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NextDayLabels - ADA Dental Claim Insurance Claim Forms, 8-1/2" X 11" Letter Size for Laser or Ink Jet Printers (Pack of 500 Sheets)
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Product details
| Management number | 219315257 | Release Date | 2026/05/03 | List Price | $13.19 | Model Number | 219315257 | ||
|---|---|---|---|---|---|---|---|---|---|
| Category | |||||||||
- 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
| Size | Pack of 500 Sheets |
|---|---|
| Brand | NextDayLabels |
| Color | White |
| Item Weight | 6 pounds |
| Manufacturer | NextDayLabels |
| Item model number | NDL-ADA forms |
| Package Dimensions | 11 x 8.5 x 1.5 inches |
| Manufacturer Part Number | NDL-ADA forms |
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