Dental Claim Form, pad of 100 Forms - ADA J430

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Dental Claim Form (2018 Version), 100 Forms per Pad - J430

Product Code:: J430

Member Price:: $15.00

Retail Price:: $22.50

Available:: Yes

Quantity

The ADA Dental Claim Form is revised to incorporate a significant change in the HIPAA standard, which now enables a dentist to include a diagnosis code (ICD-9-CM) when needed on a claim. Pad of 100 8-1/2 x 11 sheets.

Volume Discount: Order 5+ packs, save 20%!

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