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Statement of Principles
Standard Dental Treatment Plan Form
1 other sections not shown
administrative agency Approved Standard Dental Association Approved Standard Association/Provincial Dental Association Canadian Dental Association Canadian Dental Association/Provincial CD.A CD.A./Provincial Dental Association cial Dental Association CODE TOOTH commercial laboratory charges computer card claim contract coverage covered crest and approval DATE Dental Act Dental Association Approved Dental Association Policies Dental Association/Provincial Dental Dental Claim Form dental consultant DENTAL INSURANCE Dental Licensing Board dental office dental services Dental Treatment Plan dentures Disciplines or Dental Employer endodontic expertise statement fee estimate guidelines he/she Health Disciplines his/her Insurance Committee insurance company lab charge letter is suggested LETTERHEAD Manual NUMBER ON PATIENT'S oral hygiene orthodontic patient parent/guardian payment Plan Administrator POLICIES ON PREPAID pre-treatment radiographs predetermination of benefits prepaid dental plan procedure codes prosthesis Provincial Dental Association Provincial Dental Licensing records reimbursement responsibility SIGNATURE Standard Dental Claim Standard Dental Treatment study models submitted subscriber subscriber/insured Suggested Fee Guide tion Tooth Code Treatment Plan Form