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37. I hereby authorize and direct payment of the dental benefits otherwise payable to me, directly to the below named dentist or dental entity. submitting claim on behalf of the patient or insured/subscriber.)
General area of oral cavity (Box 25) is arranged by numeric codes rather than abbreviations. Tooth system (Box 26) JP, or the American system, follows the ADAs Universal Tooth Designation System with a combination of letters and numbers.
American Dental Association (ADA) The ADA Masterfile contains the most up-to-date information on dentists in the United States. The masterfile is a database of all dentists, practicing and nonpracticing, in the United States.
A dental billing payment comes in two forms: Insurance payment and/or patient payment. Your dental billing process is your strategy for collecting from these two revenue sources.
Tooth system (Box 26) JP, or the American system, follows the ADAs Universal Tooth Designation System with a combination of letters and numbers. Procedure codes (Box 29) add the most appropriate Current Dental Terminology (CDT) procedure code.
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A dental exam form is used by dental practices to collect patient information. With a free Dental Exam Form template, you can collect patient information for your dental practice! Simply customize the form to fit the way you want to communicate it with your patients.

ada claim form 2012 pdf