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ComplyRight ADA Dental Claim Form, 1-Part Continuous, 2500 Box

Item: 728369   Model: 2601
$73.99 2500/Pack

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  • 100% compliant to ensure strict adherence to size, type font and layout requirements
  • 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 ensure strict adherence to size, type font and layout requirements
  • Accommodates reporting of National Provider Identifier (NPI)
  • Designed for processing on high speed OCR scanning equipment
  • 1-part continuous form
  • Version 2006
  • Dimensions: 8-1/2" W x 11" H
  • 2500 per pack
  • Dimensions: 8-1/2" W x 11" H
  • 2500 per pack

HR Form TypeDental Claims

HR Form Pack Size2500

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