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Download the 2024 dental claim form from cms. Download the current version of the 2024 ada dental claim form © and get the completion instructions, sample form, and video. Ada dental claim form completion instructions version 2024 © american dental association page 1 of 16. Download a free printable ada dental claim form from dentaquest, a dental benefits provider.
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The form is designed so that the primary payer's name and address (item 3) is visible in a standard #10 window envelope.