Dental services

Overview

Oral health is an important part of overall physical health. In Washington, more than one in four people receive their health care from Apple Health (Medicaid). The Apple Health Dental program provides oral health and dental services to approximately 2 million Washingtonians, including children. Apple Health Dental is a fee-for-service program.

Children under 20 are eligible for a broad array of services under the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program. The Access to Baby and Child Dentistry Program (ABCD) and Mouth Matters are two key programs that expand access to young children in the dental and medical settings, respectively. ABCD has been a national model for success, and is attributed to higher utilization rates for children Medicaid enrollees, as compared to the national average.

Washington State also offers adult dental coverage. The benefit provides essential oral health services, such as:

• Emergency care
• Diagnostic care
• Prevention
• Restorative
• Oral surgery
• Removable prosthodontics

Billing guides and fee schedules

• See the following programs on the provider billing guides and fee schedules page.
  • Access to Baby and Child Dentistry (ABCD) / Mouth Matters
  • Dental Program
    • Dental-related services
    • Mobile anesthesia
    • Fee schedule
  • Orthodontic services
• ProviderOne Billing and Resource Guide

Forms

• Dental forms
  • Agreement of Acceptance (partial denture)
  • Agreement of Acceptance (complete denture)
  • Denture, partial appliance request for skilled nursing facility or assisted living facility clients
• Mobile anesthesia subcontractor reporting form
• General information for authorization
• Prior authorization pend forms submission cover sheet

Biller and provider training

• How to check a client's benefit limits using the benefit limit inquiry
• Prior authorization direct data entry (DDE) submissions for dental providers
• How to bill for Apple Health services
• Direct data entry webinar (how to bill Apple Health services with ProviderOne)
• How to Make Billing Orthodontics Easy
• WAC resources
  • Definitions—medical necessity
  • Dental related services
  • Medical and dental services fee-for-service prior authorization
  • Health care general coverage
  • Billing a client

Program resources

• Enroll as a Provider
• Overview of Apple Health pediatric dental coverage
• ABCD website
• Overview of adult dental coverage
• Department of Health Oral Health data
  • Includes information related to Washington's Oral Health programs like the Smile Survey, fluoridation, school sealant programs, and finding oral health care for patients with special needs
• Community Resources Online – 2-1-1
• The Center for Pediatric Dentistry
• DentistLink 

Dental data

Find dental utilization and performance metrics for the Apple Health (Medicaid) dental programs.

• Dental data dashboard

Dental Providers Newsletter

Subscribe to the Dental program mailing list to get the latest bulletin updates.
Recent bulletins are linked below.

Additional resources

• Bree Collaborative dental opioid recommendations
• Arcora Foundation oral health data dashboards and reports
• Department of Health: Washington State oral health system performance dashboard
• ASTDD older adult oral health promotion toolkit
• ADA guide to understanding and documenting teledenistry events
• ASTDD guidelines for silver diamine fluoride
• CA perinatal oral health guidelines
• Seal America
• Opioids