Insurance

Medicaid

Health First Colorado (Sun Life DentaQuest) — child, adult & DIDD HCBS-DD waiver benefits.

Our dental practice participates in Colorado Medicaid (Health First Colorado), providing diagnostic, preventative, restorative, endodontic, periodontal, prosthodontic, and oral surgical services according to Colorado Department of Health Care Policy and Financing (HCPF) regulations. Colorado Medicaid dental benefits are administered centrally through Sun Life DentaQuest across three primary coverage groups: Child Medicaid, Adult Medicaid, and the Division for Intellectual and Developmental Disabilities (DIDD) Home and Community-Based Services (HCBS-DD) State Plan Waiver. Looking for a kids dentist in Centennial who takes Medicaid? We welcome children and adults alike.

Health First Colorado Medicaid eligibility groups

Program Overview & Member Eligibility Groups

Dental coverage scope, frequency limitations, and annual financial parameters vary based on the enrolled member's eligibility tier. The full frequency schedule for every tier is in the [benefit grid](#benefit-grid) below.

Colorado Medicaid Child: Covers enrolled children and adolescents from birth through age 20 under federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) mandates. EPSDT provides comprehensive coverage with no annual dollar maximum.
Colorado Medicaid Adult: Covers eligible adult beneficiaries age 21 and older. Benefits operate on a state plan year (July 1 through June 30) and are subject to an Individual Annual Benefit Maximum of $3,000.00 per member across all dental provider networks.
Colorado DIDD State Plan (HCBS-DD): An enhanced adult waiver program for individuals with intellectual and developmental disabilities. Enrollees receive specialized diagnostic, preventative, and restorative allowances, operating on an Individual Annual Benefit Maximum of $3,000.00 per plan year.

Colorado Medicaid dental program exclusions and office policies

Program Exclusions & Dental Office Policies

Annual Benefit Limits: Adult Medicaid and the DIDD HCBS-DD State Plan operate on an Individual Annual Benefit Maximum of $3,000.00 per member per state plan year (July 1 through June 30). Once the $3,000.00 benefit cap is reached, non-emergency dental services are not reimbursable until the new plan year resets on July 1. Child Medicaid (ages 0–20) has no annual dollar maximum.
Dental Implants: Surgical placement of implant bodies, custom abutments, and implant-supported crowns are non-covered benefits under routine Colorado Medicaid programs.
Cosmetic Procedures: Aesthetic veneers, tooth bleaching, and cosmetic alterations are excluded from coverage.
Denture Replacement Rules: Removable complete and partial dentures are limited to once every 84 months (7 years) per patient for adults and once every 5 years for children. Early replacement within the waiting period is non-covered unless catastrophic damage or significant oral physical trauma is documented and approved under prior authorization.
Restorative Frequency Accounting: Direct amalgams and composite restorations are limited to once per 36 months for the same tooth and same surface on Child and Adult plans, and once per 12 months on the DIDD HCBS-DD Waiver plan.
Prohibition of Balance Billing: Network dentists must accept Medicaid payment in full for covered benefits. Providers cannot bill Medicaid members for the difference between private fees and Medicaid reimbursements, nor charge out-of-pocket fees for service upgrades when the plan provides standard coverage.

Sun Life DentaQuest plan administration contacts

Plan Administration & Provider Contact Directory

All Colorado Medicaid dental claims, eligibility checks, and prior authorization submissions are managed centrally through Sun Life DentaQuest:

Dental Benefit Administrator: Sun Life DentaQuest
DentaQuest Provider Portal: providers.dentaquest.com
DentaQuest Provider Inquiries: 1-855-225-1729
Health First Colorado (State Agency): healthfirstcolorado.com | Member Services: 1-800-221-3943
Important Billing Note: Primary dental claims must be submitted with valid American Dental Association (ADA) procedure nomenclature, tooth numbers, surface indicators, and approved prior authorization reference numbers directly to Sun Life DentaQuest.

