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Dental

Products & Plan Features

Programs

User Guide

Reference Guides & Policy Manuals   (Registered Providers Only)

  • CIGNA Dental Oral Health Integration ProgramSM* (PDF)
  • Dental Specialty Referral Guidelines: single-page summaries* (PDF)
  • DHMO Dental Office Reference Guide* (PDF)
  • DHMO General Dentist Policy Manual* (PDF)
  • DHMO Endodontist Reference Guide* (PDF)
  • DHMO Oral Surgery Reference Guide* (PDF)
  • DHMO Orthodontist Reference Guide* (PDF)
  • DHMO Pediatric Reference Guide* (PDF)
  • DHMO Periodontist Reference Guide* (PDF)
  • DPPO Dental Office Reference Guide* (PDF)

Policies

X-Ray Policies - NEW!

  • DHMO X-Ray Policy* (PDF)
  • DPPO X-Ray Policy* (PDF)

Forms   (Registered Providers Only)

  • Sample PQA Form 2008
  • Additional Location Form
  • NEMB (AZ only)
  • ABN (AZ only)
  • Pediatric Dental Chart
  • Adult Dental Chart
  • Periodontal Evaluation Chart
  • Medical Update Label
  • Comprehensive Treatment Plan
  • Dissatisfaction Form (CA only)
  • Notice of Provider Dispute (CA only)
  • Add a Dentist
  • Address Change Form
  • Caries Risk Assessment (PDF)
  • Dental Claim Form* (PDF)
  • Dental Office Supply Requisition Form* (PDF)
  • DHMO Uniform Referral Form — Maryland dentists only* (PDF)
  • Submitting Orthodontia Claims

  •      — Sample PPO Orthodontia Claim Form* (PDF)

Being a CIGNA Dental Provider

Your Provider Relations Team

Communications Update

Member Education Materials

** Previously known as CIGNA Choice


CIGNA Dental

CIGNA Dental Oral Health Maternity ProgramSM will provide vital dental care to eligible members, effective January 1, 2006.