Item # 174-20161 Model # 20161
$21.25
per Box
When you buy 4+
- $27.59
- Buy 2$24.39
- Buy 4+$21.25
Your delivery dates will be verified at checkout
Features easy-to-read category headings for primary payer information, other coverage, and record of service
Choose from laser cut sheets (500 per box) or 1- or 2-part continuous forms (1,500 per box)
Recycled
-
Product Information
-
Form Type :
Insurance
-
Format :
Dental Claim Form
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Sheet Size :
8-1/2" x 11"
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Form Size :
8-1/2" x 11"
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Media Quantity :
500
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Binding Type :
Loose
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Paper Color :
White
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Number of Parts :
1
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Carbonless :
No
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# Up Per Sheet/Page :
1
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NCR Paper :
No
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Numbered :
No
-
Holes Punched :
None
-
Personalization :
No
-
Security Features :
No
-
Environmental Information
-
Certifications & Standards :
SFI Sustainable Forestry Iniative
-
Miscellaneous
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Brand Name :
Medical Arts Press
-
Country of Origin :
USA
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Recycled :
Yes
-
Weight
-
Weight :
6.00 lbs. per Box
|
Description |
Price |
Unit |
Take Action |
| Insurance Carrier Collection Labels; Second Claim Submission, Fl Pink, 7/8x1-1/2", 500 Labels |
174-39777
|
$10.49
When you buy 12+
|
Roll
|
Buy
|
| Insurance Carrier Collection Labels; Primary EOB Attached, Fl Green, 7/8x1-1/2", 500 Labels |
174-39227
|
$9.59
|
Roll
|
Buy
|
| 2003, 2004 & 2006 ADA Dental Claim Envelopes; Left Window, Gummed, Non-Personalized, 500/Box |
174-35239
|
$35.99
When you buy 10+
|
Box
|
Buy
|
| 2003, 2004 & 2006 ADA Dental Window Claim Envelopes; Left Window, Gummed, Personalized, 500/Box |
174-15248
|
$40.99
When you buy 10+
|
Box
|
Buy
|
|
Description |
Price |
Unit |
Take Action |
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