Forms & publications

Notice: If you are looking for Apple Health (Medicaid) client forms and publications, please visit our Free or low-cost forms library.

Access to Baby and Child Dentistry (ABCD) Billing Guide (2014-07-01)

Instructions for billing for services provided to Washington Apple Health clients.

Provider billing guide

Agreement of Acceptance (partial denture)

13-965

Complete this form when provisioning all partial dentures.

Form

Dental fee schedule (2017-07-01)

Use this fee schedule for dental services effective July 1, 2017

Fee schedule

Dental tooth, arch, and quad numbering

70-351

Instructions on dental tooth, arch, and quad numbering.

Publication

Denture agreement of acceptance

13-809

Denture agreement of acceptance form which must be completed upon date of delivery.

Form

Denture/partial appliance request

13-788

For skilled nursing facilities clients.

Form

General Information for Authorization

13-835

Use this form (13-835) to submit an initial authorization request.

Form

Oral Health Connections patient attestation

13-0031

Complete this form with your patients for dental services provided by Oral Health Connections.

Form

Orthodontic discontinuation of service form

13-0039

This form is used to discontinue orthodontic coverage for Apple Health (Medicaid) clients

Form

Orthodontic information authorization form

13-666

Use this form prior to treatment for orthodontic services.

Form

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