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Download the 2024 version of the ADA Dental Claim Form, a standardized format for reporting dental services to patient benefit plans. Learn how to complete the form, access the CDT manual, and watch a video explaining the new features.
- Dental Insurance Frequently Asked Questions
The ADA has created a sample form for third party payer...
- Frequent General Questions Regarding Dental Procedure Codes
CDT Coding assistance is available to all ADA members, plus...
- Dental Insurance Hub: ADA Council's Actions Support Dentist Claims and Record-Keeping
During its May meeting the ADA Council on Dental Benefit...
- CDT
The ADA strives to make CDT widely available at a reasonable...
- ADA Dental Claim Form
Object Moved This document may be found here
- Oral Health Topics
The Oral Health Topics section on ADA.org is intended to...
- Research
The ADA Forsyth Institute (AFI) and the ADA Council of...
- Publication Rates
2021 ADA News rates provide advertisers maximum readership...
- Dental Insurance Frequently Asked Questions
Download the ADA Dental Claim Form in PDF format and learn how to complete it for dental claims. The form includes sections for patient, provider, plan, service, diagnosis, fee, and authorization information.
Learn how to fill out the 2024 ADA Dental Claim Form, a paper form for submitting dental claims to insurance companies or benefit plans. The form has data elements, instructions, and illustrations for reporting services, coverage, and payer information.
GENERAL INSTRUCTIONS. The form is designed so that the name and address (Item 3) of the third-party payer receiving the claim (insurance company/dental benefit plan) is visible in a standard #9 window envelope (window to the left). Please fold the form using the ‘tick-marks’ printed in the margin.
ADA 2019 Claim Form for Licensees. The ADA Dental Claim Form was last structurally revised in 2012 to incorporate key data content changes that enables diagnosis code reporting that was also incorporated into the now current version of the HIPAA standard (837D v5010) electronic dental claim.
Download and print the ADA dental claim form in PDF format. Learn how to complete the form for different types of transactions, procedures, and insurance plans.
The ADA Dental Claim Form was revised in 2019 with editorial changes to form captions and check box options for gender (M, F and U) to be consistent with the HIPAA standard electronic dental claim (837D). This is the most recent version of the form….
