Medical Insurance Coverage for Dental Procedures in Children
Georgia law guarantees that medical insurance cover dental anesthesia for many children. Coverage inclusion criteria include the child's age, extent of the dental work needed, and any medical conditions he or she may have. Please see the table below for examples of covered medical conditions. Some of these medical conditions are sufficient by themselves, while others must be of sufficient severity, or occur in conjunction with another medical problem, to justify coverage in older children. Most insurance plans insist on pre-authorization before any procedure. In the absence of pre-authorization, medical insurance may refuse to pay for anesthesia that would have been covered. We have also included a link to the legislation.
Covered Medical Condition |
ICD-10 code |
Abscess |
K04.7 |
Acute reaction to stress |
F43.0 |
ADHD |
F90.9 |
Asthma |
J45.20 |
Autism |
F84.0 |
Caries |
K02.9 |
Developmental delay |
F81.9 |
Diseases of pulp tissue |
K04.0 |
Disorder of eruption |
K00.9 |
Downs syndrome |
Q90.9 |
Epilepsy |
G40.901 |
Failed moderate sedation |
T88.52XA |
Mottled teeth |
K00.3 |
Seizures |
G40.901 |
Traumatic tooth loss |
K08.419 |