MedicaidAdministrativeHigh impact
Billing on the American Dental Association 2006 Claim Form
Maryland Medicaid·MD · Dentistry, Oral & Maxillofacial Surgery·Dental
Effective date
Jul 30, 2007
We identified it
Jun 20, 2026
Summary
Maryland Medical Assistance Program (Medicaid) is switching from the DHMH 234 form to the American Dental Association 2006 claim form for all dental service billing effective July 30, 2007. All oral health care providers and MCOs must use the new ADA form regardless of service date, as the old form will no longer be accepted.
Action Required
By July 30, 2007: All oral health care providers billing Maryland Medicaid must switch from DHMH 234 form to ADA 2006 claim form (J400). Update billing software and staff training to use new form format. Obtain copies of new form and billing instructions from DHMH website. Claims submitted on old DHMH 234 form after July 29, 2007 will be rejected. Continue using DHMH 4524 for preauthorizations.