Dental Claim Form, pad of 100 Forms - ADA J430
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Dental Claim Form (2012 Version), 100 Forms per Pad - J430

Dental Claim Form (2012 Version), 100 Forms per Pad - J430
Product Code:
J430
Member Price:
$6.50
Retail Price:
$9.75
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%!