ADA Dental Claim Form (CMS-10883)

OMB 0938-1471

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10883 Paper Submission Form and Instruction
Form CMS-10883 Electronic Submission Form and Instruction
CMS-10883.Supporting Statement Part A (3-28-24).docx Supporting Statement A
Paper Submission Form and Instruction
Electronic Submission Form and Instruction

All Historical Document Collections

202403-0938-016

2024-04-04