Box 58

Enter the code that indicates the type of dental professional rendering the service from the 'Dental Service Providers' section of the Healthcare Providers Taxonomy code list. The current list is posted at: http://www.wpc-edi.com/codes/codes.asp.

This information comes from the Provider Entry screen, Provider Information tab, Specialty field.

The available taxonomy codes, as of the first printing of this claim form, follow printed in boldface.

122300000X Dentist -- A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.) licensed by the state to practice dentistry, and practicing within the scope of that license.

1223G0001X General Practice--Many dentists are general practitioners who handle a wide variety of dental needs.

Other dentists practice in one of nine specialty areas recognized by the American Dental Association:

1223D0001X Dental Public Health

1223P0221X Pediatric Dentistry

1223E0200X Endodontics (Pedodontics)

1223P0106X Oral & Maxillofacial Pathology

1223P0300X Periodontics

1223D0008X Oral and Maxillofacial Radiology

1223P0700X Prosthodontics

1223S0112X Oral & Maxillofacial Surgery

1223X0400X Orthodontics