| Assigned number | Title | Release date Sort ascending | Language | Available to order |
|---|---|---|---|---|
| F-11014 | Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services (PDF) | 02/17/2020 | English | No |
| F-11014 | Prior Authorization / Dental Attachment 2 (PA/DA2) Oral Surgery, Orthodontic, and Fixed Prosthetic Services (Word) | 02/17/2020 | English | No |
Last revised October 6, 2026