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Access Delta Dental's administrative forms for dentists. Simplify paperwork and streamline processes. Get the forms you need today!
The form supports reporting up to four diagnosis codes per dental procedure. This information is required when the diagnosis may affect claim adjudication when specific dental procedures may minimize the risks associated with the connection between the patient’s oral
Member login or account registration to view plan information, download forms, view claims, and track dental activity.
If you visit a non–Delta Dental dentist and pay upfront, you may need to submit a claim. To do this, log in to your account and select Claims & visits and then "how to file a claim." You can also download the claim form for your plan here:
Use the My Claims tool to see Delta Dental’s estimated payment and the patient’s portion (often within moments when clinical review is not necessary). Or, you may mail a paper claim to Delta Dental. Include all required x-rays, documentation and/or written narratives.
In rare cases or if you choose an out-of-network dentist, you may need to submit your own claim to Delta Dental. To submit a claim, fill out the Dental Plan Claim Form on page 2 and attach an Attending Dentist Statement, or have your dentist complete the form.
We make it easy to protect your smile and keep it healthy, with the largest network of dentists nationwide, quick answers and personalized service. Individual dental insurance plans. Delta Dental awards $980,000 to initiatives promoting greater diversity in the oral health workforce. 2024 Delta Dental Oral Health Diversity Fund awardees include ...
Easily access the forms you need to use your benefits including dental claim form, HIPAA authorization, personal representative, and disability forms.
The form supports reporting up to four diagnosis codes per dental procedure. This information is required when the diagnosis may affect claim adjudication when specific dental procedures may minimize the risks associated with the connection between the patient’s oral and systemic health conditions.
If your dentist does not submit insurance claims, you can download a claim form. All paper claims should be mailed to: St. Louis, MO 63126-0690. If you receive vision services from an out-of-network eye doctor and you have out-of-network benefits, you can download a claim form.