Application of Dental Fluoride Varnish Tip Sheet

Incentives are paid to the linked PCP on an annual basis, following the end of quarter four. For additional information, refer to the CBI Technical Specifications.

• Administrative members at the end of the measurement period.
• Dual coverage members.

• 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 affect:
  • Speech
  • Ability to eat.
  • Ability to learn.
  • The way children feel about themselves.
• Fluoride varnish helps prevent dental caries, and in some cases, reverses early dental caries.
• Because of the high efficacy of fluoride varnish, it is now 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

DST-specific submissions for co-located dental practices only.
CDT Code: D1206, D1208

Data for this measure is 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. For example, download your Care-Based Incentives Measure Details report on the Provider Portal and compare it to your EHR/paper records.

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, 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.

• The 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 five years and younger do not visit a dentist, but they do see a PCP.¹ The 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 six months of age.
  • The use of fluoridated toothpaste starting at eruption of the first tooth. A grain of rice-sized amount is recommended for children younger than three years of age, and a pea-sized amount is appropriate for most children starting at three years of age.
  • The application of topical fluoride varnish at least once every six months, and preferably every three months, for children at high risk for caries, starting at tooth eruption. See Bright Futures Oral Health Pocket Guide for more information on high-risk criteria. 

[1] Preventing Chronic Disease: Changes in Children’s Oral Health Status and Receipt of Preventive Dental Visits, United States, 2003-2011/2012.

• Alliance Cultural and Linguistic Services are available to network providers.
  • Language Assistance Services – Request materials at 800-700-3874, ext. 5504.
  • Telephonic Interpreter Service – Directly access a telephonic interpreter 24 hours a day, 7 days a week.
  • Interpreter Services – Can be requested for the appointment with the member.
  • Virtual Remote Interpreter (VRI) Service – When an in-person interpreter might not be available or easy to access.
  • For information about the Cultural and Linguistic Services Program, call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].
• Alliance Transportation Services for patients with transportation challenges.
  • For non-emergency medical transportation (NEMT) services, call 800-700-3874, 5640 (TTY: Dial 711).
  • For non-medical transportation (NMT) services, call 800-700-3874, ext. 5577 (TTY: Dial 711).
• Bright Futures Oral Health Pocket Guide.
• Fluoride Varnish Helping Smiles Stay Strong brochure for parents and caregivers.
• Integrating Oral Health Care into Primary Care: A Resource Guide - The National Maternal and Child Oral Health Resource Center (OHRC).
• Key Elements to Incorporate Oral Health in the Pediatric Electronic Health Record - AAP Section on Oral Health
• Oral Health Integration Implementation Guide Supplement – Safety Net Medical Home Initiative.
• Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System.
• Oral Health Prevention Primer – American Academy of Pediatrics Campaign for Dental Health.
• Primary Care Physician Toolkit: Description of Resources – Smile, California.
• Smiles for Life: A national oral health curriculum.