Dental Treatment

A dentist may be the treating provider of record for an injured worker. Treatment parameters and prior authorization guidelines are applicable for all dental services, including referrals.

Documentation Requirements

WSI requires legible medical documentation, which specifies the extent of the injury and treatment provided. In addition to the medical documentation, WSI requests a dental provider complete the Dentist’s Report of Injury (C31) form for each of the following:

  • Initial evaluation
  • Major change in the condition or treatment plan
  • Discharge from care

Prior Authorization

Dental Authorization includes detailed information on prior authorization requirements and instructions for submitting a prior authorization request.


WSI does not provide pre-treatment estimates of payment. For information on reimbursement of dental procedures, refer to the WSI Dental Fee Schedule. The Dental Fee Schedule Guideline provides additional information on WSI’s pricing methodology, payment parameters, billing requirements, and reimbursement procedures.


The Quick Reference for Dental Providers contains additional information related to dental treatment and authorization requirements.

If a concern arises during treatment of an injured worker, e.g. the injured worker not attending appointments, symptoms not consistent with the injury, cancellation of medical appointments, or noncompliance with treatment plan, contact Customer Service at 701-328-3800 or 800-777-5033.