Florida Healthy Kids Incentive Form

To get your $10 Walmart gift card you must:

While showing active coverage, make sure to have the qualifying dental services:

I had a sealant

Date of service

Yes

Member Information

First Name

Last Name

Date of Birth

Phone

Mailing address

City

Zip code

If you have questions, please call DentaQuest toll free 888-696-7566. TTY: 800-466-7566

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