What to Bring to a Colorado Medicaid Dental Appointment

Health First Colorado (Colorado Medicaid) member identification card or State Department of Health Care Policy and Financing (HCPF) verification document
Valid government-issued photo identification of the adult patient, parent, or legal guardian
Complete medication list and primary care medical provider contact information (essential for sedation and surgical prior authorization requests)
Prior dental history details if dentures, crowns, or root canals were completed at an outside facility within the past 7 years

Benefit grid

Health First Colorado Dental Benefit Comparison by Program Tier

Frequency limits by program tier, as published in the Health First Colorado dental benefit schedule administered by Sun Life DentaQuest. Child limits apply to members ages 0 to 20 under EPSDT; adult limits apply to members age 21 and older; the DIDD HCBS-DD Waiver column applies to enrolled special-needs adults. The Prior Auth column shows whether Sun Life DentaQuest must approve the service before treatment. Our team verifies your eligibility tier before every visit.

Program Tiers, Annual Maximums & Cost-Sharing

Program Tier	Who Is Covered	Annual Benefit Maximum	Patient Cost-Sharing & Deductible	Prior Auth (PA)
Child (Ages 0–20) EPSDT eligible	Enrolled children and adolescents from birth through age 20 under federal EPSDT mandates	No annual maximum	$0 deductible / 100% covered (in & out of network)	No
Adult (Ages 21+) Standard Medicaid	Eligible adult beneficiaries age 21 and older	$3,000.00 per plan year (July 1 – June 30)	$0 deductible / 100% covered (in & out of network)	No
DIDD HCBS-DD Waiver Special needs adult	Adults enrolled in the Division for Intellectual and Developmental Disabilities HCBS-DD State Plan Waiver	$3,000.00 per plan year (July 1 – June 30)	$0 deductible / 100% covered (in & out of network)	No

Diagnostic – Oral Evaluations7 services

Service Description	Child (Ages 0–20, EPSDT)	Adult (Ages 21+)	DIDD HCBS-DD Waiver	Prior Auth (PA)
Periodic oral evaluation	Two of periodic, comprehensive, or re-eval per 1 year per provider/location	Two of periodic, comprehensive, or perio eval per 12 months per patient	Four of periodic, limited, detailed, re-eval, or perio eval per 12 months per patient	No
Limited oral evaluation – problem focused	Two per 1 year per provider or location	Two per 12 months per location	Four shared emergency/evaluations per 12 months per location	No
Oral evaluation under age 3	Two per 1 year per provider or location	Not a covered benefit	Not a covered benefit	No
Comprehensive oral evaluation	One per 3 years per provider or location	One per 36 months per location	One per 24 months per location	No
Detailed and extensive oral evaluation	Two per 1 year per provider or location	Two per 12 months per provider or location	Four shared evaluations per 12 months per provider/location	No
Re-evaluation – limited, problem focused	Two shared evaluations per 1 year per provider/location	Two per 12 months per provider or location	Four shared evaluations per 12 months per provider/location	No
Comprehensive periodontal evaluation	One per 1 year per provider or location	One per 36 months per patient	One per 36 months per patient	No

