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Dental Claim Form HEADER INFORMATION Delta Dental of Massachusetts PO Box 2907 Customer Service Milwaukee, WI 532012907 8008720500 1. Type of Transaction (Mark all applicable boxes) Statement of Actual

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What is j430d dental claim form?

The J430D dental claim form is a standard form used to file dental claims for reimbursement.

Who is required to file j430d dental claim form?

Dental providers are required to file the J430D dental claim form in order to request reimbursement for services provided to patients.

How to fill out j430d dental claim form?

The J430D dental claim form must be filled out with the patient's personal information, details of the dental services provided, and any supporting documentation, such as x-rays or invoices.

What is the purpose of j430d dental claim form?

The purpose of the J430D dental claim form is to request reimbursement from insurance companies for dental services provided to patients.

What information must be reported on j430d dental claim form?

The J430D dental claim form must include the patient's name, date of birth, insurance information, details of the dental services provided, dates of service, and the provider's information.

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