93300 CLAIM FORMS AND TREATMENT FORMS

GENERAL SERVICES

PROFESSIONAL CONSULTATIONS

Completing CDA "Blank" Approved Standard Claim Forms.

Upon request, Providing a Written Treatment Plan/Outline for a Patient, Similar to the Example in the
CDA Policy Manual on Claim Form Completion.

Completing Prepaid Claim Forms which do not conform with Code 93301

For Extraordinary Time Spent In Relation To Claim Forms/Treatment Plan Forms, The Claim Problem
of The Patient Or Processing of Payments

For Extraordinary office Time Spent, In Forwarding Predetermination Records, In Predeterminations
Situations, To Third Parties Plus Expenses (i.e. registration, postage, etc.)

Payment For Orthodontic Treatment In Progress

Predetermination of available benefit. NO FEE