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In this video tutorial, the presenter demonstrates how to fill out the top portion of a dental insurance claim form for Hugh Morus. Begin with the first box in the upper-left corner labeled "header information" and select "statement of actual services." Then, move to the second box; the authorization number is not needed, so enter "N/A." In box three, provide the insurance company details, entering "Prudential insurance" along with the address: P.O. Box 807, New York, NY 00216. Boxes four through eleven pertain to other coverage, which should be filled out if Hugh has dual coverage.