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ATTENDING DENTISTS STATEMENT CHECK ONE dentist PRETREATMENT ESTIMATE* *REQUIRED FOR TREATMENT OVER $300 DENTISTS STATEMENT OF ACTUAL SERVICES CITY OF YONKERS C×O THE PREFERRED GROUP P.O. Box 15136

How to fill out attending dentist39s statement 6800

How to fill out attending dentist's statement 6800:

1. Make sure to fill in the patient's personal information accurately, including their name, address, and contact information.
2. Provide details about the dental treatment that was provided to the patient. Include the dates of treatment, specific procedures performed, and any relevant diagnostic codes.
3. Indicate the cost of each dental procedure performed. Break down the costs, including the fee for service, any insurance coverage, and the patient's responsibility.
4. If applicable, include any supporting documentation, such as X-rays or lab reports, that can provide further evidence of the treatment provided.
5. Sign and date the attending dentist's statement 6800 to verify its accuracy and authenticity.

Who needs attending dentist's statement 6800:

1. Patients who have received dental treatment and need to submit a claim to their insurance company for reimbursement.
2. Insurance companies that require documentation to process dental claims and determine coverage.
3. Dental offices that want to maintain detailed records of the treatment provided to their patients.

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What is attending dentist's statement 6800?

The attending dentist's statement 6800 is a form used by dentists to report on dental services provided to patients.

Who is required to file attending dentist's statement 6800?

Dentists who have provided dental services to patients are required to file the attending dentist's statement 6800.

How to fill out attending dentist's statement 6800?

The attending dentist's statement 6800 should be filled out with details of the dental services provided, patient information, and any other required information as per the form instructions.

What is the purpose of attending dentist's statement 6800?

The purpose of attending dentist's statement 6800 is to report on dental services provided to patients for billing and record-keeping purposes.

What information must be reported on attending dentist's statement 6800?

Information such as patient details, date of service, description of services provided, and any other required information as per the form instructions must be reported on attending dentist's statement 6800.