ComplyRight Dental Claims, 100/Pack (1900100)
Item #:
901-24433066
Model #:
1900100
Brand:
ComplyRight
(1 reviews)
Item #:
901-24433066
Loading...
$13.59
Per each
Upgrade to get 5% off, earn points 10% faster and more.
Customers also viewed
Medical Arts Press® Compact Animal Record Card
Item #: 901-20376
Medical Arts Press® Privacy Practices Acknowledgement
Item #: 901-28984
ComplyRight™ HIPAA Notice of Privacy Practices Poster (A2123)
Item #: 901-728245
ComplyRight™ HIPAA Protecting Patient Privacy Poster (A2126)
Item #: 901-728247
ComplyRight™ Employee Records Folder, Letter Size, Pack of 25 (A5001)
Item #: 901-1949184
ComplyRight™ Expanded Employee Records Folder, Letter Size, Pack of 25 (A5008)
Item #: 901-1949181
TOPS Voice Message Pad, 8-1/2" x 8-1/4", White, 50 Sheets/Pad (44165)
Item #: 901-903037
ComplyRight™ Orthodontic Case Envelo-File®
Item #: 901-AR1048
ComplyRight™ CMS-1500 Health Insurance Claim Form (02/12); 100 Sheets
Item #: 901-CMS12650657
ComplyRight™ Georgia Job Application, Pack of 50 (A2179GA)
Item #: 901-1182913EDI
ComplyRight™ New York Job Application, Pack of 50 (A2179NY)
Item #: 901-1182876EDI
ComplyRight™ Kansas Job Application, Pack of 50 (A2179KS)
Item #: 901-1182885EDI
ComplyRight™ Connecticut Job Application, Pack of 50 (A2179CT)
Item #: 901-1182917EDI
ComplyRight™ Texas Job Application, Pack of 50 (A2179TX)
Item #: 901-1182982EDI
ComplyRight™ Florida Job Application, Pack of 50 (A2179FL)
Item #: 901-1182914EDI
ComplyRight™ Illinois Job Application, Pack of 50 (A2179IL)
Item #: 901-1182911EDI
Description
This ADA dental claim form allows healthcare providers to bill a patient's insurance company for reimbursement of dental claims. These forms in laser format feature 8.5" x 11" size. This is the latest version of the claim/attending dentist form (2019).
- Dental claim forms
- 100 forms per pack
- Comes as a white sheet with black text
- Dimensions: 8.5"W x 11"L
- This is the latest version of the claim/attending dentist form (2019)
- 100% compliant to meet the American Dental Association (ADA) guidelines
- Features laser format
Specifications
Brand
ComplyRight
Form Size
8 1/2" x 11"
Length in Inches
11
Medical Form Pack Size
100
Medical Form Type
Dental Claims
Pack Qty
100
Print Type
Laser
True Color
Black/White
Width in Inches
8.5