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You should submit the Tooth System, MISSING TEETH INFORMATION, Permanent, Primary, d o f, A B C D E, F G H I, T S R Q P, O N M L K, f o d, AUTHORIZATIONS, ANCILLARY CLAIM/ TREATMENT, Radio, graph, s Oral Image, s Model, s and Provider, s Office field with the appropriate information.
You'll be requested to write down the data to help the platform fill in the part 52, A © 2006 American Dental Association, J, 400 (Same as ADA Dental Claim, To Reorder call 1, 800, 947, 4746 or, X Signed (Treating Dentist), Date, and 56, A
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