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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.7 2012 American Dental Association (ADA) Dental Claim Filing Instructions : 6.7.3 2012 ADA Dental Claim Form

Samples of the ADA Dental Claim form can be found on the ADA website at

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.