Item #: 728369 | Model #: 2601
ComplyRight ADA Dental Claim Form, 1-Part Continuous, 2500 Box
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ComplyRight ADA Dental Claim Form, 1-Part Continuous, 2500 Box

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Product Details
  • Accommodates reporting of National Provider Identifier (NPI)
  • Designed for processing on high speed OCR scanning equipment
  • 1-part continuous form
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73.99
73.99
https://www.staples-3p.com/s7/is/image/Staples/s0480835
00015171312272
ComplyRight
ComplyRight ADA Dental Claim Form, 1-Part Continuous, 2500 Box
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.

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.

  • 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
All claim forms officially licensed by the American Dental Association and supported by most popular dental software packages
Specifications
HR Form Type Dental Claims
HR Form Pack Size 2500
Width in Inches 8.5
Number of Parts 1
True Color White
Pack Qty 1
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