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ADA 2012 Insurance Claim Form, Continuous - One-Part

Item#: Size:
Quantity 1000 2000 3000 4000 5000
60157X  Not Imprinted $57.99 $115.99 $157.99 $207.99 $234.99
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Benefits and Features

Speed your third-party billing with updated claim/attending dentist forms. Authorized by the American Dental Association (ADA) and ready for your continuous printer, these one-part forms keep information neat for faster, more error-free processing.

  • Convenient and easy to use ADA compliant forms make third party billing a breeze
  • One-part continuous format for fast yet thorough processing of multiple claims
  • Accepts updated billing codes and has more room for provider and patient ID numbers
  • Fold lines on forms help ensure proper placement of address in envelope window
  • Use with envelope: CE2003