A-Z Topics

Code on Dental Procedures and nomenclature

Requesting a Change to The code

Code Change Request Forms

There are separate Change Request Forms for each of the specific actions noted below. These forms are Microsoft Word ® documents that are intended to be downloaded to your computer, completed at your convenience and returned by e-mail, to dentalcode@ada.org.

Procedure Code Changes

• ADDITION Request Form | Microsoft Word file/198k (Updated 05/13/09)
• REVISION Request Form | Microsoft Word file/181k (Updated 05/13/09)
• DELETION Request Form | Microsoft Word file/173k (Updated 05/13/09)

Category of Service and Subcategory of Service Changes

• ADDITION Request Form | Microsoft Word file/179k (Updated 05/13/09)
• REVISION Request Form | Microsoft Word file/199k (Updated 05/13/09)
• DELETION Request Form | Microsoft Word file/185k (Updated 05/13/09)

• Code Change Request Form Completion Instructions | PDF file/30k

1. For optimum results and security we recommend that the form first be saved to a storage drive on your computer; then be completed at your convenience before being returned via Email.
2. Before completing the form please review the Guidelines, Evaluation Criteria and Instructions concerning Code change requests that are found on other pages of this web site.
3. Change request forms include questions that concern the various components of a dental procedure code (e.g., Nomenclature, Descriptor). Please review the Components of a Dental Procedure Code for an explanation of each of the three parts.
4. Please provide comprehensive answers to all questions.
   • When completing the form on your computer as a Microsoft Word ® document the response boxes will enlarge automatically to accommodate all text entered.
5. Complete a separate form for each action being requested (e.g., two Code additions = two request forms).
6. Any additional information that supports the request should be in an electronic format (e.g., PDF) and may be included as an Email attachment.
7. Should supporting information include work protected by copyright, written authorization to reprint and distribute such work must be included. Without such authorization the work will not be distributed to members of the Code Revision Committee.

All questions concerning request form completion and submission should be directed to the American Dental Association (ADA) via E-mail (dentalcode@ada.org) or telephone (ADA Members, please use the toll-free number on the back of your membership card; Direct dial, 312-440-2500).

PLEASE NOTE: Contact the ADA if you do not receive a notice of receipt from the Code Revision Committee Secretariat by fifteen days from the date of your change request submission.

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