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ComplyRight ADA ADA Dental Claim Form, 2-Part Continuous, 1000 Box

Item: 728286   Model: 2602
$63.99 1000/Pack

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  • 100% compliant to meet ADA guidelines
  • Accommodates reporting of National Provider Identifier (NPI)
  • Designed for processing on high speed OCR scanning equipment

Authorized for use by the American Dental Association, these dental claim forms allow the attending dentist to bill patients’ insurance providers for reimbursement of dental claims.

Authorized for use by the American Dental Association, these dental claim forms allow the attending dentist to bill patients’ insurance providers for reimbursement of dental claims.

All claim forms officially licensed by the American Dental Association and supported by most popular dental software packages

  • 100% compliant to meet ADA guidelines
  • Accommodates reporting of National Provider Identifier (NPI)
  • Designed for processing on high speed OCR scanning equipment
  • 2-part continuous form
  • Version 2006
  • Dimensions: 8-1/2" W x 11" H
  • 1000 per pack
  • Dimensions: 8-1/2" W x 11" H
  • 1000 per pack

HR Form TypeDental Claims

HR Form Pack Size1000

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