ADA Dental Insurance Paper Claim Form


The ADA Dental Claim is the standard claim form used by dental providers to bill for services.
• Commercially Printed on 8.5″ x 11″ paper – 20 # white bond
• Laser cut sheets for use in inkjet or laser printers
• Instructions for government/private health programs on back
• Accommodates National Provider Identifier (NPI) reporting
• ADA Council on Dental Benefit Programs – with 2019 revisions required for 2020 claim submissions
Shrink wrapped and offered in packs of 200, 300 or 500 sheets.



The American Dental Association (ADA) Dental Claim form is the standard claim form accepted by most insurance carriers for dental billing. It includes updates made in 2019 by the ADA’s  Council on Dental Benefit Programs. These updates make the form consistent with the HIPAA standard electronic dental claim transaction.

Order sets of 200, 300 or 500 claim forms.