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(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 to alleviate immediate pain or infection; and

(iii) a provider must obtain prior authorization from the department for an extraction that is required for a reason other than to alleviate immediate pain or infection;

(B) local anesthesia, materials, and routine postoperative care are considered components of a complete surgical procedure and may not be billed separately;

(8) anesthesia and sedation in accordance with 7 AAC 110.155 and necessary for dental services covered under this section;

(9) professional consultation, if medically necessary or if requested by the department. (b) Except as provided in 7 AAC 110.200(3), the department will not pay for the following dental services for recipients under 21 years of age:

(1) dental services not identified in the Fee Schedule: Dental Services for Children, adopted by reference in 7 AAC 160.900;

(2) behavior management in conjunction with any services covered under 7 AAC 110.155;

(3) indirect pulp capping;

(4) endodontic apical surgery and retrograde fillings;

(5) immediate, interim, and temporary dentures;

(6) dental implant and implant-related dental services;

(7) inlays, overlays, and three-fourth crowns;

(8) restoration of etched enamel or deep grooves without obvious dentin involvement;

(9) space maintainers for anterior teeth;

(10) tobacco counseling; tobacco counseling is considered a component of periodic and comprehensive evaluations and may not be billed separately;

(11) denture characterization and personalization, and precision attachments;

(12) experimental dental procedures;

(13) local anesthesia; local anesthesia is considered a component of covered dental procedures and may not be billed separately;

(14) anesthesia or sedation in conjunction with a noncovered service. (Eff. 2/1/2010, Register 193; am 8/25/2010, Register 195; am 11/1/2010, Register 196; am