Submit a Delta Dental Claim
Follow the below steps to submit a Delta Dental Claim:
- Download the claim form for your Delta Dental plan.
- Complete the patient and subscriber information on the form.
- Provide a detailed receipt or document provided 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)
- Dentist's Tax Identification Number (TIN)
- State license number
- Specialty code
- NOTE: if any information above is missing from the document you receive from your dentist, enter it onto the claim form.
- Make copies of the completed claim form and Statement of Treatment or detailed receipt for your records.
- Mail the original copies to the address printed on the claim form.