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When visiting a Delta Dental dentist, the dental office completes and submits a claim form to Delta Dental on your behalf.
You do not need to bring a claim form if you are receiving treatment from a Delta Dental dentist.

If you are visiting a non-Delta dentist, follow the instructions below:

1. Complete # 1 through # 15 of the claim form and attach a copy of the dentist's statement of treatment, including the dentist's name and phone number (with area code). Delta will use the dentist's statement to process the claim. It's very important that the statement include a description of each service the dentist performs.
   
   
2. Once completed, make a copy of the form for your records and mail the original to:
   Delta Dental of California
   P.O. Box 997330
   Sacramento, CA 95899-7330
   

Claims are usually processed within 2 weeks unless additional information is required from you or the dentist.

Ready to download and print a claim form?
Click here.