Downloadable Dental Form: ADA Code D4273: Autogenous connective tissue graft

Downloadable dental forms help the dental practice run more smoothly. Knowing what forms patients need to fill out for what situations makes all the difference in communication.

Content Dam Diq Online Articles 2016 12 Dental Forms 1

Access all of the Downloadable Dental Forms offered on DIQ in one convenient location.

This month's downloadable form focuses on ADA Code D4273: Autogenous connective tissue graft.

This form is required by most insurance companies in order to facilitate an explanation of benefits for a preauthorization or reimbursement. Make sure to include recent periodontal charting, and if available, a full mouth set of x-rays.

Click here or on the image below to view and download the form.

Visit the new Downloadable Dental Forms page to view all of the available FREE forms for your dental practice's use.

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