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34a Diagnosis Code(s): Enter up to four applicable diagnosis codes after each letter (A. D.). The primary diagnosis code is entered adjacent to the letter A.
What is supporting documentation on a dental insurance claim? X-rays. Intraoral photos. Clinical notes (examples below) Charting. Narratives.
To Print The Standard ADA Form: Go to Office Manager Reports Blank ADA Form. Select the correct form, and click Yes. Check Save as Default Claim Form if you want the current selection to be selected by default each time you print a blank form.
The ADA Dental Claim Form provides a common format for reporting dental services to a patients dental benefit plan. ADA policy promotes use and acceptance of the most current version of the ADA Dental Claim Form by dentists and payers.
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