Create a Dental Claim
2024 ADA Dental Claim Form ©
- You can now clearly identify Claims for services done by a locum tenens dentist.
- The Payer ID can now be reported on the Claim.
- The last scaling and root planing dates can now be reported.
Create a Dental Claim
Dental Claims are entered on the Post Charge screen just like Medical Claims with a few differences.
On the Charge Entry screen, select Dental for the Claim Type.
Quadrants, Tooth Numbers, and Surfaces are entered in the Modifier fields.
When the Charge is Saved, a second entry screen will display to enter additional information.
Additional Dental Fields
Additional information about the dental procedure(s) can be added on this screen.
- Ancillary Claim Info
- Total Months of Treatment
- Months of Treatment Remaining
- Tooth Status
- M: Missing
- E: To be Extracted
- Tooth Information: This panel is controlled by the Tooth Identifier or Surface area entered in the Modifier 1 field.
- Select Save [F2] when finished.
Additional Fields for Paper Claims
In the screenshot as shown above, select the Click here link to modify the fields on a paper Claim.
Modify a Dental Charge
To modify a Procedure or Modifier, select the Modify button on the Encounter Dashboard.
- In the Procedure panel, select the line item number.
To modify the Dental fields: Ancillary Claim Info, Tooth Status, and Tooth Information, select the Dental Fields link on the Encounter Dashboard to make changes to these fields.
For Paper Claims, select the Click here link to modify the fields.
Additional instructions on completing the ADA paper claim form (external link:
ada_dental_claim_form_completion_instructions_2024.pdf