Filing a Dental Claim

When you visit a Delta Dental dentist, your dentist should take care of your claim.

However, if you go to a non-Delta Dental dentist, you will need to file your claim with Delta Dental.

1. Fill out Sections 1-15 of the Dental Plan Claims Form.
   • For Section 9, Employer (Company) Name, write in “DGA-PPHP.”
   • For Section 10, Group Number, write in “0480.”
2. Attach a copy of the dentist’s statement of treatment to the claim form.The statement of treatment should include the dentist’s name, phone number, a description of each service the dentist performed, and the amounts billed and paid for each service.
3. If you do not have a U.S. social security number, you can either call our office for the alternate social security number we assigned to you for identification purposes or enter your “Enrollee Number” which appears on your Delta Dental coverage card.
4. Mail the completed form and statement to:

   
   Delta Dental
   P.O. Box 997330
   Sacramento, CA 95899-7330