How to file a 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.

1. Fill out a claim form.

Open the Delta Dental PPO claim form open new tab and enter your information in the electronic form fields. Then, print the form to add your signature. Your dentist's signature is also required.

You may also print the blank PDF and fill out the form manually.

2. Attach a Statement of Treatment.

Ask your dentist for a copy of the Statement of Treatment or a detailed receipt that includes:

• Name, address and complete phone number of dentist
• Date each service was performed
• Description, procedure code and fee of each service performed
• List of affected teeth
• Total cost of services performed
• Dentist's National Provider Identifier (NPI)
• Dentist's Tax Identification Number (TIN)
• State license number
• Specialty code

If the Statement of Treatment or receipt is missing any of this information, please enter it on the claim form. A dental office staff member can provide you with the necessary information.

3. Make a copy for your records.

Make copies of the complete claim form and the Statement of Treatment or receipt. Keep them for your records.

4. Mail us your claim.

Using the address on your claim form, mail the original copies of the completed claim form and the Statement of Treatment or detailed receipt.

To find the correct mailing address, go to the "Select your Plan" dropdown menu at the top of the form. Select the Delta Dental company for your plan.

What happens next?

We usually process claims within two weeks. If we need more information, we'll reach out to your dentist.