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  • Tricare Dental Program Claim Form - Tricare

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DENTIST'S CLAIM FORM Check One: Dentist's pre-treatment estimate Dentist's statement of actual services 1. Patient name UNITED CONCORDIA TDP OCONUS Dental Unit P.O. Box 69418 Harrisburg, PA 17106-9418.

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TRICARE covers adjunctive dental care. as part of the "medical" benefit. Dental coverage for diagnostic and preventive services, restorative services, orthodontics, oral surgery, endodontics and other non-medical services are provided under two different dental plans: TRICARE Active Duty Dental Program.

TRICARE Prime offers fewer out-of-pocket costs than Tricare Select, but less freedom of choice for providers. There are four Tricare Prime Plans: Tricare Prime. Tricare Prime Remote....Copay Amounts. ServiceActive Duty CostGroup A Retiree CostPrimary Care$0$24Specialist$0$36Urgent Care$0$36Emergency Room$0$732 more rows • 7 Nov 2022

The TRICARE Dental Program (TDP) is a voluntary dental plan. Sponsors can enroll through the Beneficiary Web Enrollment website. You can enroll if you're a: Family member of an active duty service member.

If yes, then you can file your claims online. Fill out the TRICARE Claim Form. Download the Patient's Request for Medical Payment (DD Form 2642). ... Include a Copy of the Provider's Bill. ... Submit the Claim. ... Check the Status of Your Claims.

Dental Claims PlanLocationClaims AddressTRICARE Dental ProgramOCONUS Service AreaUnited Concordia TRICARE Dental Program P.O. Box 69452 Harrisburg, PA 17106 Fax: 1-844-827-9926 (toll-free) 1-717-635-4520 (toll)3 more rows • May 6, 2022

TRICARE covers adjunctive dental care. as part of the "medical" benefit. Dental coverage for diagnostic and preventive services, restorative services, orthodontics, oral surgery, endodontics and other non-medical services are provided under two different dental plans: TRICARE Active Duty Dental Program.

In general, TRICARE excludes services and supplies that are not medically or psychologically necessary for the diagnosis or treatment of a covered illness (including mental disorder), injury, or for the diagnosis and treatment of pregnancy or well-child care.

Preventive Care Preventive dental care is used to protect your gums and teeth from decay and infection. The TDP covers two routine dental cleanings in a consecutive 12-month period for each enrollee.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232