CHIP Value-Added Services Redemption Form

Fill out the below information and click 'submit' to redeem your DentaQuest value added service reward.

Member Information  
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Your Plan:


What service did you receive at your dental appointment?

Annual Preventive Care Reward:





Dental Visit Within 90 Days Reward:

Emergency Room Follow-Up Care Reward:

Your Child's Oral Health and the ER Quiz
Take this quiz and test your knowledge.

1. Your child has a toothache. What should you do?:



2. You took your child to a hospital ER for a toothache. What should you do next?:



3. Your child has a toothache, but you don’t have a Main Dentist. What should you do?:



4. When should you call your dentist for an immediate visit?:



5. When should you take your child to a hospital ER for oral care?: