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The ADA Dental Claim Form provides a common format for reporting dental services to a patient's dental benefit plan. ADA policy promotes use and acceptance of the most current version of the ADA Dental Claim Form by dentists and payers.
- Dental Insurance Frequently Asked Questions
Do you have a dental insurance question or concern? If so,...
- Frequent General Questions Regarding Dental Procedure Codes
When it comes to the Code on Dental Procedures and...
- Dental Insurance Hub: ADA Council's Actions Support Dentist Claims and Record-Keeping
During its May meeting the ADA Council on Dental Benefit...
- CDT
Using these Code Sets, the ADA has developed three dental...
- 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 ... ADA Forsyth Institute....
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- Dental Insurance Frequently Asked Questions
The following information highlights certain form completion instructions. Comprehensive ADA Dental Claim Form completion instructions
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.
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…
ADA Dental Claim Form. Introduction. The ADA Dental Claim Form has been revised to incorporate key changes to the HIPAA standard electronic dental claim transaction. This version of the form, front and reverse sides, is illustrated on the next two pages.
The following information highlights certain form completion instructions. Comprehensive ADA Dental Claim Form completion instructions are printed in the CDT manual. Any updates to these instructions will be posted on the ADA’s web site (ADA.org).
American Dental Association Dental Claim Form. Comprehensive completion instructions for the ADA Dental Claim Form are found in the current version of the CDT manual published by the ADA. Five relevant extracts from that manual follow.
