(1) The maximum dental benefits paid under the basic dental plan will be 85% of the billed services received. Up to $1,615 in basic dental care will be paid per benefit year for each enrollee. For example, $1,900 in services received results in $1,615 paid.

(a) Providers may not balance bill the enrollee, parent, or guardian for the remaining 15% of the billed charges.

(b) Providers may bill the enrollee, parent, or guardian for services received in excess of $1,900 per benefit year.

(2) Providers must bill for services using the procedure codes and modifiers set forth, and according to the definitions contained in the American Dental Association Manual of Current Dental Terminology (CDT 2014).

(3) The following procedures are not a benefit of the HMK coverage group Dental Program:

(a) D5900 through D5999 maxillofacial prosthetics;

(b) D7610 through D7780 treatment of fractures;

(c) D7940 through D7999 other repair procedures; and

(d) D8000 through D8999 orthodontics.

(4) Providers must comply with all applicable state and federal statutes, rules and regulations, including the United States Code governing the HMK Plan and all applicable Montana statutes and rules governing licensure and certification.

(5) Providers must also comply with the requirements of ARM Title 37, chapter 85, subchapters 4 and 5 to the extent those provisions are not inconsistent with this subchapter.

(6) For purposes of applying the provisions of any Medicaid rule as required by this subchapter, references in the Medicaid rule to "Medicaid" or the "Montana Medicaid program" or similar references shall be deemed to apply to the HMK coverage group or the HMK Plus coverage group as the context permits.