Submit a Delta Dental Claim

How to Submit an Out-of-Network Claim Online Through Delta Dental

  1. Log in to your Delta Dental member account.
  2. From the left-hand menu, select Claims & visits.
  3. Click File an out-of-network claim.
  4. Review the required information needed to submit your claim, including your Delta Dental member ID, dentist information, service date, procedure details, total cost, and statement of treatment or receipt.
  5. Gather and save all required documents before starting your claim.
  6. Click Start a digital claim.
  7. Enter or confirm the subscriber information.
  8. Select whether the services were performed in country or out of country.
  9. Upload the required documents, including the claim form, statement of treatment or receipt, and X-rays if applicable.
  10. Click Submit claim.
  11. After submission, a confirmation page will display your reference number. Please save this number for your records.

Click here to find the full how to guide with pictures!


How to Submit an Out-of-Network Claim by Mail Through Delta Dental

  1. Ask the dental office for a detailed receipt or billing statement, including: 
    • Amount paid (in original currency)
    • Services provided and teeth treated
    • Name and address of dentist
    • Date of service
  2. Download and complete a claims form.
    • Visit deltadentalins.com/enrollees and select See what’s next under “After your visit.” 
    • Follow the instructions under How to file a claim to identify and download the correct claim form for you.
    • Fill out the form with your information.
  3. Attach your receipt.
    • Provide a detailed receipt or a document given to you by the dentist that includes:
      • Dentist’s name, address and phone number 
      • 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) and Tax Identification Number (TIN)
      • State license number
      • Specialty code
  4. Mail your claim form and receipt in. 
    • Print and mail to the address printed on the form.