Caries Risk Assessment is provided by the Primary Care Dentist (PCD) and is billed using a current dental terminology (CDT) procedure code. The reimbursement will be the same regardless of the determined risk level. The risk assessment must be provided at least once per year in conjunction with an oral evaluation service by a PCD. It may be provided a second time with prior authorization and documentation of medical necessity.

The risk assessment forms are available online or in Appendix D of the Provider Administrative Manual.