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American Dental Association Dental Claim Form

American Dental Association Dental Claim Form - Dentistry · Comprehensive completion instructions for the ADA Dental Claim Form are found in the current version of the CDT manual

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Page 1: American Dental Association Dental Claim Form - Dentistry · Comprehensive completion instructions for the ADA Dental Claim Form are found in the current version of the CDT manual

American Dental Association Dental Claim Form

Page 2: American Dental Association Dental Claim Form - Dentistry · Comprehensive completion instructions for the ADA Dental Claim Form are found in the current version of the CDT manual

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.

Billing Division: 24833 Revised Effective Date: September ...€¦ · For dental claims, forward a dental claim form, completed by both the plan member and the dentist. If your claim

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