Key points
- Confirm the treated patient, subscriber or policyholder, relationship, current plan information, and any secondary coverage.
- Check procedure dates, CDT codes, tooth or surface information when applicable, fees, and totals against the treatment record.
- Verify treating and billing dentist information, service location, identifiers, and signatures or authorizations that apply.
1. Patient and subscriber
Confirm the treated patient, subscriber or policyholder, relationship, current plan information, and any secondary coverage.
2. Treatment lines
Check procedure dates, CDT codes, tooth or surface information when applicable, fees, and totals against the treatment record.
3. Provider and location
Verify treating and billing dentist information, service location, identifiers, and signatures or authorizations that apply.
4. Supporting documents
Confirm whether the plan requests radiographs, narratives, prior payer information, or other attachments and make sure they match this claim.
5. Print review
Preview the final form, check alignment and completeness, and retain a copy of what was submitted.
Dental-claim review
- Confirm payer/subscriber/patient identity before reviewing treatment lines.
- Review procedure date, tooth/oral-cavity information, code, quantity, fee, diagnosis pointers, and attachments as a connected record.
- Finish with billing/treating dentist identifiers, signatures/authorizations, and print quality.
Sources and verification
Use the ADA source below for the current 2024 Dental Claim Form and completion guidance, together with the dental plan’s requirements.
Related guides
- What Is the 2024 ADA Dental Claim Form?
- Printing the 2024 ADA Dental Claim Form
- Understanding the Main Sections of the ADA Dental Claim Form
Try the software
MedClaimSoftware’s ADA Dental Claim program is designed for the current 2024 form and can save/retrieve claim data and print from Windows. A limited-use trial is available without a credit card. ADA Dental Claim software.