Shopping Cart

Your cart is empty.

Your cart is empty.

NextDayLabels - ADA Dental Claim Insurance Claim Forms, 8-1/2' X 11' Letter Size for Laser or Ink Jet Printers (Pack of 100 Sheets)

5.0 Write Review
Free shipping on orders over $29.99

$19.99

$ 7 .99 $7.99

In Stock

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


Product Description

ada
5
ada-2
ndl
Customer Reviews
4.6 out of 5 stars 1,286
4.7 out of 5 stars 358
5.0 out of 5 stars 13
4.5 out of 5 stars 1,225
4.5 out of 5 stars 9,768
4.3 out of 5 stars 172
Qty 500 Sheets Per Pack 25 Sheets Per Pack 500 Labels Per Roll - 1 Roll 25 Labels Per Sheet - 50 Sheets 30 Labels Per Sheet - 50 Sheets 100 Forms per pack