Electronic Dental Claims Setup and Overview

Electronic Dental Claims Setup and Overview

Before creating Dental Claims, some preliminary set up needs to be done.


Ask Support or your Implementation Manager to activate the Internal Setting(s).

Dental Setup

Dental Payer

  • On the Insurance in the Insurance Library, select Electronic/Dental for the Primary Form Type.



ANSI 5010 Dental Segments

Loop 2300 Claim Level

CLM*432E82**150***11::1*Y*A*Y*Y*B

DTP*472 (Service Date)
DTP*452 (Appliance Placement)
DN1 (Ortho Months of Treatment)
DN2 (Tooth Status)

HI*ABK:Z0120



Loop 2400 Line Level

LX*1

SV3*AD:D1110:TH*150*11********1

TOO (Tooth Information)
DTP*441 (Prior Placement)
DTP*452 (Appliance Placement)
DTP*446 (Replacement)
DTP*196 (Treatment Start)
DTP*198 (Treatment End)

REF*6R*432E82L1


Modifiers/Tooth Identifier/Surface/Quadrant

Dental Modifiers can be 1 to 8 characters.

  • The Tooth Identifier, Surface Codes, and Quadrant Codes must be added to the Modifier Library.
  • In Charge entry, the Modifiers will not auto advance to the next Modifier field on databases where Dental has been activated.
  • Tab to the next Modifier fields.
  • Tooth Identifier: The Tooth Identifier is added in the Modifier 1 field.
  • 1 through 32
  • Surface Codes: These must be ANSI Codes. The Surface Codes identify the area of the tooth that was treated.
  • B: Buccal
  • D: Distal
  • F: Facial
  • I: Incisal
  • L: Lingual
  • M: Mesial
  • O: Occlusal
  • These are added in the Modifier field.
  • If more than 1 Surface Code, add as an additional Modifier.
  • Quadrant Codes: The Quadrant Codes will be used in the Modifier field. A Quadrant is defined as four or more contiguous teeth and/or teeth spaces distal to the midline.
  • The Code starts with a 2-digit ANSI code that designates the area of the oral cavity: 00, 01, 02, 10, 20, 30, or 40.
  • It ends with .Q
  • 00: Entire oral cavity
  • 01: Maxillary arch
  • 02: Mandibular arch
  • 10: Upper right quadrant
  • 20: Upper left quadrant
  • 30: Lower left quadrant
  • 40: Lower right quadrant
  • Example: 00.Q


Add Taxonomy Code to Box 56A

If the Payer wants a Taxonomy Code on the Claim, ask Support or your Implementation Manager to add the Cross Code to put the Taxonomy Code on the Claim.

  • Individual Taxonomy code for Dental
  • Pay To/Billing Group Taxonomy for Dental


Instructions on completing the 2019 ADA form (external link): ADA Dental Claim Form


Learn More 

 Create a Dental Claim





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