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services in a group practice, the group must

(1) be enrolled in accordance with 7 AAC 105.210; and

(2) consist of one or more individuals who meet the requirements of (c) of this section. (Eff. 2/1/2010, Register 193; am 3/1/2024, Register 249) Statutory Authority: Authority: AS 47.05.010 AS 47.07.030 AS 47.07.040 7 AAC 110.145. Dental services for adults. (a) Payment for emergent dental services covered under this subsection does not reduce a recipient's annual limit under (b) and (c) of this section. Except as specifically excluded under (g) of this section, the department will pay for the following emergent dental services identified in the Fee Schedule: Emergent Adult Dental Services, adopted by reference in 7 AAC 160.900, for recipients 21 years of age or older, as follows:

(1) the following dental services for the immediate relief of pain or acute infection:

(A) limited oral evaluation not more than two times per fiscal year;

(B) extractions; under this subparagraph,

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Page 2350

Official source

services in a group practice, the group must

(1) be enrolled in accordance with 7 AAC 105.210; and

(2) consist of one or more individuals who meet the requirements of (c) of this section. (Eff. 2/1/2010, Register 193; am 3/1/2024, Register 249) Statutory Authority: Authority: AS 47.05.010 AS 47.07.030 AS 47.07.040 7 AAC 110.145. Dental services for adults. (a) Payment for emergent dental services covered under this subsection does not reduce a recipient's annual limit under (b) and (c) of this section. Except as specifically excluded under (g) of this section, the department will pay for the following emergent dental services identified in the Fee Schedule: Emergent Adult Dental Services, adopted by reference in 7 AAC 160.900, for recipients 21 years of age or older, as follows:

(1) the following dental services for the immediate relief of pain or acute infection:

(A) limited oral evaluation not more than two times per fiscal year;

(B) extractions; under this subparagraph,

(i)a claim submitted for up to two extractions in a single…#

(i) a claim submitted for up to two extractions in a single day must be accompanied by medical justification; and

(ii)a provider must obtain prior authorization from the…#

(ii) a provider must obtain prior authorization from the department for three or more extractions in a single day or four or more extractions in a 12-month period;

(C) one intraoral periapical radio graph to determine if an extraction is necessary;

(D) anesthesia or sedation in accordance with 7 AAC 110.155 and necessary for dental services covered under this section; a claim submitted to the department for payment of costs for general anesthesia must be accompanied by written medical justification for the service;

(2) a dental service that exceeds a limit established in (b) and (c) of this section if the department determines, based on medical justification submitted with a prior authorization request, that a delay in the provision of the service will endanger the life of the recipient. (b) Subject to appropriation under AS 47.07.067 and except as specifically excluded under (g) of this section, the department will pay up to $1,150 per state fiscal year for the dental