NextDayLabels - ADA Dental Claim Insurance Claim Forms, 8-1/2' X 11' Letter Size for Laser or Ink Jet Printers (Pack of 100 Sheets)
$19.99
$19.99
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8
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$8.99
1.Size:Pack Of 100 Sheets
- Comprehensive Form: This ADA American Dental Association Dental Claim Form is a comprehensive document for submitting dental claims and treatment information. Pack of 100 Sheets
- Detailed Sections: The form includes sections for patient information, policyholder/subscriber details, dental benefit plan information, and a record of services provided.
- Coding Support: It allows for entering diagnostic codes, treatment codes, and other relevant coding for proper claim processing.
- Authorization Segment: There is a dedicated section for obtaining authorizations and signatures from the patient or policyholder.
- Dentist Information: The form provides fields to enter the treating dentist's name, address, license number, and other relevant details, Made in the USA by Next Day Labels TM
