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procedures and may not be billed separately;

(14) anesthesia or sedation in conjunction with a noncovered service or a service for which service limits have been exhausted;

(15) dental sealants;

(16) orthodontic services. (Eff. 2/1/2010, Register 193; am 8/25/2010, Register 195; am 11/1/2010, Register 196; am 5/1/2016, Register 218; am 12/1/2022, Register 244) Statutory Authority: Authority: AS 47.05.010 AS 47.07.040

AS 47.07.030 AS 47.07.067 7 AAC 110.150. Dental services for recipients under 21 years of age. (a) Except as provided in 7 AAC 110.200(3), the department will pay for the services identified in the Fee Schedule: Dental Services for Children, adopted by reference in 7 AAC 160.900, as follows, provided to a recipient under 21 years of age:

(1) periodic oral evaluation not more than two times per calendar year, limited oral evaluation not more than two times per calendar year, and comprehensive oral evaluation not more than two times per calendar year; panoramic radio graphs not more than one time per calendar year and other dental radiographs as necessary for dental care;

(2) preventive care, as follows:

(A) prophylaxis, limited to necessary scaling, polishing, and instructions on oral hygiene and diet, not more than two times per calendar year;

(B) topical application of fluoride not more than four times per calendar year, or topical fluoride varnish not more than four times per calendar year, or a combination of topical application of fluoride and fluoride varnish not more than four times per calendar year;

(C) sealants, limited to one time per tooth per calendar year; and

(D) space management therapy restricted to posterior teeth; the department will pay for a primary teeth space maintainer only if a significant risk exists of detrimental drifting occurring before the permanent tooth erupts and for a permanent teeth space maintainer only if