The 2019 ADA Dental Claim Form is Now in Effect

September 2019
Workers Compensation

In early June of 2019, the American Dental Association (ADA) released its new Dental Claim Form, effective as of its release date. The ADA Dental Claim Form was last updated in 2012 to incorporate the capability to apply diagnoses codes. The 2019 ADA Dental Claim Form consists of minor editorial changes to maintain consistency with the current HIPAA standard 837D v5010 Electronic Dental Claim Form. The editorial amendments to the claim form are as follows:

The editorial amendments to the claim form instructions are as follows:


To avoid payment delays, always submit claims to payers using the most current claim form available. Contact your practice management software vendor to update to the 2019 ADA Claim Form. While the ADA Claim Form completion instructions should be followed, be aware that some payers have unique processing requirements (e.g., how to report procedures performed on multiple teeth). Comprehensive 2019 ADA Dental Claim Form completion instructions are posted on the ADA’s web site (


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Fixed Partial Denture Repair

A single cast metal crown restoration that is retained, supported and stablized by an abutment on an implant; may be screw retained or cemented.

NOTE: May be orthodontic related