Reviewed By Dr. Jodi Kuhn
Reading time: 3 minutes
If you live in Colorado and need your wisdom teeth removed, Medicaid may help cover the cost. However, coverage depends on your age and whether the tooth is causing a real dental problem.
We provide dental care for the whole family at our offices in Denver, Aurora, Thornton, and Hampden. We proudly accept Medicaid and make quality dental care accessible for every child.
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Dental and Vision Care in One Convenient Location
At our Denver and Aurora locations, Youth Dentistry & Orthodontics and Youth Vision are conveniently located in the same building. This means your child can receive both dental and vision care at one familiar location, without extra travel or scheduling stress.
When Will Medicaid Pay for Wisdom Teeth Removal?
Health First Colorado may cover wisdom teeth removal if it is medically necessary and done by a provider who accepts Medicaid.
Coverage is different for:
- Children and teens (ages 0–20)
- Adults (21 and older)
Removal is usually covered when there is pain, infection, swelling, damage to nearby teeth, or other dental problems. It is not automatically covered if the tooth is healthy and not causing issues.
How Dental Coverage Works Under Health First Colorado
Health First Colorado provides dental benefits for both children and adults. However, the rules are not the same for every age group.
Coverage for Children and Teens (Ages 0–20)
For members ages 0–20, wisdom teeth removal is covered when there is a documented dental problem.
Covered services include:
- Simple extractions of visible teeth
- Surgical removal
- Removal of impacted wisdom teeth
Prior authorization is not required for standard wisdom tooth removal in this age group. However, an important rule applies. If the wisdom teeth are not causing symptoms, Medicaid will not cover removal unless the child has been approved for orthodontic treatment.
This means removal “just in case” is not covered unless:
- There is pain
- There is infection
- There is visible damage
- There is an approved orthodontic reason
Coverage for Adults (Ages 21 and Older)
Adults also have dental benefits under Health First Colorado.
Wisdom teeth removal may be covered if there is:
- Ongoing pain
- Infection or swelling
- An impacted tooth causing damage
- Decay that cannot be fixed
- Gum disease around the tooth
- A cyst or other problem seen on an X-ray
For adults, documentation is very important. The dentist must clearly show that the tooth is causing a real problem. Routine removal of healthy wisdom teeth without symptoms may not be covered.
What Does “Medically Necessary” Mean?
Medical necessity means the removal is needed to treat a real dental problem.
Your dentist may document:
- Your symptoms
- What they see during the exam
- What the X-rays show
- Why waiting would not be safe
If the tooth is healthy and not causing problems, coverage may be denied.
Why You Must See a Medicaid Provider
Health First Colorado only pays for treatment from enrolled Medicaid providers. If the dentist or oral surgeon does not accept Medicaid, the procedure will not be covered. Always confirm that the office participates in Health First Colorado before scheduling surgery.
Youth Dentistry & Orthodontics accepts Health First Colorado at all of our locations. Our team will review your benefits, confirm eligibility, and explain coverage before scheduling treatment.
Get Help Understanding Your Medicaid Benefits
If you or your child is having pain, swelling, or concerns about wisdom teeth, schedule an evaluation. We can examine the area, take X-rays if needed, and explain how your Medicaid benefits apply.
Contact Youth Dentistry and Orthodontics to schedule an appointment at any of our locations.
📍Denver Youth Dentistry and Orthodontics: 1400 Grove Street, Denver, CO 80204 | (303) 825-2295
📍Aurora Youth Dentistry and Orthodontics: 14251 E. 6th Avenue, Aurora, CO 80011 | (303) 343-3133
📍Thornton Youth Dentistry and Orthodontics: 550 E. Thornton Parkway, Suite 240A, Thornton, CO 80229 | (303) 280-8878
📍Hampden Youth Dentistry and Orthodontics: 7400 East Hampden Ave. Unit C1, Denver, CO 80231 | (720) 826-3694
FAQs
How much is wisdom teeth removal without insurance in Colorado?
The total amount depends on the type of extraction and the condition of the teeth. A simple extraction is different from a surgical or impacted removal. An exam and X-rays are needed to determine the type of procedure required.
Is wisdom teeth removal a surgery?
If the tooth is fully visible and easy to remove, it may be a simple extraction. If the tooth is impacted or under the gum, the procedure is considered a surgical removal because it may require cutting the gum or removing bone.
Is it necessary to remove wisdom teeth?
Not always. Wisdom teeth only need to be removed if they are causing pain, infection, damage to nearby teeth, or other dental problems. If the teeth are healthy and not causing issues, they may simply be monitored over time.
