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RETURN TO Administrative Services Only Inc. PO Box 9005 Lynbrook NY 11563 516 396-5500/ 800 537-1238 NORTH SHORE SCHOOLS FEDERATED EMPLOYEES BENEFIT TRUST FUND DENTAL CLAIM FORM PRE-TREATMENT ESTIMATE PLEASE SUBMIT PRE-OPERATIVE X-RAYS FOR INLAYS CROWNS BRIDGES DENTURES PERIO SURGERY ROOT THERAPY AND NON-ROUTINE EXTRACTIONS. X-RAYS OF FULL ARCH REQUIRED FOR ALL BRIDGE WORK. POST TREATMENT X-RAYS REQUIRED FOR ALL ROOT THERAPY CLAIMS. RECOMMENDED FOR INLAYS CROWNS BRIDGES DENTURES PERIODONTAL...
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