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.
