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)