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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. Follow the steps below to ensure your claim is filed accurately.

  1. Download the claim for your Delta Dental plan:
  2. Complete the patient and subscriber information on the claim.
  3. Attach a copy of the dentist's Statement of Treatment.

    Note: Statement of Treatment formats can vary by provider. In order to ensure that your claim is complete, and to expedite processing, fill out the claim completely.

    The following information is required:

    Dentist and practice information:

    • Dentist and practice name
    • Complete phone number (including area code)
    • Complete address (including city, state and ZIP code)
    • National Provider Identifier (NPI)
    • Tax identification number (TIN)
    • State license number
    • General anesthesia permit number, if appropriate

    Treatment information

    • A description of each service that the dentist performed
    • Specialty code for each service
    • Fee for each service
  4. Print the claim and make a copy for your records.
  5. Mail the claim to the Delta Dental company through which you have coverage.

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

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