Dental Provider Incentive Program
Beginning October 1, 2023, the Agency for Health Care Administration (Agency) initiated the Dental Provider Incentive Program (DPIP). This program will provide bonus reimbursements to highly performing dental providers who have prioritized the improvement of oral health in Florida.
To qualify for enhanced payments beginning October 1, 2024, eligible dental providers must achieve the DPIP Qualifying Criteria listed below for calendar year 2023 services. Qualified providers receive enhanced payments for specific preventive and diagnostic services provided to children under the age of 21 years. The qualifying services are directly linked to five of the Agency’s highest priority oral health quality measures. All Statewide Medicaid Managed Care (SMMC) dental health plans participate in this program.
DPIP Covered Physician Types:
Providers eligible to participate in the Dental Provider Incentive Program are the dentist types below:
• General Dentists
• Pediatric Dentists
DPIP Qualifying Criteria: A dental provider must achieve or exceed the benchmarks for each of the following metrics.*
Metric | Incentive Threshold Rate | Metric Description |
Preventive Dental Services** | 65% | Percentage of children ages 1 to 20 who are eligible for at least 90 continuous days, are eligible for EPSDT services, and who received at least one preventive dental service during the measurement period. |
Oral Evaluation – Total | 65% | Percentage of enrolled children under age 21 who received a comprehensive or periodic oral evaluation within the reporting year. |
Caries Risk Assessment – Total | 70% | Percentage of enrolled children under age 21 years who have caries risk documented in the reporting year. |
Sealant Receipt or Permanent 1st Molars – at least one | 60% | Percentage of enrolled children who have ever received sealants on permanent first molar teeth: at least one by the 10th birthdate. |
Topical Fluoride for Children (Total) | 65% | Percentage of children aged 1-21 years who received at least 2 topical fluoride applications within the reporting year. |
* The Agency reserves the right, in its sole discretion, to establish a panel size requirement in addition to the DPIP metrics.
**Preventive Dental Services has a measurement period of 10/1 – 9/30. The other performance measures are based on calendar year.
DPIP: Qualified Providers
Qualified Providers who have met all the Qualifying Criteria are eligible to receive the DPIP incentive payment for Included Services.
DPIP-excluded provider types are not eligible to receive the incentive payment. For additional information on the DPIP-excluded provider types, please click the link below.
DPIP: Included Services and Enhanced Payments
DPIP services are covered dental services rendered to recipients under 21 years of age, utilizing the following preventive and diagnostic dental procedure codes:
Procedure Code | Description | Service Category |
| D1330 | Oral Hygiene Instruction | Preventive |
| D1120 | Prophylaxis - Child | Preventive |
| D1208 | Topical application of fluoride – excluding varnish | Preventive |
| D1351 | Sealant – Per tooth | Preventive |
| D1206 | Topical application of fluoride varnish | Preventive |
| D1999 | Unspecified preventive procedure, by report | Preventive |
| D0120 | Periodic oral evaluation – established patient | Diagnostic |
| D0150 | Comprehensive oral evaluation – new or established patient | Diagnostic |
| D1354 | Interim caries arresting medicament application. Silver Diamine Fluoride | Preventive |
| D0145 | Oral evaluation for a patient under three years of age and counseling with a primary caregiver | Diagnostic |
DPIP: Enhanced Payments
Payment for Included Services are equivalent to 140% of the Florida Medicaid fee-for-service (FFS) rate that is in effect on October 1 of the program year, as calculated in the table below. Payments are retrospective and additional details will be forthcoming. For the State-specified preventive and diagnostic dental procedure codes included in the DPIP, the following rates apply for enhanced payments:
Procedure Code | Description | SFY 2023 DPIP Rate |
| D1330 | Oral Hygiene Instruction | $12.54 |
| D1120 | Prophylaxis - Child | $29.26 |
| D1208 | Topical application of fluoride – excluding varnish | $22.99 |
| D1351 | Sealant – Per tooth | $27.17 |
| D1206 | Topical application of fluoride varnish | $22.99 |
| D1999 | Unspecified preventive procedure, by report | $20.63 |
| D0120 | Periodic oral evaluation – established patient | $31.35 |
| D0150 | Comprehensive oral evaluation – new or established patient | $33.43 |
| D1354 | Interim caries arresting medicament application. Silver Diamine Fluoride | $9.06 |
| D0145 | Oral evaluation for a patient under three years of age and counseling with a primary caregiver | $33.43 |
NOTE – If a Qualified Provider’s current payment rate already equals or exceeds the DPIP fee schedule for included services, the current payment rate will not change.
