Dental Claim Submissions

Proper Submission of Dental Claim Forms

Treatment date

  • Report every date that a dental service was actually performed or completed.
  • Multi-staged procedures such as crowns, bridges, dentures, and root canal treatment should be submitted upon completion of the service.
  • Completion date for fixed partial dentures, crowns, onlays, and inlays is the cementation date regardless of the type of cement utilized.
  • Completion date is the date of insertion for removable prosthetic appliances.
  • Completion date for immediate dentures is the date the remaining teeth are removed and the denture is inserted.
  • Completion date for root canal therapy is the date the canals are permanently filled.


Treatment rendered

  • Report each dental service or procedure that was rendered, including— but not limited to— tooth number, surfaces and materials.


Coordination of benefits

  • Report any other benefit coverage, insurance payments, and adjustments for the dental services.


Disclosure of waiver

  • Insure you clearly disclose on the claim form if there is any intention to waive a patient's co-payment, or any portion of the patient’s co-payment responsibility.


Disclosure of discounts

  • Insure any discounts extended to the patient for these services are clearly detailed, including any reduced fees that resulted from the use of coupons or promotions.


Disclosure of "free" services

  • Clearly reflect the fee of the services actually being charged and collected from the patient.


Services not performed

  • Report only services that are actually performed.


Identification of appropriate dentist

  • Insure both the billing dentist and the treating dentist are clearly identified by name and license number.



  • Delta Dental does not make payment based on any form of bartering services.