Search

Item Details

ComplyRight ADA Dental Claim Form, 1-Part Continuous, 1000/Pack

Item: 728273   Model: 26011
$31.49 Each

Pickup today

,

Out of stock online

Pickup today

,

Check another store

Pickup today

,

Check another store

Available online only

Buy in store today

,

Check another store

Out of stock online

Buy in store today

,

Check another store

Available in-store only

Free Shipping

  • 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)

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.

ComplyRight ADA Dental claim form measures 8 1/2" x 11" and accommodates reporting of National Provider Identifier. Form is officially licensed by the American Dental Association and is sold as 1000 pieces per pack.

  • 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)
  • Printed with special "dropout" red ink on 20# paper
  • Designed for processing on high speed OCR scanning equipment
  • Continuous formats
  • Version 2006
  • Dimensions: 8-1/2" W x 11" H
  • Pack size 1000

HR Form TypeDental Claims

HR Form Pack Size1000

Width in Inches8.5

Number of Parts1

True ColorWhite

Pack Qty1

The product was not found. Please verify the sku and try again.