ADA 2012 Insurance Claim Form, Continuous - Two-Part

Item#: 60158X Size: 8 1/2 x 11"
Quantity 1000 2000 3000 4000 5000
60158X  Not Imprinted $174.99 $344.99 $468.99 $625.99 $709.99
We recommend this quantity.

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 two-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
  • Two-part continuous format

    for fast yet thorough processing of multiple claims; first copy is white, second copy is canary.
  • 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: