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ADA Dental Claim Form

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.

The following materials are prepared by ADA Practice Institute staff with contributions from the ADA Council on Dental Benefit Programs and other internal and external knowledge experts.

Technical questions concerning the ADA Dental Claim Form's content or completion should be directed to the ADA's Practice Institute staff via email (dentalcode@ada.org) or via telephone (ADA Members, please use the toll-free number on the back of your membership card / Direct Dial 312.440.2500).

The ADA Dental Claim Form and the CDT manual are copyrighted documents. Reproduction of copyrighted information is subject to a licensing agreement.

  • For information about licensing of the ADA Dental Claim Form, please see CDT.
  • For any questions regarding pricing or purchasing copies of the ADA Dental Claim Form, including one that may be individually completed or printed. please visit the ADA Catalog or call 800.947.4746.