the American Academy of Pediatric Dentists. EPSDT guidelines specify that, as part of a child’s physical exam, physicians should:

  • Perform oral health risk assessments at 6 and 9 months of age
  • Refer children to a dental home for routine and preventive care within six months of first tooth eruption or by age 1

For more information, refer to our EPSDT clinical practice and billing guideline.

Related quality measures: Healthcare Effectiveness Data and Information Set (HEDIS®) measures for dental hygiene and preventive care include Oral Evaluation, Dental Services (OED) and Topical Fluoride for Children (TFC). These measures focus on identifying signs of tooth decay early and establishing healthy habits. Refer to our Quality Care 2026 booklet for information on documentation and coding for quality measures. You can access it in Availity® Essentials within our Payer Spaces in the resources section.  

Tips to consider: The EPSDT program spotlights early intervention to give children a healthy start as they grow. You can help by:

  • Including oral health as part of well-child visits
  • Offering same-visit fluoride during oral evaluations when appropriate
  • Ensuring EPSDT dental evaluations and fluoride varnish treatments are properly coded in patient medical records
  • Educating parents on the importance of dental hygiene and keeping dentist appointments

The EPSDT program is a vital component of Medicaid that helps individuals under the age of 21 receive appropriate preventive health, dental, mental health, developmental and specialty services. All primary care providers who treat Medicaid members under the age of 21 are required to provide comprehensive health care, EPSDT screenings and preventive services. 

If you have any questions about EPSDT services or our clinical practice and billing guideline, email our Quality Improvement Department.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. The information provided does not constitute coding or legal advice. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Illinois. BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer. 

HEDIS is a registered trademark of the National Committee for Quality Assurance.