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Health Fund

Dental Claims

Dental Claims Submission Guidelines

When you visit a Delta Dental dentistA doctor of dentistry who is licensed to practice dentistry at the time and place involved where the particular dental procedure was rendered., 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 pdf.
  • 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
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