Yes, Presbyterian’s Centennial Care Medicaid plan does cover dental services for both children and adults, with benefits administered by DentaQuest on Presbyterian’s behalf.1DentaQuest. DentaQuest and Presbyterian Health Plan Celebrate 25 Years of Partnership One thing to know up front: New Mexico renamed Centennial Care to Turquoise Care effective July 1, 2024, but the core Medicaid benefit package carried over, so the dental coverage members had under Centennial Care is the same coverage now listed under the Turquoise Care name.2Independent Living Resource Center NM. Turquoise Care Change Special MCO Open Enrollment Period
What that coverage looks like depends heavily on the member’s age. Adults get a defined set of preventive and basic restorative services with frequency limits. Children get much more.
What Adults Get (Age 21 and Older)
New Mexico Medicaid’s dental policy for adults covers a specific list of procedures with set frequency limits:3New Mexico Human Services Department. MAD Dental Services Policy
- One cleaning every 12 months and one clinical oral exam every 13 months
- Fluoride treatments when medically necessary
- One full-mouth x-ray series every 60 months; bitewing x-rays every 12 months
- Amalgam and resin fillings, prefabricated stainless steel and resin crowns on permanent teeth, and recementation of crowns
- Therapeutic pulpotomy (an endodontic procedure)
- Denture adjustments (two per 12 months) and repairs to complete and partial dentures
- Emergency services to control bleeding, relieve pain, or eliminate acute infection, including emergency oral exams
DentaQuest’s provider manual for Presbyterian Medicaid also confirms that a broader range of specialty services, including crowns, endodontics (root canal therapy), extractions, full and partial dentures, periodontal treatment, general anesthesia, and operating-room dental cases, fall within the program, subject to authorization criteria.4DentaQuest. NM Presbyterian and Blue Cross Medicaid Office Reference Manual
What Adult Coverage Excludes
State policy lists several services that are not covered for adult members:3New Mexico Human Services Department. MAD Dental Services Policy
- Cosmetic procedures, including bleaching and veneers
- Dental implants
- Fixed bridges
- Nitrous oxide
- Treatment of TMJ disorders
What Children Get (Under 21)
Children’s dental coverage is considerably broader. Federal law requires state Medicaid programs to cover any medically necessary dental service for children under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, including pain relief, treatment of infections, restoration of teeth, and ongoing dental health maintenance.5Medicaid.gov. Dental Care New Mexico treats pediatric dental care as an essential health benefit and its benchmark plan includes both basic and major dental services for children.6HealthInsurance.org. Dental Insurance in New Mexico
The clearest difference from adult coverage is orthodontics: braces are a covered benefit for eligible members under 21.7Blue Cross Blue Shield of New Mexico. Turquoise Care Dental Care There are no copayments or premiums for children’s dental services under New Mexico Medicaid.8Kids Dental Vision Care. Medicaid and Most Insurance Accepted in New Mexico
Emergency and Urgent Dental Care
Dental emergencies are covered. The program defines a dental emergency as a life-threatening condition, with examples that include a broken or knocked-out tooth and a toothache with swelling that may indicate infection.7Blue Cross Blue Shield of New Mexico. Turquoise Care Dental Care Emergency room services provided by a dentist, care of abscesses, and treatment of fractures are covered.9InsureKidsNow.gov. New Mexico Summary of Benefits
Urgent dental problems, meaning something that needs same-day attention but isn’t severe enough for the ER, should be seen within 24 hours. If a member can’t get an urgent appointment in that window, they should call Member Services.7Blue Cross Blue Shield of New Mexico. Turquoise Care Dental Care Emergency dental care does not require prior authorization, though claims may be reviewed afterward to confirm the situation qualified as an emergency.3New Mexico Human Services Department. MAD Dental Services Policy
Which Services Need Prior Approval
DentaQuest manages prior authorization for Presbyterian members. Procedures likely to require approval before treatment starts include cast crowns, endodontics, removable prosthodontics such as dentures, periodontal treatment, general anesthesia, IV sedation, and operating-room cases. Providers must submit documentation, including x-rays and clinical narratives, and DentaQuest typically issues decisions within two business days. If a provider performs a non-emergency service without getting the required authorization, the financial responsibility falls on the provider, not the member.4DentaQuest. NM Presbyterian and Blue Cross Medicaid Office Reference Manual
Finding a Dentist and Getting Answers
Members can look up in-network dentists using the DentaQuest “Find a Dentist” tool or through the Presbyterian provider directory at phs.org, selecting “Medicaid – Turquoise Care” as the plan.10Presbyterian Health Plan. PHP Provider Directory11DentaQuest. New Mexico Medicaid Dental Coverage Network participation can change, so confirm with both the dentist’s office and the plan before scheduling.
For benefit questions, Presbyterian’s Customer Service Center is at 505-923-5200 or toll-free at 888-977-2333 (TTY: 711), Monday through Friday, 8 a.m. to 6 p.m. Presbyterian also runs an Ombudsman Program to help members access services and work through prior authorization, reachable at 505-923-5780 or ombudsman@phs.org.12Presbyterian Health Plan. Presbyterian Turquoise Care Member Guide Full details on covered services, frequency limits, and exclusions live in the Presbyterian Turquoise Care Member Handbook, available through the myPRES portal at phs.org or by request through Customer Service or info@phs.org.