La. Admin. Code tit. 50, § XXV-501 - Adult Denture Services

A. Only the following services are reimbursable under the Adult Denture Program and only in accordance with program policy and guidelines:

1. comprehensive oral examination*;

2. intraoral radiographs, complete series*;

3. complete denture, maxillary*;

4. complete denture, mandibular*;

5. immediate denture, maxillary*;

6. immediate denture, mandibular*;

7. maxillary partial denture, resin base (including clasps)*;

8. mandibular partial denture, resin base (including clasps)*;

9. repair broken complete denture base;

10. replace missing or broken tooth, complete denture, per tooth;

11. repair resin denture base, partial denture;

12. repair or replace broken clasp, partial denture;

13. replace broken teeth, partial denture, per tooth;

14. add tooth to existing partial denture;

15. add clasp to existing partial denture;

16. reline complete maxillary denture (laboratory)*;

17. reline complete mandibular denture (laboratory)*;

18. reline maxillary partial denture (laboratory)*;

19. reline mandibular partial denture (laboratory)*;

20. unspecified removable prosthodontic procedure, by report*.

Notes

La. Admin. Code tit. 50, § XXV-501

Promulgated by the Department of Health and Hospitals, Office of the Secretary, Bureau of Health Services Financing, LR 31:81 (January 2005), repromulgated LR 31:1589 (July 2005).

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.