Reimbursing Physicians for Fluoride Varnish


Reimbursing Physicians for Fluoride Varnish

This information is up-to-date as of April 6, 2017. In 2015, the Medicaid programs in Delaware and New Hampshire began to compensate pediatric health professionals for tooth decay prevention services. In 2017, Indiana became the final state to compensate pediatric health professionals for this oral health service.

A Cost-effective Solution to Improving Access

Young children see primary medical care providers earlier and more frequently than they see dentists. This is particularly true for children in low-income families, who face persistent barriers to accessing dental care.

For these reasons, the medical office is an ideal place to deliver a set of preventive dental services—including the application of fluoride varnish.

By compensating physicians through Medicaid for providing valuable dental care intervention, states can help reduce the tremendous access barriers low-income children face when trying to obtain much needed oral health care services.  Pew and the American Academy of Pediatrics encourage all states to adopt this reimbursement policy.

Why is Fluoride Varnish Cost Effective?

Twenty-eight percent of children aged two to five have had cavities and, of these children, 73 percent were in need of treatment. Fluoride varnish offers the following benefits:

  • Fluoride varnish applied at primary medical care visits can reduce decay rates by one-third, and lead to significant cost savings in restorative dental care and associated hospital costs.
  • The lack of access to preventive dental measures can result in high costs for complex restorative procedures, especially if the child requires hospital-based care. Such care can cost as much as $15,000 per admission, carries a slight but real risk of anesthetic death, and places big burdens on public resources and state Medicaid budgets.
  • Fluoride varnish is an inexpensive preventive measure that can curb high costs to state Medicaid programs for treating tooth decay. Most Medicaid programs pay between $15 and $30 for the procedure, and some also separately reimburse for screening, anticipatory guidance, and risk assessment.

All 50 states and the District of Columbia have Medicaid programs that pay medical providers for preventative dental care. In North Carolina, a leader in the field, these services reached 60,000 children under age 4 in 2007.

Learn More

For more information, see the 2009 issue brief from the National Academy for State Health Policy (NASHP) as well as presentations from Pew’s September 2009 webcast on the importance of engaging medical providers in caring for young children’s oral health needs. Information is also available from your state chapter of the American Academy of Pediatrics