Welcome to Delta Dental of New Jersey's Benefits Connection System

DISCLAIMER I represent that the patient has signed an authorization to submit the claim to Delta Dental and to authorize release to Delta Dental of all information relevant to the claim. I confirm that the dates of services as entered are dates of completion of the services. I confirm that the fees entered are the actual fees charged and intended to be collected from the patient, net of any discount given to the patient, and that the dentist does not intend to waive co-payment in whole or in part. I confirm that claims submitted without indication of "COB" are claims where there is no other coverage for the services submitted. I confirm that the fee submitted on claims where "COB" is indicated have been limited to the maximum amount I am permitted to charge the patient for each procedure under the primary coverage. I have identified the dentist who actually performed each of the procedures. I represent that the services are dentally necessary and not for cosmetic reasons.