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Benefits SUM Sample Dental Claim Form Instructions Image 0
Benefits SUM Sample Dental Claim Form Instructions Image 0
Benefits SUM Sample Dental Claim Form Instructions Image 0
Benefits SUM Sample Dental Claim Form Instructions Image 1
Benefits SUM Sample Dental Claim Form Instructions Image 1
Benefits SUM Sample Dental Claim Form Instructions Image 2
Benefits SUM Sample Dental Claim Form Instructions Image 2

Benefits SUM Sample Dental Claim Form Instructions

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Comprehensive completion instructions for the ADA Sample Dental Claim Form. The Form has been revised to incorporate key changes to the HIPAA standard electronic dental claim transaction. Please note that changes to the form and changes to the completion instructions are highlighted.