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

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.