NYSDA Publications

2024 ADA Dental Claim Form

Jan 30, 2024
Did you know that the ADA Dental Claim Form has been revised for 2024? The new form includes additional fields to record treatment provided by a “locum tenens” dentist; a patient’s last scaling and root planing dates; and third-party payer ID fields. Additional information is available on the ADA’s website; ADA Dental Claim Form | American Dental Association.

View a video outlining the changes; https://www.youtube.com/watch?v=cFXN8jp_E9M 

To purchase and download a pdf version of the claim form: Dental Claim Form (2024 Version) Downloadable PDF - American Dental Association