Understanding Texas Medicaid Dental Benefits
Texas Medicaid dental coverage depends on which program you are enrolled in. The main programs are:
- STAR — for children, pregnant women, and qualifying adults (parents and caretakers)
- CHIP — Children's Health Insurance Program for children in families with income above Medicaid limits but below 206% of the federal poverty level
- STAR+PLUS — for adults with disabilities or adults 65 and older
- Texas Health Steps — preventive care program for children birth through age 20
Dental coverage is delivered through managed care dental plans — primarily DentaQuest, MCNA Dental, and UnitedHealthcare Dental depending on your county and MCO enrollment. Each plan must cover the minimum Medicaid benefits defined by HHSC, and most offer additional value-added benefits on top of that baseline.
Changes Effective March 1, 2025 — Texas Health Steps Dental
Teledentistry added (D9995): Effective March 1, 2025, Texas Medicaid began reimbursing teledentistry services for Texas Health Steps dental providers. Dentists may now bill procedure code D9995 alongside an exam code (D0120 or D0140) to indicate the service was delivered via real-time audiovisual teledentistry. The service must meet the same standard of care as in-person dental services.
Oral health literacy education added (D9994): Also effective March 1, 2025, procedure code D9994 became a separately reimbursable Medicaid benefit for children ages 6 months through 35 months. This covers patient/caregiver education to improve oral health literacy — billable by Texas Health Steps dental providers, FQHCs, and local health departments.
First Dental Home services: First Dental Home (FDH) services — the preventive dental program for infants and toddlers — may now be billed and reimbursed separately under certain conditions.
Source: Texas Medicaid & Healthcare Partnership (TMHP) — tmhp.com · Published January 10, 2025
Adult Dental Coverage — Texas STAR Medicaid (Ages 21+)
Source: Aetna Better Health Texas · aetnabetterhealth.com/texas/whats-covered-star.html · Accessed March 2026
Adults who are pregnant or age 21 and older enrolled in Texas STAR Medicaid are eligible for the following dental benefits:
- Dental cleaning (prophylaxis) — every 6 months, for qualifying adults
- X-rays — once per year
- Limited fillings — for covered teeth when medically necessary
- Simple extractions — for symptomatic or infected teeth
- Fluoride treatments — covered for qualifying adults
Generally NOT Covered for Adults Under Texas Medicaid
- Dental implants (except in extremely limited medically necessary circumstances)
- Crowns for cosmetic reasons
- Orthodontics / braces (for adults)
- Teeth whitening or cosmetic procedures
- Veneers
- Major restorative work beyond what is deemed medically necessary
For dental work that falls outside Medicaid coverage, we offer CareCredit and Sunbit financing — both subject to lender credit approval options. See our payment plans page for sourced details on both.
Children's Dental Coverage — Texas Health Steps & CHIP
Source: TMHP.com · UHC Dental Texas · MCNA Dental Texas · Accessed March 2026
Texas provides more comprehensive dental coverage for children than for adults. Children enrolled in Medicaid (through Texas Health Steps) or CHIP receive:
- Preventive exams and cleanings — routine checkups every 6 months
- X-rays — as part of routine exams per periodicity schedule
- Fluoride treatments — at regular visits
- Dental sealants — for cavity prevention on permanent molars
- Fillings — composite and amalgam restorations when needed
- Extractions — primary and permanent teeth when necessary
- Orthodontics — for children with severe functional or medical need (prior authorization required)
- Oral health education (D9994) NEW Mar 2025 — for children 6–35 months
- Teledentistry (D9995) NEW Mar 2025 — exam services may now be delivered via real-time audiovisual
Your Child's First Dental Visit Should Be at Age 1
Texas Medicaid's First Dental Home program encourages the first dental visit by age 1 or within 6 months of the first tooth erupting. For children enrolled in Medicaid, this first visit is covered — including an exam, cleaning, fluoride, and oral health education for parents and caregivers.
Many Houston families in our service area (particularly in 77060, 77076, 77088) are unaware that infant dental visits are a Medicaid benefit. Early visits catch problems before they become painful and help children develop positive associations with dental care.
Source: TMHP.com, January 2025. Call 832-779-5522 to verify your child's Medicaid eligibility for First Dental Home services.
How to Check If Your Family Qualifies for Medicaid or CHIP in Texas
Texas Medicaid and CHIP eligibility depends on household income, family size, age, and citizenship status. In general:
- Children may qualify for Medicaid with family income up to approximately $3,697–$5,438/month (family of 4, 2025 limits)
- Children in families with income above Medicaid limits but below 206% of the federal poverty level may qualify for CHIP
- Pregnant women and parents/caretakers may qualify for STAR Medicaid
- Apply online at YourTexasBenefits.com or call 2-1-1 (Option 2)
Mi Smile Family Dental Accepts Texas Medicaid
We accept Medicaid and CHIP for patients of all ages at our Greenspoint location. Not sure if your plan is accepted? Call us — we verify your coverage before your appointment.
832-779-5522 Request Appointment