Medicaid dental coverage for kids in North Dakota

Pediatric dental care in North Dakota is one of the most thoroughly covered benefits in the entire Medicaid program. Federal EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) law requires North Dakota Medicaid / Healthy Steps to provide every child enrolled in Healthy Steps or full Medicaid with comprehensive dental services from the first tooth onward. That means twice-yearly cleanings, fluoride treatments, sealants on permanent molars, fillings, root canals on baby teeth, stainless-steel crowns, extractions, and even orthodontia when it is medically necessary — all at no out-of-pocket cost to your family.

Who is eligible for Healthy Steps in North Dakota?

Children under age 19 in North Dakota qualify for Healthy Steps if their family's gross income is at or below 175% of the federal poverty level. Using the 2024 federal poverty guidelines, that translates to:

Limits assume one parent's reportable income; pregnant women and children with medical disabilities may qualify above these thresholds. EPSDT covers periodic exams, prophylaxis, sealants, fillings, and extractions for under-21.

What does North Dakota Medicaid / Healthy Steps actually cover for kids?

Coverage is divided into three tiers — preventive, basic, and major — and unlike adult Medicaid dental, every tier is included for children with no annual dollar cap.

Preventive (covered 100%, no copay)

• Periodic oral exams every six months from age 1.
• Prophylaxis (cleanings) every six months.
• Fluoride varnish up to four times per year for high-risk children.
• Dental sealants on first and second permanent molars.
• Bitewing and panoramic x-rays at age-appropriate intervals.
• Patient education and oral-hygiene counseling.

Basic restorative (covered 100%)

• Amalgam and composite fillings.
• Stainless-steel crowns on baby teeth.
• Pulpotomies (baby root canals) and pulpectomies.
• Simple and surgical tooth extractions.
• Space maintainers when a baby tooth is lost prematurely.

Major services (prior authorization usually required)

• Permanent crowns and root canals on adult teeth.
• Orthodontia for severe malocclusion, cleft palate, or craniofacial conditions.
• Sedation dentistry (nitrous oxide, oral conscious sedation, or hospital general anesthesia) for very young children or those with special health-care needs.
• Periodontal scaling for adolescent gum disease.

How to enroll in Healthy Steps

Apply at North Dakota Medicaid / Healthy Steps's online portal, by mail with a paper application, or in person at any community health center listed in our North Dakota directory. Most CHCs employ a dedicated enrollment counselor who can complete the application with you in 30 minutes and submit it electronically. You will need:

• Proof of North Dakota residency (utility bill, lease, school enrollment letter).
• Birth certificates or hospital records for each child.
• Social Security numbers for everyone applying.
• Recent pay stubs (last 30 days) or last year's tax return.
• Immigration documents if applicable — note that DACA recipients in North Dakota may also qualify.

What if your application is denied or your child is between coverages?

You still have options. Federal law requires every community health center in North Dakota — there are 35 of them across 18 cities — to charge on a sliding-fee scale tied to household income. Families at or below 100% FPL typically pay nothing; those between 100% and 200% FPL pay a small nominal fee, often $25 to $45 for a complete pediatric dental visit. Read our companion guide on sliding-fee pricing in North Dakota for the full breakdown.

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