Dental Claims

Submission Guidelines

When you visit a Delta Dental dentist, you do not need to fill out a dental claim form (your dentist will take care of that for you). However, all dental claims for non-Delta Dental dentists should be filed with Delta Dental, following the instructions below:

• Download and print the Delta Dental Claim Form (Adobe Acrobat reader required, click here for free download).
• Complete Sections 1-15 of the claim form and attach a copy of the dentist's statement of treatment, including the dentist's name and phone number. It's very important that the statement include a description of each service the dentist performs.
• Mail the claim form and dentist's statement to:
• Delta Dental
• P.O. Box 997330
• Sacramento, CA 95899-7330