DescriptionName Address City State Zip Code 18. Relationship to Policyholder/Subscriber in 12 Above J400 Same as ADA Dental Claim Form J401 J402 J403 J404 To Reorder call 1-800-947-4746 or go online at www. Wpc-edi. com/codes/taxonomy Should there be any updates to ADA Dental Claim Form completion instructions the updates will be posted on the ADA s web site at www. Adacatalog. org Comprehensive completion instructions for ...
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