HEALTHCARE FORMS 9 Dental Claim Forms 1-Part Item No. Description Paper Size Color Per carton Weight Wada2019CS Continuous (2019) ADA White 81⁄2 ˝ x 11˝ Black 2500 30 Lbs Wada2019csr Laser (2019) Red ADA White 81⁄2 ˝ x 11˝ OCR Red 2500 30 Lbs 2-Part Item No. Description Paper Size Color Per Carton Weight Wada20122 Continuous (2012) ADA White/Canary 91⁄2 ˝ x 11˝ Black 1000 22 Lbs 2-Part Item No. Description Paper Size Color Per Carton Weight Ccfub042* Continuous CMS-1450 White/White 91⁄2 ˝ x 11˝ OCR Red 1000 22 Lbs Wcms1500212 Continuous CMS 1500 (02/12) White/Canary 91⁄2 ˝ x 11˝ OCR Red 1000 22 Lbs Wcms15002W12 Continuous CMS 1500 (02/12) White/White 91⁄2 ˝ x 11˝ OCR Red 1000 22 Lbs Wcms1500U212 Ncr Uniset CMS 1500 (02/12) White/Canary 81⁄2 ˝ x 11˝ OCR Red 500 11 Lbs Claim Forms 1-Part Item No. Description Paper Size Color Per Carton Weight Ccfub041* Continuous Cms-1450 White 91⁄2 ˝ x 11˝ OCR Red 2500 30 Lbs Nlcfub041* Laser Cms-1450 White 81⁄2 ˝ x 11˝ OCR Red 2500 30 Lbs WCMS1500112 Continuous Cms 1500 (02/12) White 91⁄2 ˝ x 14˝ OCR Red 2500 30 Lbs WCMS1500CL12 Laser Cms 1500 (Al) (02/12) White 81⁄2 ˝ x 11˝ OCR Red 2500 30 Lbs WCMS1500CS12 Laser Cms 1500 (02/12) White 81⁄2 ˝ x 11˝ OCR Red 2500 27 Lbs Note: Healthcare claim forms (AL) are designed for use in the state of Alabama with a lower right corner cut. *Revised to include NPI. 1-Part Item No. Description Paper Face Size Per Carton Weight WLCS101-BK Generic Laser Statements White Blue 81⁄2 ˝ x 11˝ 2000 27 Lbs WLCS101MC-BK Generic Laser Statements, MC/VISA White Blue 81⁄2 ˝ x 11˝ 2000 27 Lbs WLCS104-BK Generic Laser Statements, MC/VISA/DISC White Burgundy 81⁄2 ˝ x 11˝ 2000 27 Lbs WLCS105-BK Generic Laser Statements, MC/VISA White Burgundy 81⁄2 ˝ x 11˝ 2000 27 Lbs WLCS106-BK Generic Laser Statements, MC/VISA/DISC White Blue 81⁄2 ˝ x 11˝ 2000 27 Lbs WLCS107-BK Generic Laser Statements, MC/VISA/DISC/AMEX White Blue 81⁄2 ˝ x 11˝ 2000 27 Lbs WLCS108-BK Generic Laser Statements White Burgundy 81⁄2 ˝ x 11˝ 2000 27 Lbs Medical Laser Billing Statements WLCS105-BK WLCS101-BK WLCS107-BK
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