Diagnostic – Radiographs (X-Rays)8 services

Service Description	Child (Ages 0–20, EPSDT)	Adult (Ages 21+)	DIDD HCBS-DD Waiver	Prior Auth (PA)
Intraoral – comprehensive radiographic series	One of complete series, vertical bitewings, or pano per 5 years per provider/location	One of complete series or vertical bitewings per 60 months per patient	One of complete series or vertical bitewings per 60 months per patient	No
Intraoral – periapical first radiographic image	Six periapical/tomosynthesis images per 1 year per provider/location	Six periapical/tomosynthesis images per 12 months per patient	Six periapical/tomosynthesis images per 12 months per patient	No
Intraoral – periapical each additional image	Covered as clinically indicated; no time limits	Covered as clinically indicated; no time limits	Covered as clinically indicated; no time limits	No
Intraoral – occlusal radiographic image	Two per 2 years per provider or location	Covered as clinically indicated; no time limits	Covered as clinically indicated; no time limits	No
Extraoral 2D projection & posterior images	Covered as clinically indicated; no time limits	Covered as clinically indicated; no time limits	Covered as clinically indicated; no time limits	No
Bitewing radiographs (single, two, three, four)	One of single/two per 1 year; one of three/four per 1 year per provider/location	One procedure (single, two, three, or four images) per 12 months per patient	Two procedures (single, two, three, or four images) per 12 months per patient	No
Vertical bitewings (7 to 8 radiographic images)	One of complete series, vertical bitewings, or pano per 5 years per provider/location	One of complete series or vertical bitewings per 60 months per provider/location	One of complete series or vertical bitewings per 60 months per provider/location	No
Panoramic radiographic image	One of complete series, vertical bitewings, or pano per 3 years per provider/location	One per 60 months per provider or location	One per 60 months per location	No

Preventive5 services

Service Description	Child (Ages 0–20, EPSDT)	Adult (Ages 21+)	DIDD HCBS-DD Waiver	Prior Auth (PA)
Routine dental cleaning (prophylaxis – adult/child)	Two child or adult cleanings per 1 year per patient	Two cleanings (prophylaxis, gingival scaling, or perio maintenance) per 12 months	Four cleanings (prophylaxis or perio maintenance) per 12 months per patient	No
Topical application of fluoride (varnish / gel)	Two to three applications per 1 year per patient	Covered with documentation / medical necessity	Four applications per 12 months per patient	No
Pit and fissure sealants – per tooth	Two per lifetime, same tooth per patient (unrestored permanent molars)	Not a covered benefit for adult populations	Not a covered benefit for adult populations	No
Space maintainers (fixed unilateral/bilateral)	Two per lifetime per quadrant or arch	Not a covered benefit for adult populations	Not a covered benefit for adult populations	No
Space maintainers (removable unilateral/bilateral)	Two per lifetime per quadrant or arch	Not a covered benefit for adult populations	Not a covered benefit for adult populations	No

Restorative8 services

Service Description	Child (Ages 0–20, EPSDT)	Adult (Ages 21+)	DIDD HCBS-DD Waiver	Prior Auth (PA)
Amalgam restorations (1 to 4+ surfaces)	One per 36 months, same tooth and same surface per patient	One per 36 months, same tooth and same surface per patient	One per 12 months, same tooth and same surface per patient	No
Resin composite restorations – anterior (1 to 4+)	One per 36 months, same tooth and same surface per patient	One per 36 months, same tooth and same surface per patient	One per 12 months, same tooth and same surface per patient	No
Resin composite restorations – posterior (1 to 4+)	One per 36 months, same tooth and same surface per patient	One per 36 months, same tooth and same surface per patient	One per 12 months, same tooth and same surface per patient	No
Single crowns (porcelain, ceramic, PFM, full metal)	One crown per 84 months (7 years), same tooth per patient	One crown per 84 months (7 years), same tooth per patient	One crown per 84 months (7 years), same tooth per patient	Yes
Prefabricated stainless steel crowns – primary	One of stainless steel or coated crown per 36 months, same tooth	Not a covered benefit for adult populations	Not a covered benefit for adult populations	No
Prefabricated stainless steel crowns – permanent	One per 36 months, same tooth per patient	One per 36 months, same tooth per patient	One per 36 months, same tooth per patient	No
Core buildup, including any pins	One of core buildup or post/core per 84 months, same tooth per patient	One of core buildup or post/core per 84 months, same tooth per patient	One of core buildup or post/core per 84 months, same tooth per patient	Yes
Prefabricated post and core in addition to crown	One of core buildup or post/core per 84 months, same tooth per patient	One of core buildup or post/core per 84 months, same tooth per patient	One of core buildup or post/core per 84 months, same tooth per patient	Yes

