ComplyRight ADA Dental Claim Form, Laser-Cut Sheet, 1000/Cartoon (12001)

Item #: 728276 | Model #: 12001
$35.24
$35.24

About this product

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