Submit X-rays and Documentation

Use this secure web form to submit supporting claim documentation, such as narratives, X-rays or periodontal charts, to Delta Dental of Arizona.

Tips For Using This Tool

Use this tool when:

You submitted a claim using a paper form or the online claims submission tool in the Dentist Connection
You received a request for additional information to process a claim
You need to submit a document so we can process your patient’s claim

Is your documentation clearly marked?
Supporting documentation must be clearly marked with the appropriate identifying information, including:

Patient name
Date of service
Treating dentist name
Claim number (if applicable)

Our mission is to improve lives by promoting optimal oral health.

Delta Dental of Arizona is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.

Information provided on this site is for general education purposes only and is not intended as a diagnosis, treatment or a substitute for professional medical or dental advice, diagnosis or treatment. For even more oral health information, check out the Protect My Smile library on the Delta Dental Plans Association website.