Dental Evaluation Tools, Clinical Criteria, and Prior Authorization Forms

Dental Cone beam Computed Tomography (CBCT) Scans Clinical Criteria (06/25/2024)

Dental Services (04/11/2023)
Denture Evaluation Tool (07/1/2023)
Limited Orthodontic Treatment (05/05/2023)
Treatment to Control Harmful Habits (05/05/2023)
Comprehensive Orthodontic Treatment (05/05/2023)
Procedure codes that require reporting for Area of Oral Cavity (01/22/2016)
Dental Claim Submission – ICD 10 Dental Diagnosis update Communication (02/17/2015)