{"product_id":"ada-dental-claim-insurance-claim-forms-8-1-2-x-11-for-laser-or-ink-jet-printers","title":"ADA Dental Claim Insurance Claim Forms, 8-1\/2\" X 11\" for Laser or Ink Jet Printers","description":"With sections for patient info, dental benefits, service records, and dentist details.\u003cbr\u003e\u003cp\u003eComprehensive Form: This ADA American Dental Association Dental Claim Form is a comprehensive document for submitting dental claims and treatment information.\u003c\/p\u003e\u003cp\u003ePack and Case: Available in pack of 500 sheets and case of 2500 sheets\u003c\/p\u003e\u003cp\u003eDetailed Sections: The form includes sections for patient information, policyholder\/subscriber details, dental benefit plan information, and a record of services provided.\u003c\/p\u003e\u003cp\u003eCoding Support: It allows for entering diagnostic codes, treatment codes, and other relevant coding for proper claim processing.\u003c\/p\u003e\u003cp\u003eAuthorization Segment: There is a dedicated section for obtaining authorizations and signatures from the patient or policyholder.\u003c\/p\u003e\u003cp\u003eDentist Information: The form provides fields to enter the treating dentist's name, address, license number, and other relevant details, Made in the USA by Next Day Labels TM\u003c\/p\u003e","brand":"vendor-unknown","offers":[{"title":"Pack","offer_id":58379864146245,"sku":"NDL1695P","price":36.15,"currency_code":"USD","in_stock":true},{"title":"Case","offer_id":58379864179013,"sku":"NDL1695C","price":36.15,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0993\/0217\/9141\/files\/ndl1695-1_c3039e42-d546-4014-899b-18b537df95fd.jpg?v=1782405974","url":"https:\/\/qualityforms.com\/products\/ada-dental-claim-insurance-claim-forms-8-1-2-x-11-for-laser-or-ink-jet-printers","provider":"Quality Forms","version":"1.0","type":"link"}