Endodontic5 services

Service Description	Child (Ages 0–20, EPSDT)	Adult (Ages 21+)	DIDD HCBS-DD Waiver	Prior Auth (PA)
Therapeutic pulpotomy	One per lifetime, same tooth per patient	Not standard on adult schedule	Covered as clinically indicated	No
Endodontic therapy (root canal – anterior)	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	Yes
Endodontic therapy (root canal – premolar)	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	Yes
Endodontic therapy (root canal – molar)	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	Yes
Root canal retreatment (anterior, premolar, molar)	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	Yes

Periodontal8 services

Service Description	Child (Ages 0–20, EPSDT)	Adult (Ages 21+)	DIDD HCBS-DD Waiver	Prior Auth (PA)
Gingivectomy or gingivoplasty	One per 3 years, same quadrant per patient	One per 36 months, same quadrant per patient	One per 12 months, same quadrant per patient	Yes
Gingival flap procedure & osseous surgery	One per 12 months, same quadrant per patient	Covered with clinical documentation	Covered with clinical documentation	Yes
Clinical crown lengthening – hard tissue	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	Yes
Bone replacement grafts & tissue regeneration	One per lifetime, same tooth per patient	Covered as clinically indicated	Covered as clinically indicated; no time limits	Yes
Periodontal scaling and root planing	One per 3 years, same quadrant per patient	One per 36 months, same quadrant per patient	One per 36 months, same quadrant per patient	Yes
Scaling in presence of generalized gingivitis	Two shared preventative cleanings per 1 year per patient	Two shared cleanings per 12 months per patient	Covered with comprehensive charting	No
Periodontal maintenance	Two shared preventative cleanings per 1 year per patient	Two shared cleanings per 12 months per patient	Four shared cleanings per 12 months per patient	No
Localized delivery of antimicrobial agents	One per 36 months, same quadrant per patient	One per 36 months per patient	One per 36 months per patient	Yes

Prosthodontic – Dentures & Bridges7 services

Service Description	Child (Ages 0–20, EPSDT)	Adult (Ages 21+)	DIDD HCBS-DD Waiver	Prior Auth (PA)
Complete dentures (maxillary & mandibular)	One per 5 years per patient	One per 84 months (7 years) per patient	One per 84 months (7 years) per patient	Yes
Immediate dentures (maxillary & mandibular)	One per lifetime per patient	One of complete or immediate denture per 84 months per patient	One per 84 months (7 years) per patient	Yes
Partial dentures (resin base, cast metal, flexible)	One per 5 years per patient	One per 84 months (7 years) per patient	One per 84 months (7 years) per patient	Yes
Immediate partial dentures	One per lifetime per patient	One per 84 months (7 years) per patient	One per 84 months (7 years) per patient	Yes
Unilateral removable partial dentures	One per 5 years per patient or quadrant	Covered as clinically indicated	One per lifetime, same quadrant per patient	Yes
Denture adjustments (complete & partial)	One per 12 months per patient	One per 12 months per patient	One per 12 months per patient	No
Fixed partial denture retainer crown (bridge retainer)	One per 84 months, same tooth per patient	One per 84 months, same tooth per patient	One per 84 months, same tooth per patient	Yes

Oral Surgery5 services

Service Description	Child (Ages 0–20, EPSDT)	Adult (Ages 21+)	DIDD HCBS-DD Waiver	Prior Auth (PA)
Simple extraction (erupted tooth or exposed root)	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	No
Surgical extraction (removal of bone / sectioning)	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	No
Removal of impacted tooth (soft tissue)	Covered as clinically indicated; no time limits	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	No
Removal of impacted tooth (partially / completely bony)	Covered as clinically indicated; no time limits	One per lifetime, same tooth per patient	One per lifetime, same tooth per patient	No
Removal of residual tooth roots	Covered as clinically indicated; no time limits	Covered as clinically indicated; no time limits	Covered as clinically indicated; no time limits	No

