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Dental General Manual, Covered Services and Bulletins


Provider Dental Manuals

Dental Manual (Updated 4.1.20)

2020 Dental Prior Authorization Process Update 01.02.20

Tribal Provider Manual (4.1.20)

Dental Fee Schedule (4.1.20)

Edits EOBs and Resolutions 4.2.20
This is a list of edits that may post when verifying claims in the Secure Web Portal, along with the possible EOB codes that would post on any claim denials.  Each edit and EOB code combination has a suggested resolution.

Provider Medicaid and State Health Care Benefit Plan 12.31.19

Important Policy Changes/Additions

Dental Manual (Update 1.1.20)
Dental Manual (Update 10.1.19)
Dental Manual (Update 7.1.19)
Dental Manual (Updated 4.1.19)
Dental Manual (Updated 1.1.19)
Dental Manual (Updated 10.1.18)
Dental Manual (Updated 7.1.18)

To search for specific information within the PDF document, select Ctrl F on your keyboard and type your keyword in the find box.

Dental Forms

Orthodontic Parent Handout - Spanish Version
Orthodontic Parent Handout
Prior Authorization Request - Non DME
Oral Surgery Request Form
Attachment Cover Sheet
Adjustment /Void Form (118K)
Tooth Replacement Request Form
Order vs Delivery Date Form
Dental Provider Client Acceptance Form Update
Malocclusion Referral Form for Clients under 12
Maloccusion Treatment Request Form


Dental Provider Workshop Presentation

Severe Malocclusion Program
Workshop 2019 New Providers
Wyoming Medicaid 2019

Important Dental Information

Dental FAQs
Dental Tutorial

 Malocclusion Program

Malocclusion Program Ortho 2.27.19
SM Presentation 8.26.14
Interceptive Program 2.10.15

Dental Bulletins

Additional Links

Medicaid and State Healthcare Benefit Plans: Provides client benefit plan names, descriptions, eligibility limitations, coverage types and coverage limitations. This information is useful when determining if a client is eligible for services.
Carrier Code List: List of Insurance Carrier Codes and Names