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Most Recent Prophy Date

Pre-op Images
before original protected treatment was completed

Post-op Images
after original protected treatment was completed

Failure or Damage Images
showing claim eligible issue(s) with original protected treatment

Clinical Notes
Must include all entries from date of original diagnosis through the date claim is submitted

Patient Ledger
Must include all entries from date of original diagnosis through the date claim is submitted and show teeth numbers, procedure codes, and fees