ADA Dental Insurance Claim Fillable PDF


The ADA Dental Claim Fillable PDF is ideal for completing the standard claim form used by dentists to bill for services.

  Type, Print & Save as PDF
Create unlimited claims/templates
 Prints Text Only on Pre-Printed Claim Forms
 Install on up to 2 Computers



A perfect solution for providers submitting ADA Dental paper claims. The ADA Dental claim form is used by dentists to bill insurance companies for services rendered. It provides a common format for reporting dental services to a patient’s dental benefit plan. This version of the claim form includes 2019 changes that will be required by payers in 2020.

  • Immediate Download of the 2019 ADA Dental claim PDF after purchase with Credit Card or PayPal.
  • This PDF prints both the form and typed text, or just text only on the ADA Dental Paper Claim.

ADA policy promotes use and acceptance of the most current version of the ADA Dental Claim Form by dentists and payers.

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