Allows healthcare providers to bill a patients insurance company for reimbursement of medical claims
- Use for medical forms to ensure patients privacy.
$163.59 Original price was: $163.59.$142.25Current price is: $142.25.
Buy More and Save with Volume Discount:
| Quantity | 2 + | 5 + | 10 + |
|---|---|---|---|
| Price | $142.11 | $141.97 | $141.82 |
99995 in stock
Allows healthcare providers to bill a patients insurance company for reimbursement of medical claims
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| Weight | 20.3 lbs |
|---|---|
| Dimensions | 15.75 × 11 × 9.75 in |
Claim Forms
ComplyRight ADA Dental Claim Forms (2024 Version), Laser, 8-1/2in x 11in, Box Of 1,000 Forms

99995 in stock