What We Do

SoonerCare (Oklahoma Medicaid) pays for preventative, diagnostic and restorative services for eligible members under the age of 21. Some limited exams, limited x-rays and emergency extractions are covered for eligible recipients age 21 and over. Please visit Medicaid Compliance for the Dental Professional from the Centers for Medicare & Medicaid Services (CMS) to learn about compliance facilitation and good documentation procedures, as well as access a Program Integrity Toolkit.  


The Oklahoma Health Care Authority (OHCA) is governed by the Oklahoma Administrative Rules 317:30-5 and uses the dental codes identified in the Current Dental Terminology (CDT) Manual.

OAR 317:30-5 PART 79. DENTISTS

Fee Schedules

• Dental Fees - (you must agree to the terms for usage before downloading the PDF file)


New Caries Risk Assessment Dental Codes

The Oklahoma Health Care Authority has introduced coverage of caries risk assessment dental codes D0601, D0602 and D0603.  The concept of risk-based dental caries management is not new and is based on the belief that dentists can use certain indicators to classify caries risk status. Assessment should allow for targeted patient/guardian education and engagement in the caries prevention process. Use of this tool will also aid in more accurate predictions of future caries experience and provide a basis to determine if preventive services can be planned more appropriately with the data obtained. 

Your evaluation of each individual member’s caries risk will determine the correct D code to submit for reimbursement - depending upon whether the member is found to be low, moderate or high risk. The updated form is available for download on the OHCA website. Dentists are able to submit a request for payment by completion and submission of the Oklahoma Health Care Authority Caries Risk Assessment Form and signed instructions page. The completed caries risk assessment form should be uploaded via the SoonerCare provider portal for authorization. All signatures and boxes must be completed. The caries risk code submitted for payment must reflect the findings on the completed form. The assessment may be reimbursed once per member per year. Submission of the OHCA Caries Risk Assessment form is now required, in addition to the DEN-2 form, when referring SoonerCare members for orthodontic treatment.

If you have additional questions or comments, contact the OHCA Dental Unit at (405)522-7401.


Commonly Used Forms

  Training Documents

  Services Requiring Prior Authorizations

All requests must demonstrate medical necessity. Providers have 7 days to submit additional information for any PAR that was pended for additional documentation. After 7 days, the PAR will "system cancel" and must submit a new PAR with all necessary documentation.

OHCA’s dedicated staff within Provider Services will assist dental providers with prior authorizations. Please call 405-522-7401 for assistance.

PA requests must be mailed to: 
HPE/Dental Authorization
P.O. Box 548804
Oklahoma City, OK  73154

We are unable to accept faxed PA submissions.

How to submit dental PAs on the Provider Portal (Tutorial)


General Dental Prior Authorizations


PA requests (PARs) should be filed on the currently approved American Dental Association (ADA) claim form accompanied by sufficient documentation (e.g.., study models where indicated, radiographs or images to substantiate need, and documentation that the requested services would be within the scope of the OHCA Dental Program).

Minimum required records to be submitted with each dental PAR are:

1.      comprehensive treatment plan,

2.      right and left mounted bitewing x-rays or panoramic x-ray, and

3.      periapical films of tooth/teeth involved or the edentulous areas if not visible in the bitewings.

X-rays and/or images must be identified by the tooth number and include date of exposure, member name, member ID, provider name, and provider ID. All x-rays or images, regardless of the media, must be submitted together with a completed and signed comprehensive treatment plan that details all needed treatment at the time of examination and a completed current ADA form requesting all treatments requiring PA.  The film/print must also clearly identify the requested service. If you are requesting periodontal services, please also send periodontal charting. Records will not be returned.

Please note that providers are notified via the OHCA Provider Portal as to whether services are denied or approved. A letter is also mailed to the member’s family.


 Orthodontic Prior Authorizations

Orthodontic PA requests should be submitted on the current ADA claim form accompanied by sufficient documentation to ensure that the requested services would be within the scope of the OHCA Dental Program.

In order to efficiently process your requests for minor and comprehensive orthodontia (all D8000 series), please be sure to place the following in ONE BOX or ENVELOPE:

The following information is required to process all requests for comprehensive orthodontics (braces):

  • Caries Risk Assessment
  • Current ADA  claim form and HLD-1 form; 
  • 3-D model images or Study Models (images preferred);
  • Panoramic x-ray;
  • Referral letter from the member’s general dentist;
  • Detailed description of any oral maxillofacial anomaly;
  • Estimated length of treatment;
  • Intraoral photographs showing teeth in centric occlusion and/or photographs of trimmed anatomically occluded diagnostic casts. A lingual view of casts may be included to verify impinging overbites;
  • Cephalometric x-rays with tracing, and panoramic film, with a request for prior authorization of comprehensive orthodontic treatment;
  • If diagnosed as a surgical case, submit an oral surgeon's written opinion that orthognathic surgery is indicated and the surgeon is willing to provide this service

If you are sending several requests at once, they may be sent in one large box or envelope, but please DO NOT SEPARATELY MAIL the paperwork from the other documentation. Records will not be returned.

Please note that  study models, film, digital media or printouts must be of sufficient quality to clearly demonstrate for the reviewer the pathology which is the basis for the minor orthodontics (orthodontic appliances) requested. . Providers are notified via the OHCA Provider Portal Secure Site as to whether services are denied or approved. A letter is also mailed to the member’s family.


Radiographs (X-rays) 


Please note the guidelines from the ADA and the Food and Drug Administration (FDA) regarding radiographs. OAR 317:30-5-696(3)(D) requires that all x-rays be medically necessary. Non-routine dental procedures require PA. X-rays must be identified by left and right sides with the date, member name, member ID, provider name, and provider ID.

Dental Periodicity Schedule


The OHCA Dental Advisory Committee on Periodicity (DACP) intends this guideline to help providers make clinical decisions concerning preventive oral health care for infants, children, and adolescents. Because each child is unique, these recommendations are designed for the care of children who have no contributory medical conditions and who are developing normally. These recommendations will need to be modified for children with special health care needs or if disease or trauma manifests variations from the normal. The American Academy of Pediatric Dentistry (AAPD) and DACP emphasize the importance of very early professional intervention and the continuity of care based on the individualized needs of the child.

Services for Waiver Members with Developmental Disabilities

Dental benefits for adult SoonerCare members served through the In-Home Supports Waiver or Community Waiver have been expanded. Adults with developmental disabilities served in these waivers are evaluated by their case managers for initial services such as a general exam, cleaning and x-rays. Requests for additional treatment may now be directed to the case manager to include up to $1,000 in services such as fillings and root canals in the plan of care year.

All services must be prior authorized by the member’s case manager. The Oklahoma Department of Human Services Developmental Disabilities Services Division has prepared information packets about the expanded benefits to distribute to interested dental providers. Packets are available upon request from the local DDSD nurse or Julie Whitworth at the DHS state office, 405-521-2237.