Does ProviderOne Cover Dental? Adults, Children, and Costs

Yes. If you have Washington Apple Health and a ProviderOne services card, your dental care is covered at no cost to you, with no separate dental plan to buy. Children under 21 receive a broad range of preventive and treatment services; adults 21 and older receive a narrower set focused on basic and preventive care.¹ Show the card at a participating dentist and the state pays the provider directly.

What Adults Get (Age 21 and Older)

Adult coverage includes routine exams, cleanings, X-rays (bitewings, panoramic, periapical, and full-mouth series), fillings (composite or amalgam), fluoride treatments, and extractions.²

Beyond the basics, Apple Health also pays for scaling and root planing (deep cleanings for gum disease), nitrous oxide sedation, general anesthesia and IV sedation when medically necessary, oral surgery including biopsies, and complete and partial dentures.²

What Adult Coverage Excludes

Several services many patients expect are not covered for adults. Apple Health does not pay for bridges, porcelain crowns, dental implants, or orthodontics. Root canals are covered only on anterior (front) teeth, not on molars or premolars. The only crowns included in standard adult coverage are stainless steel.² When a back tooth cannot be saved through a covered procedure, the typical covered path is extraction followed by dentures. Immediate dentures (placed right after tooth removal) are also not a covered benefit, and the Health Care Authority has warned providers against billing them as standard complete dentures.³

What Children Get (Age 20 and Under)

Children’s coverage is substantially broader. Federal Medicaid rules (the Early and Periodic Screening, Diagnostic and Treatment benefit) require states to provide a full range of preventive and treatment services for enrolled children under 21.⁴

For children, Apple Health covers routine exams, cleanings, X-rays, sealants, fillings, crowns, fluoride application, and extractions. Orthodontic treatment (braces) is available for children with cleft palate or other serious dental conditions, with prior authorization to confirm medical necessity.⁵ Children age five and under may qualify for the Access to Baby and Child Dentistry program, which connects young enrollees to participating dentists and uses primary care medical offices for preventive services like fluoride varnish.⁴

What You Pay

Nothing for covered services. Apple Health dental has no copays, no deductibles, and no out-of-pocket costs. The ProviderOne card works like an insurance card at the dentist’s office, and the state pays the provider. Apple Health premiums themselves are either free or very low depending on income.⁵

Frequency Limits and Prior Authorization

Covered doesn’t mean unlimited. Routine exams and cleanings are generally covered every six months, certain X-rays are limited to once a year or less often for full-mouth scans, and some procedures carry yearly quantity caps.⁶

Some procedures need the dentist to get prior authorization from the Health Care Authority before treatment. Complete and partial dentures require prior approval.⁷ Complex oral surgery, periodontal surgery, and early denture replacement also need advance approval, as does orthodontic treatment for children. The provider submits a written request with clinical information from the past twelve months, and an approved authorization remains valid for six to twelve months as long as the patient stays eligible.⁸ A recent change dropped the prior authorization requirement for crown build-up and post-and-core services for patients 20 and younger.³

Expanded Coverage for Specific Groups

Some adults get more than the standard adult benefit. People enrolled in Developmental Disabilities Community Services, or living in a skilled nursing facility or alternate living facility, may receive certain services at increased frequency.² Adults with developmental disabilities can also get stainless steel crowns on posterior teeth with supporting documentation, which standard adult coverage does not include.⁷ Patients with diabetes may receive up to four periodontal maintenance cleanings in a twelve-month period.

Emergency Dental Care

Apple Health covers palliative (emergency) dental treatment for pain, limited to once per day per patient. After-hours emergency office visits and hospital visits for dental emergencies are also covered at one visit per day per provider. Post-surgical complications such as dry socket are covered when medical necessity is documented.⁹

Finding a Dentist Who Takes Apple Health

You need a dentist who accepts Apple Health, and that can take some searching. DentistLink, a free nonprofit referral service run by the Arcora Foundation in partnership with the Health Care Authority, connects enrollees with participating dentists. You can search the online directory, call or text a referral specialist at 844-888-5465 on weekdays, or submit an online request. DentistLink can also help arrange transportation to dental appointments.¹⁰

If a Service Is Denied

You have the right to appeal. Start by filing an appeal with your health plan, in writing if possible, as soon as the denial notice arrives. If you are already receiving a service that is being terminated or reduced, filing within ten days of the notice date preserves coverage during the appeal.¹¹

If the plan upholds the denial, you can request a hearing through the Office of Administrative Hearings by calling 1-800-583-8271 or writing to P.O. Box 42488, Olympia, WA 98504. Expedited appeals, resolved within 72 hours, are available for urgent medical situations. Further review through the Board of Appeals and then Superior Court is available after that.¹¹

1
Washington Healthplanfinder. Washington Apple Health
2
Washington State Health Care Authority. Apple Health Adult Dental Coverage
3
Washington State Health Care Authority. Apple Health Dental Providers Newsletter, February 2026
4
Arcora Foundation. Medicaid Facts and Figures Executive Summary
5
DentistLink. Apple Health Medicaid Covers Dental Care
6
BTY Dental. Dental Treatments Using Apple Health Medicaid in Washington
7
King County. Adult Dental Coverage Apple Health
8
Cornell Law Institute. WAC 182-535-1220
9
Cornell Law Institute. WAC 182-535-1098
10
DentistLink. DentistLink
11
Washington Law Help. Appeal Denial Your Health Plan