Emergency, Anesthesia & Consultation4 services

Service Description	Child (Ages 0–20, EPSDT)	Adult (Ages 21+)	DIDD HCBS-DD Waiver	Prior Auth (PA)
Emergency palliative treatment of dental pain	Covered as clinically indicated; no time limits	Covered as clinically indicated; no time limits	Covered as clinically indicated; no time limits	No
Intravenous moderate conscious sedation	One initial 15-minute unit; thirteen subsequent units per day	One initial 15-minute unit; thirteen subsequent units per day	One initial 15-minute unit; thirteen subsequent units per day	Yes
Deep sedation / general anesthesia	Covered for qualifying surgical / hospital conditions	Covered for qualifying surgical / hospital conditions	Covered for qualifying surgical / hospital conditions	Yes
Diagnostic consultation	One per 12 months per provider or location	One per 12 months per provider or location	One per 12 months per provider or location	No

Important Coverage Disclaimer: Medicaid dental coverage is subject to patient eligibility status on the exact date of service, network participation of the treating dentist, verified procedure code frequency limitations, and prior authorization approval where mandated by state program policy. Children under age 21 have broader protections under federal EPSDT mandates when medically necessary. This page is compiled for dental provider administrative reference and patient education, and does not guarantee payment, reimbursement amounts, or treatment authorization. Official determinations issued by Sun Life DentaQuest and Health First Colorado supersede this summary.

GOOD TO KNOW

Medicaid questions, answered.

Everything you need to know before your first visit. Have another question?

Call (303) 923-9068 →

Is there a yearly limit on Colorado Medicaid dental benefits?

Adult Medicaid and the DIDD HCBS-DD waiver operate on an Individual Annual Benefit Maximum of $3,000.00 per member per state plan year (July 1 through June 30). Once the cap is reached, non-emergency services are not reimbursable until the plan year resets on July 1. Child Medicaid (ages 0–20) has no annual dollar maximum under EPSDT.

Do I need to pay anything out of pocket if I have Health First Colorado?

Covered services carry a $0 deductible and are covered at 100%. As a network dentist we accept Medicaid payment in full for covered benefits and cannot balance-bill you for the difference between private fees and Medicaid reimbursement. If a procedure isn't covered, such as implants or cosmetic work, we explain the cost up front before any treatment.

Is emergency dental care covered by Medicaid?

Yes. Emergency palliative treatment of dental pain is covered as clinically indicated with no time limits across all three program tiers, and limited problem-focused evaluations are covered for urgent visits.

Which Medicaid dental services need prior authorization?

Sun Life DentaQuest requires prior authorization for crowns, core buildups and posts, root canals and retreatments, periodontal surgery and scaling and root planing, dentures and bridge retainers, and IV sedation or general anesthesia. Our team submits the request with the required documentation before treatment is scheduled.

What should I bring to my appointment if I have Medicaid?

Your Health First Colorado member ID card or HCPF verification document, a valid government-issued photo ID for the adult patient, parent, or legal guardian, a complete medication list with your primary care provider's contact information, and details of any dentures, crowns, or root canals completed at an outside office within the past 7 years.

Are dental implants covered by Colorado Medicaid?

No. Surgical placement of implant bodies, custom abutments, and implant-supported crowns are non-covered under routine Colorado Medicaid programs, as are veneers, tooth bleaching, and other cosmetic procedures. We can discuss covered alternatives such as partial or complete dentures, plus financing options for non-covered care.

What if my Medicaid coverage changes — can I still continue my treatment here?

Absolutely. Coverage is verified on the exact date of service, so if your eligibility or program tier changes our team will re-verify your benefits with Sun Life DentaQuest and guide you through the next steps to keep your treatment on track.