CMS 1500 Dental Claim Filing

Policy Number: DP-X-012

Last Updated: Sept. 12, 2022

The CMS 1500 must be used when the services are for care, which is a benefit under medical surgical benefits. A blank copy of the CMS 1500 that you can print for claim submission is available here. Handwritten, legible claims are acceptable.  

When filing with dental codes on a CMS 1500, a “D” must be in the first position of the dental code. Tooth numbers and descriptions for supplies must be included on the claim. Incomplete information will cause the claim to be returned.