Dental Claim Form - Provider Specialty Code

This is the code that is to be entered in box 56A of the dental claim form.

Dentist 122300000X
General Practice 1223G0001X
Dental Public Health 1223D0001X
Endodontics 1223E0200X
Orthodontics 1223X0400X
Pediatric Dentistry 1223P0221X
Periodontics 1223P0300X
Prosthodontics 1223P0700X
Oral and Maxillofacial Pathology 1223P0106X
Oral and Maxillofacial Radiology 1223D0008X
Oral and Maxillofacial Surgery 1223S0112X

The 122300000X code for "Dentist" may be used by any licensed dentist ("A dentist is a person qualified by a doctorate in dental surgery or dental medicine licensed by the state to practice dentistry, and practicing within the scope of that license").

The other codes may be used instead if the dentist wants to further specify the area of practice.