Item #: 728273 | Model #: 26011
ComplyRight ADA Dental Claim Form, 1-Part Continuous, 1000/Pack
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ComplyRight ADA Dental Claim Form, 1-Part Continuous, 1000/Pack

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Product Details
  • Version 2006
  • Dimensions: 8-1/2" W x 11" H
  • Pack size 1000
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31.49
31.49
https://www.staples-3p.com/s7/is/image/Staples/s0480833
00015171312173
ComplyRight
ComplyRight ADA Dental Claim Form, 1-Part Continuous, 1000/Pack
Product Description
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.

  • Version 2006
  • Dimensions: 8-1/2" W x 11" H
  • Pack size 1000
  • 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
Specifications
HR Form Type Dental Claims
HR Form Pack Size 1000
Width in Inches 8.5
Number of Parts 1
True Color White
Pack Qty 1
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