ADA Fillable PDF -Dental Claim Form

Updated for 2020

The ADA PDF Claim Form is accepted by most insurance carriers. It has been updated by the American Dental Association to be consistent with electronic claim submission systems.

The PDF template is easy to download and use. Type in the form fields and print your first claim in just minutes! Save to your Mac or PC.

User Highlights

  • Easy to Use:  Open in Adobe Reader and start typing. The form looks exactly like the ADA Claim on the computer screen.
  • Efficient: Save & re-use your templates over and over. Optional form calculations add up the service charges for you.
  • Affordable: One-time purchase charge to create unlimited claims. Install on up to 2 computers such as home and office.

ADA Fillable PDF for Mac & Windows

Purchase Options

ADA Fillable PDF Single User


One Time Purchase

  • Type, Print & Save as PDF

  • Create Unlimited Claims

  • Prints 1500 and Typed Text

  • Prints Text Only

  • Install on 2 Computers
  • Adds Up Charges Automatically

Buy & Download


Using the ADA Fillable Claim Form

  • Getting Started

    To get started, open the form with Adobe Reader on your Mac or Windows computer and type in the fields. The PDF has the “look and feel” of the original ADA Claim Form. The fill fields are positioned to match the placement grid on the standard claim. 

  • Easy Data Entry

    The familiar layout is highlighted in blue and tabbed for fast data entry. Each field includes detailed instructions to help the user avoid common billing errors. Adds up service charges automatically (optional feature).

  • Mac & Windows

    This PDF is designed to work with Adobe Reader software, the free and trusted PDF viewer. Type, each claim on your computer, not online or in the cloud.

ADA Claim Form

Print your Claim

  • Print Options

    The ADA Fillable PDF has two print options built into the menu at the top right of the PDF.

  • Print the ADA Claim Form with black typed text on plain paper. Print the back side as well to ensure the claim will be accepted.

  • If you have a commercially printed Dental Claim Form, choose to print "text only" from the menu.

Need Paper Claims for your Printer?

Billing Package - ADA Fillable PDF & 200 Claim Forms

  • Saving the Claim

    Save each claim with a unique file name on your computer. Create your own office or patient templates to save time and avoid payment errors.

  • Save on up to two computers, such as home and office. Easily open, edit and resave the template over and over.

  • Keep Protected Health Information (PHI) safe by following your computer safeguards to meet HIPAA Security Rules.


The ADA Fillable PDF is saved safely to your Mac or PC keeping confidential patient information offline.