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Special Features
Comprehensive Form: This ADA American Dental Association Dental Claim Form is a comprehensive document for submitting dental claims and treatment information. Pack of 500 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
NextDayLabels - UB-04 (CMS 1450) Health Hospital Insurance Claim Form, Laser 8-1/2 x 11 500 Per Pack
KWD 11
NextDayLabels - CMS 1500 / HCFA 1500 Insurance Claim Forms - Laser/Ink-Jet Compatible (New Version 02/12) Letter Size 8-12" x 11", 500 Sheets Per Pack
KWD 7
NextDayLabels - 1096 Transmittal 2023 Tax Forms, for Laser or Inkjet Printers, Quickbooks and Other Accounting Software Compatible (Pack of 10)
KWD 6.500
Blank Laser/Ink Jet Prismatic Red/Blue Laser Check Stock - Check On The Top, for Versacheck, Quick-Books, and Other Check Writing Software (100 Per Pack)
KWD 7.500
