Providers:
Check out our monthly must-read designed to help you stay informed, save time and focus on patient care.
For commercial providers only
Effective Jan. 1: Adult prophylaxis age criteria update
To better align preventive care guidelines with patients' dental development and oral health needs, Delta Dental of Michigan will change the age threshold for adult prophylaxis (D1110) from 14 years of age to 12 years of age, effective Jan. 1, 2027.
Submitting claims
Dates of service prior to Jan. 1 will continue to be processed under the current policy. A prophylaxis performed on a 13-year-old or younger member before the effective date will be considered a child prophylaxis and adjudicated according to the existing guidelines.
Providers should continue to submit claims using the appropriate CDT code based on the member's age and the applicable policy requirements at the time the service is rendered.
For all providers
News and information for all participating commercial, Medicaid and Medicare providers
Cracking the code: D0120 (periodic exam), D0140 (problem-focused exam) and D0150 (comprehensive exam)
Code D0120, Periodic Oral Evaluation, is used for periodic exams. This is an exam for an established patient where the dentist may check for caries, gum disease and other changes since the patient’s last visit.
Code D0140, Problem-Focused Exam, is used when a patient presents with a specific concern or dental problem, including a toothache, broken tooth or lost crown.
Code D0150, Comprehensive Oral Evaluation, is used for a thorough, initial exam. This exam is typically for a new patient, a patient who hasn’t been seen in at least three years or a patient with a new oral or systemic health concern. The dentist may review the patient’s dental and medical history, evaluate the entire mouth (including an oral cancer screening) and establish a baseline for future care.
Better together: Your professional services representative and customer service
Access starts with awareness. When you know what's available, you can spend less time searching and more time getting results.
Your professional services representative is available to answer questions and provide guidance on a variety of topics, including EFT enrollment, network participation and understanding your contract or fee schedule.
For account-specific inquiries, claims questions and other detailed support needs, our customer service team offers additional resources and assistance at 800-524-0149.
Reporting provider, location or practice changes to provider records
Providers should notify provider records by calling 800-656-6459 or emailing providerrequests@deltadentalmi.com when there is a:
New provider joining the practice
Provider leaving or retiring from the practice
Change to office location
Change to practice ownership
Update to office contact information, including phone number, fax number and address
Change to accepting new patients status
Change to network directory status information
To help ensure the most efficient and accurate help, providers should include the following information in any phone or email communication regarding provider, location or practice changes.
Office TIN
Office location involved
Provider name
Provider NPI
Effective date of the change (such as a provider termination, addition or location update)
Meet us Oct. 17: The Michigan Dental Assistants Association Annual Session
We’re proud to sponsor and attend the Michigan Dental Assistants Association (MDAA) Annual Session Oct. 17 in Frankenmuth. Members of the professional services team will be at the Delta Dental booth throughout the event, available to answer questions and provide resources or support.
Pre-treatment estimate vs. prior authorization
A pre-treatment estimate allows the office and patient to receive an estimate of how a proposed treatment may be covered under the member’s benefits before services are performed. It’s not a guarantee of payment, as final payment is based on the member’s eligibility, benefits and applicable plan provisions at the time services are rendered.
Prior authorization is different in that certain services or benefits may require review and approval before treatment is performed, depending on the member’s plan requirements.
Offices should verify the member’s benefits and requirements prior to treatment to determine whether prior authorization is required, or whether they are requesting an estimate of benefits.
Oral lesion testing update
CDX Diagnostics Inc. filed for Chapter 7 bankruptcy protection Aug. 20, 2026. Providers who use exfoliative cytology for suspicious oral lesions may consider alternatives such as OraLiva.
OraLiva, an AI-powered system, offers a noninvasive brush test and can be shipped without slide preparation. Peer-reviewed studies report 92% sensitivity and 89% specificity, with test results typically available within one week.
Sample collection is reimbursable under Code D7288 for eligible members. You can learn more at oraliva.com or call 919-275-0046.
Dec. 8: TeamSmile volunteer opportunity
Make a difference in a child's life—one smile at a time. TeamSmile is seeking dentists, hygienists, dental assistants and community volunteers for a Detroit event Dec. 8.
Your time and expertise can help provide essential oral healthcare and education to local children.
For Medicaid and Medicare providers only
What to expect from family dental home assignments
Family dental home assignments are designed to help members connect with a dentist, while preserving their ability to choose where they receive care. For patients already established with your office, little to nothing will change; they will simply be formally assigned to their current provider. Members without an established dental provider may be assigned to a nearby dental home to help them begin receiving care. Assigned members are not required to visit that provider and may continue to see any dentist they choose. Dental home assignments are intended to support member access to care and are not expected to result in a sudden, significant increase in patient volume.
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