| Assigned Number | Title | Release Date Sort ascending | File Type | Language | Available to Order |
|---|---|---|---|---|---|
| F-11014 | Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services | 02/17/2020 | English | No | |
| F-11014 | Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services | 02/17/2020 | Word | English | No |
Last revised June 30, 2025