Six men stormed the army-run school, according to military officials, and soldiers surrounded the building.
A provincial health minister told Sky News that a female teacher and a soldier were among the dead. The death toll could be as high as 95, according to the AFP news agency.
Around 500 children and teachers were believed to be inside, with many students taken to local hospitals in a critical condition.
The army said some children are still being held hostage by the militants.
Gunmen and suicide bombers targeted the school while an exam was taking place, said one teacher.
"We selected the army's school for the attack because the government is targeting our families and females," said Taliban spokesman Muhammad Umar Khorasani. "We want them to feel our pain."
One of the wounded students, Abdullah Jamal, said that he was with a group of 8th, 9th and 10th graders who were getting first-aid instructions and training with a team of Pakistani army medics when the violence began for real.
When the shooting started, Abdullah, who was shot in the leg, said nobody knew what was going on in the first few seconds.
"Then I saw children falling down who were crying and screaming. I also fell down. I learned later that I have got a bullet," he said, speaking from his hospital bed.
"All the children had bullet wounds. All the children were bleeding," Abdullah added.
A Taliban spokesman told the Reuters news agency the attack was "revenge" for an army offensive against the group in North Waziristan.
"Our suicide bombers have entered the school, they have instructions not to harm the children, but to target the army personnel," he said.
Sky News
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