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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 guideAgreement of Acceptance (partial denture)
13-965Complete this form when provisioning all partial dentures.
FormDental fee schedule (2017-07-01)
Use this fee schedule for dental services effective July 1, 2017
Fee scheduleDental tooth, arch, and quad numbering
70-351Instructions on dental tooth, arch, and quad numbering.
PublicationDenture agreement of acceptance
13-809Denture agreement of acceptance form which must be completed upon date of delivery.
FormDenture/partial appliance request
13-788For skilled nursing facilities clients.
FormGeneral Information for Authorization
13-835Use this form (13-835) to submit an initial authorization request.
FormOral Health Connections patient attestation
13-0031Complete this form with your patients for dental services provided by Oral Health Connections.
FormOrthodontic discontinuation of service form
13-0039This form is used to discontinue orthodontic coverage for Apple Health (Medicaid) clients
FormOrthodontic information authorization form
13-666Use this form prior to treatment for orthodontic services.
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