Dental prior authorization

Prior authorization list

While not required, we encourage prior authorization for the services listed below. The list is not comprehensive.

To request authorization for these services, you may use the ADA Dental Claim Form and mark the "Request for pre-determination/preauthorization" box. Please include clinical documentation sufficient to determine eligibility and dental or medical necessity.

To determine if we recommend or require prior authorization for a particular service, search our Authorization Grid.