Dental Claim Form, two-part carbonless - ADA J431
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Dental Claim Form (2012 Version) 2-part carbonless - J431

Dental Claim Form (2012 Version) 2-part carbonless - J431
Product Code:
J431
Member Price:
$8.00
Retail Price:
$12.00
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. Two-part carbonless 8-1/2 x 11. Pack of 100 sets.