How to file a dental claim

Delta Dental dentists will handle all claims and paperwork for you. However, if you visit a non-Delta Dental dentist, you may need to file the claim yourself.

If you do need to file a claim form:

  1. Download the claim form for your Delta Dental Plan:
  1. Complete the patient and subscriber information on the claim form.
  2. Attach a copy of the dentist's Statement of Treatment, including the dentist's name, complete phone number, and a description of each service that the dentist performed.
    Please see the “Important note” below.
  3. Make a copy for your records.
  4. Mail the original copies to the address printed on the form. On the Delta Dental PPO, DPO and Delta Dental Premier form, choose your Delta Dental member company from the interactive dropdown list at the top of the form to display the address.

We usually process claims within two weeks unless additional information is required from you or the dentist.

Important note: A Statement of Treatment or similar document you receive from your dentist may not include enough information for us to process the claim. It is best to ask a dental office staff member for the dentist and treatment information and to enter it directly onto the claim.

In addition to the dentist's name, address and phone number, and a description of each service, its procedure code and fee, we also need the following information to process the claim:

  • Dentist’s National Provider Identifier (NPI)
  • Tax identification number (TIN)
  • State license number
  • Specialty code

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Forms

Claim Forms

Tip

How To File
A Dental Claim

Dentists who accept Delta Dental will file claims for you. You only need to file a claim when visiting a non-Delta Dental dentist.

Customer Service Forms

For fastest response, select the form for the company through which you receive benefits.

Grievance Forms by Program

We urge you to communicate directly with your dentist. If you cannot obtain a satisfactory resolution, file an online grievance report or call customer service.