shield dental claim form
Dental Claim Form
Ask your dentist to complete Sections 2 and 3, and sign the claim form; or attach an original itemized superbill. 3. All bills must include the following:.
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ADA Dental Claim Form
Comprehensive completion instructions for the ADA Dental Claim Form are found in Section 4 of the ADA. Publication titled CDT-2007/2008.
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claims filing instructions
If the form is hand-written, the information must be clear, must be written in black or blue ink and all data must be within the pre-determined lines/boxes on
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