Medical Provider Forms

Medical Providers

Thank you for your interest in promoting your pediatric patients' oral health. While preventable, tooth decay is the number one chronic disease of childhood. Keeping children cavity-free helps them thrive and improves their oral health for a lifetime. By delivering preventive oral health services during well-child checks, you can help improve the oral health of your pediatric patients.

Here you will find all the details to enroll your office to receive reimbursements from Washington Dental Service, determine patient eligibility and submit claims.

To sign up with Washington Dental Service, complete and submit the following forms to WDS at P.O. Box 75688, Seattle, WA 98175-0983, or by FAX: (800)460-3159. Direct Deposit
Reimbursement available for the following services
  • D0120 - Periodic Oral Evaluation
  • D1203 - Topical Application of Fluoride
Determine patient eligibility (once provider is enrolled on WDS system)
  • Call WDS Customer Service at (800)554-1907 and use the interactive voice response system (IVR). Here you will get instant information or you can request a fax back with eligibility information. Click here for IVR flow chart.
Submit claims
  • Use Health Insurance Claim Form (HCFA-1500) or electronic version (837P).
  • Submit claims to: Washington Dental Service, PO Box 75983, Seattle, WA 98175-0983.
Other forms Oral Health Training is Available: Washington Dental Service Foundation provides an in-office Continuing Medical Education (CME) course to train primary care medical providers to deliver oral health preventive services to young children during well-child checks. If you are interested in having an in-office training over a lunchtime, please contact Madlen Caplow at mcaplow@deltadentalwa.com or (206)473-9542, or visit www.KidsOralHealth.org for more information.
Questions? Call Washington Dental Customer Service at (800) 554-1907, Monday through Friday, between 8 am and 5 pm, PT.
Patients
Individual Plans
WDS now offers two different types of Individual coverage - Traditional plan and Clear Plan from Delta Dental.
Dentist
Looking for a Dentist?
This directory lists the most current listing of dentists that participate in the Delta Dental Network for the state of Washington.