N.M. Admin. Code § 13.10.6.11 - MINIMUM BENEFITS
All plans shall include at least the following basic dental services which shall be covered by the prepaid charges set forth in the evidence of coverage. If other dental services will be available to eligible members on a voluntary basis, they must be listed in the plan. Dental services not included in the plan shall be shown as exclusions.
A.
Emergency services: Emergency
dental services are those necessary to control bleeding, relieve pain, and
eliminate acute infection.
B.
Diagnostic services: Diagnostic dental services are those services
necessary to identify dental abnormalities. They shall include but need not be
limited to radiographs and clinical examination.
C.
Preventive services:
Preventive dental services shall include but need not be limited to oral
prophylaxis, the application of topical fluorides when applicable, and a viable
maintenance care recall system accompanied by evidence that this recall system
is fully implemented.
D.
Therapeutic services: Therapeutic services shall include:
(1) pulp therapy for permanent and primary
teeth exclusive of root canal therapy,
(2) restoration of carious (decayed)
permanent and primary teeth with materials other than cast
restorations,
(3) routine tooth
extractions.
E.
Out of area care: In the event a member requires emergency dental
services as defined in 13 NMAC 10.6.11.1 [now Subsection A of
13.10.6.11 NMAC] while located
outside the geographic area served by the plan and the member pays for such
services, reimbursement shall become the responsibility of the dental service
provider from which the patient has elected to receive care under the
contract.
Notes
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