(A) Payment may be made not more frequently than once per one hundred eighty days to a physician, physician assistant, or advanced practice registered nurse for the topical application of fluoride varnish to the teeth of a child younger than six years of age.
(B) As part of the application of fluoride varnish, a practitioner must provide three related services:
(1) An oral assessment for the identification of obvious oral health problems and risk factors, which may be omitted if an oral assessment is conducted or has been conducted during an early and periodic screening, diagnosis, and treatment (EPSDT) visit;
(2) Communication with the parent or guardian about the fluoride varnish procedure and proper oral health care for the child; and
(3) If the child has obvious oral health problems and does not have a dental provider, referral to a dentist or to the county department of job and family services.
(C) The application of fluoride varnish during a well child visit or a sick child visit should not be the sole reason for the visit.