Dental Claim Form, Bond in Red Ink - ADA J434

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Dental Claim Form (2012 Version), Bond in Red Ink - J434

Product Code:: J434

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. 100 per pad.