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Get ADA J430D 2012

Coverage” applies to the primary carrier. 4. Other Dental or Medical Coverage?: Mark the box after “Dental?” or “Medical?” whenever a patient has coverage under any other dental or medical plan, without regard to whether the dentist or the patient will be submitting a claim to collect benefits under the other coverage. • Leave blank when the dentist is not aware of any other coverage(s). • When either box is marked, complete Items 5 through 11 in the “Other Coverage” secti.

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