ADA Claim Form: A Guide for Dental Billers and Coders (2024 Update)
Published by the American Dental Coders Association
The ADA Dental Claim Form is the cornerstone of dental billing. Whether you’re filing claims electronically or on paper, understanding how to accurately complete this form is essential for reimbursement success. For dental billers and coders, mastery of the ADA Claim Form isn’t optional — it’s critical to the financial health of every dental practice.
This guide breaks down the ADA Claim Form step-by-step, highlighting common mistakes and offering best practices to streamline your billing process.
Looking to deepen your knowledge? Enroll in the Certified Dental Billing Specialist (CDBS) program or explore the Dual Certification Program through the American Dental Coders Association.
What Is the ADA Dental Claim Form?
The ADA Claim Form is the standardized document used to report dental procedures to insurance companies for payment. It was developed by the American Dental Association and is accepted by all major dental payers.
Update: The current version is the 2024 ADA Claim Form, which includes structural revisions to support:
- Locum tenens (temporary provider) reporting
- Last scaling and root planing date
- Benefit plan payer ID codes
When Is the ADA Form Used?
- Submitting paper claims to insurance payers
- Attaching supporting documentation (e.g., x-rays, narratives)
- Providing information for pre-authorization or pre-determination
Key Sections of the ADA Claim Form
1. Patient and Subscriber Information (Fields 1–20)
Includes name, DOB, address, policy number, and insurance group ID.
Common Error: Submitting outdated insurance details or incorrect subscriber relationships.
2. Provider Information (Fields 21–36)
Details for rendering and billing providers, including NPI, license number, and place of service.
Tip: Always include both billing and treating provider NPIs if they differ.
3. Procedure and Diagnosis Codes (Fields 29a–34)
CDT procedure codes, fees, tooth numbers/surfaces, and ICD-10 codes.
Best Practice: Order ICD-10 codes by medical necessity priority.
4. Attachments and Remarks (Field 35)
Use this space for narratives or supporting documentation references.
Tip: Always use correct attachment indicators (e.g., “A” for x-ray, “B” for narrative).
5. Authorizations and Signatures (Fields 36–53)
Provider and patient signatures, dates of service, and assignment of benefits.
Common ADA Claim Form Mistakes
- Omitting NPI or submitting mismatched provider info
- Incorrect or outdated CDT and ICD-10 codes
- Missing documentation for perio, crowns, or surgical codes
- Patient/subscriber mismatch with payer system
- Wrong payer ID or claim address
Best Practices for ADA Form Accuracy
- Verify insurance prior to appointments
- Use updated billing software with the 2024 form layout
- Attach required documentation upfront
- Double-check claim form before submission
- Track every claim until paid or resolved
Advance Your Career with Certification
Mastering the ADA Dental Claim Form is a foundational skill. ADCA offers expert-led training through our fully online certifications:
- Certified Dental Billing Specialist (CDBS)
- Certified Dental Coder (CDC)
- Dual Certification Program
- CDBS Exam
- CDC Exam
Final Thoughts
The ADA Claim Form might seem routine, but one mistake can delay payment by weeks or trigger a denial. By understanding how to properly complete the 2024 version, you protect the practice’s revenue, ensure compliance, and deliver smoother patient experiences.
Get trained, get certified, and take control of your billing process with the American Dental Coders Association.