Looking for a form? You’ll find all our electronic and downloadable forms here, organized by topic and plan type.
Delta Dental dentists will file claims for you. But if you decide to visit a non-Delta Dental dentist, you may need to file one of the following claim forms:
- Delta Dental PPOTM, DPO and Delta Dental Premier® 367 KB
- DeltaCare® USA 276 KB
- AARP Dental Insurance Plan
Do you want to contact Customer Service online? Fill out the form, and we’ll get back to you via email.
Delta Dental PPO, DPO and Delta Dental Premier:
- Alabama, Florida, Georgia, Louisiana, Mississippi, Montana, Nevada, Texas or Utah
- Delaware, District of Columbia, New York, Pennsylvania, Maryland or West Virginia
DeltaCare USA and DeltaVision®:
If you have a grievance, submit the relevant form for your plan:
- Delta Dental PPO, DPO and Delta Dental Premier
- Other languages: español | 中文 343 KB
- DeltaCare USA
- Other languages: español | 中文 183 KB
- Other languages: español | 中文 286 KB
- Denti-Cal/State, County and Local Dental Programs
- Other languages: español | 中文 162 KB
- DeltaCare USA Continuous Orthodontic Coverage 26 KB
- If you or an eligible member of your family has started orthodontic treatment under a previous dental plan sponsored by an employer/organization, you may be able to continue that coverage when you switch to a DeltaCare USA plan. Please have your treating orthodontist complete and submit this form along with a claim form within 30 days of your new plan’s effective date.
- Disclosure of Health Information 85 KB
- This form authorizes Delta Dental to release your health information to an appointed representative, such as a family member.