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  • Denti-cal Combination-tar Dc-217 Claim Form Specifications

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DENTICAL COMBINATIONTAR DC217 CLAIM FORM SPECIFICATIONS DENTICAL BOX ON FORM WHERE IN EAGLESOFT 1 Patient Name (Last, First, M.I.) Edit Person REPRINT ( P ) /RECREATE ( C ) P 2 Patient Soc. Sec. No.

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While Medi-Cal does cover orthodontic work, not all treatments are covered by the program. Moreover, age restrictions make many Medi-Cal patients ineligible for orthodontic coverage. As of 2022, Medi-Cal orthodontic coverage is only available to patients under the age of 21—no extensions allowed.

Denti-Cal will only provide up to $1800 in covered services per year. Some services are not counted towards the cap, such as dentures, extractions, and emergency services. Your dental provider must check with Denti-Cal to find out if you have reached the $1800 cap before treating you.

Reason Code 081 - Periodontal procedures cannot be justified on the basis of pocket depth, bone loss, and/or degree of deposits as evidenced by the submitted radiographs and/or charting. Refer to Periodontal General Policies (D4000- D4999) in section 5 of the Provider Handbook.

To file a claim, you must submit a Medi-Cal Claim Form for Beneficiary Reimbursement. The claim form must be filled out in blue or black ink; • The claim form must have an original signature (no copies will be accepted); The Claim Form must include: • A photo copy of your Medi-Cal Beneficiary Identification Card (BIC).

Medi-Cal Dental Program's Payer ID number is 94146.

Medi-Cal is California's Medicaid program. It is very common in California. Medi-Cal doesn't cover Dental Implants. If you have Medi-Cal and need Dental Implants, you can make use of our attractive financing options.

The most common misconception surrounding the Medi-Cal program and dentistry is that Denti-Cal is a separate program that people have to qualify into or out of; this is simply untrue. Nearly everyone that qualifies for Medi-Cal benefits can reap the benefit of Denti-Cal with no additional work on their part.

What is the Medi-Cal Dental Program's Payer ID? A. Medi-Cal Dental Program's Payer ID number is 94146. 1.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232