Item #: 728276 | Model #: 12001
ComplyRight ADA Dental Claim Form, Laser-Cut Sheet, 1000/Cartoon
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ComplyRight ADA Dental Claim Form, Laser-Cut Sheet, 1000/Cartoon

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$39.79
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Product Details
  • Dimensions: 8-1/2" W x 11" H
  • 1000 per carton
  • All claim forms officially licensed by the American Dental Association and supported by most popular dental software packages
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39.79
39.79
https://www.staples-3p.com/s7/is/image/Staples/s0480768
00015171312371
ComplyRight
ComplyRight ADA Dental Claim Form, Laser-Cut Sheet, 1000/Cartoon
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 carton.

  • Dimensions: 8-1/2" W x 11" H
  • 1000 per carton
  • 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
  • Laser Cut Sheet
  • Printed with special "dropout" red ink on 20# paper
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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