Application of Fluoride Varnish Tip Sheet

Incentives will be paid on an annual basis, following the end of Quarter 4. For additional information, refer to the CBI Technical Specifications.

• History of dental caries is an important predictor of risk for future disease.
• Children with early childhood decay are more likely to get more decay in their lifetime. Baby teeth are in a child’s mouth until age 11 or 12.
• Decay can go beyond pain and it affects:
  • Speech
  • Ability to eat.
  • Ability to learn.
  • The way children feel about themselves.
• Fluoride varnish helps prevent dental caries and, in some cases, reverse early dental caries. Fluoride can reduce decay by 30-63%, depending on if it is coupled with dental health counseling.
• Because of the high efficacy of fluoride varnish, it is now being applied in non-dental settings.
• The application is quick, easy, and painless, and can be delegated to nursing and medical assistant staff.

• Application of topical fluoride varnish by a physician or other qualified health care professional CPT Code: 99188.

Data for this measure will be collected using claims and provider data submissions via the Data Submission Tool (DST) on the Provider Portal. To find gaps in data:

• Run a report from your electronic health record (EHR) system: or.
• Manually compile patient data (Example: Download your Care-Based Incentives Measure Details report on the Provider Portal and compare to your EHR/paper charts).

This measure allows providers to submit fluoride varnish codes to the Alliance from the clinic EHR system or  paper records by the DST contractual deadline. This includes fluoride varnish applications that were completed before the member was eligible for Medi-Cal or during a gap in coverage. To submit, you may upload data files to the DST on the Provider Portal. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Provider Portal.

• United States Preventive Services Task Force (USPSTF) recommends that PCPs apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. Why PCPs? About 75% of children 5 years and younger do not visit a dentist, but they do see a primary care clinician. As such, a child’s PCP can play a major role in helping children’s teeth stay healthy.
• American Academy of Pediatrics (AAP) recommends:
  • Performing oral health risk assessments on all children at every routine well-visit beginning at 6 months of age.
  • Recommended use of fluoridated toothpaste starting at eruption of the first tooth: a grain of rice sized amount is recommended for children younger than 3 years, and a pea-sized amount is appropriate for most children starting at 3 years of age.
  • Application of fluoride varnish at least once every 6 months, and preferably every 3 months, starting at tooth eruption.

• Alliance interpreting services are available to network providers:
  • Telephonic interpreting services are available to assist in scheduling members.
  • Face-to-face interpreters can be requested to be at the appointment with the member.

  For information about our Cultural and Linguistic Services Program, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].

• Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.
• Bright Futures Oral Health Pocket Guide
• Fluoride Varnish Helping Smiles Stay Strong brochure for parents and caregivers.
• Child Health and Disability Prevention (CHDP) Dental Training: Fluoride Varnish.
• CHDP Fluoride Varnish Protocol and Standing Order.
• CHDP Steps to Implement Fluoride Varnish in Your Medical Practice.
• CHDP County Offices.
• CHDP Dental Training: Fluoride Varnish.
• Smile California (Medi-Cal Dental Program)
  • Primary Care Physician Toolkit: Description of Resources.
• AAP Oral Health Prevention Primer.
• Smiles for Life: A National Oral Health Curriculum.
• Key Elements to Incorporate Oral Health in the Pediatric Electronic Health Record AAP Section on Oral Health.
• The National Maternal and Child Oral Health Resource Center (OHRC): Integrating Oral Health Care into Primary Care: A Resource Guide.
• Safety Net Medical Home Initiative: Implementation Guide - Oral Health Integration.
• Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System.