Dental Provider Guide

Plan Documents and Helpful Information

• DLV 503 (PDF)
• DLV 507 (PDF)
• Embedded Pediatric Dental HMO Breakdown (PDF)
• Southern Nevada Pediatric Dental Fee Schedule (PDF)
• Southern Nevada General Dentistry Fee Schedule (PDF)
• Northern Nevada General Dentistry Fee Schedule (PDF)
• Endodontic Dental Fee Schedule (PDF)
• Oral Surgery Dental Fee Schedule (PDF)
• Orthodontic Fee Schedule (PDF)
• Periodontic Fee Schedule (PDF)
• Frequency and Limitation Grid (PDF)
• Dental Claim Reconsiderations (PDF)

For additional plan information, forms, and policies, please visit our Health Plan of Nevada Provider Summary guide here.