Hi there and thanks for asking a question today!
The Illinois State Dental Society recommends that you talk with your dentist about the problem first. If that doesn't work, or isn't an option, you can complete a "Request for Review of Dental Services Form" and submit it to the Illinois State Dental Society.
The following link offers suggestions on dealing with your dentist and also a link to the form:
http://www.isds.org/publicInfo/handleDispute.asp
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