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Dental General Manual, Covered Services and Bulletins


Dental Manuals

Dental Manual
Dental Fee Schedule

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

Dental Provider Workshop Presentations 2015

Dental Provider Checklist  2015
Wyoming Medicaid Portal Web Portal Presentation
Medicaid Policy

Important Dental Information

2015 Manual Updates

2/19/15 - Updated Retention of Records Section 3.8.2, updated Chapter 9 Wyoming HIPAA 5010 Electronic Specifications, updated Benefit Plan Guide

1/28/15 - Updated Benefit Plan Guide Appendix and revised Section 10.3
1/26/15 - Revised Invoice Charges Section 6.4.1

2014 Manual Updates

12/17/14 - Updated Section on page 10-18 to include additional information regarding D8660
11/17/14 - Updated all claim form information to reflect the new 2012 ADA Claim Form
10/14/14 -  Updated Section 10.2.2 Information on code D0376
9/1/14 - Updated Section 6.7 (LOA), updated Section 10..2.21 to reflect the new Malocclusion Program Changes, added new forms (Referral Under 12 and Malocclusion Treat ment Request) Section and
7/1/14 - Added D0367 to Section 10.2.2, added D0191 to Section 11.2.1, Added D4355 Section 11.2.5
4/1/14 - Removed Note in Section 10.1.14
3/17/14 - Added sentance regarding D4910 in Section 10.2.9
3/1/14 - Added FQHC Section 10.1.7, Added codes to section 10.2.11
2/14/14 - Added Code D7941 to Section 10.2.13
2/4/14 - Added wording to Section 10.2.9

July 1, 2014 Changes

Effective July 1, 2014 and foward, Wyoming Medicaid will be accepting new dental codes.  Information regarding these new codes, billing for deliverable items, Letter of Agreements (LOAs) was sent out in a provider bulletin via email.




As of January 1, 2015, Wyoming Medicaid will only accept the 2012 or newer ADA claim form. Older versions of this form will no longer be accepted and will be returned to the provider unprocessed.


Dental Bulletins and Forms

2015 Bulletins

PERM Provider Education 5.18.15
2015 Dental Workshops Postcard 4.27.15
Re-Enrollment Deadline Approaching 4.1.15
Oral Surgery Dental RA Banner 3.4.15
Periodicity Dental RA Banner 2.19.15
Periodicity Dental Pamphlet 1.30.15
Periodicity Schedule Checklist 1.29.15

2014 Bulletins

2012 ADA Dental Claim Form Mandate 11.26.14
Re-Enrollment Reminder Email 10.10.14
Policy Change for Root Canal/Crowns 9.16.14
Orthodontic Parent Handout-Spanish Version
Web Portal Billing for Dentists 8.26.14
Severe Malocclusion 8.26.14
Orthodontic Referral Updates for all Dentists 8.15.14
Othodontic Updates for Orthodontic Providers 8.15.14
Malocclusion Treatment Request Form
Malocclusion Referral Form for Clients under 12
July 1, 2014 Dental Program Changes
Client Acceptance Form Reminder
On-line/Web Re-enrollment 5.1.14
Wyoming Medicaid ICD-10 Information
2nd Qtr 2014 Health Check Newsletter
Sample ADA Dental Claim Form

2013 Bulletins

Tooth Replacement Request Form 10.1.13
Medicaid and Kid Care Application Changes 9.10.13
Dental Program Changes 10.1.13
Dental Nitrous Oxide Update 8.7.13
1+1 Dental Program
PDAP Oxygen Termination 7.1.13
Dental Program Changes Email
Dental Program Changes 8.1.2013
Revised Dental Client Accpetance Notice
Recovery Audit Contractor Information and Training Opportunities 5.10.13
Important Dental Enrollment Policy 2.19.13
Dental CDT Code Changes 1.7.13
Wyoming Medicaid Fraud/Program Integrity Information
Orthodontic Parent Handout - Updated 8.19.14
Wyoming Medicaid Dental Training Presentation
Crippling Malocclusion Program Criteria Presentation
Dental Provider Client Acceptance FormUpdated
Letter of Agreement
Revised Medicaid Policies

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