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Fee Schedules

Use the fee schedule tool to request a copy of your PPO fee schedule or Premier MRA (fee schedule). Fee schedule reports are generated Monday - Friday during normal business hours. If you do not receive the report email from Delta Dental of Arizona within 24 hours, please check your spam or trash folders. It's possible your email provider accidentally tagged the email as junk mail.

If your office has multiple specialties, please complete this form for each specialty.

All fields are required.

Business Tax ID
(numbers only) 

AZ License ID
(numbers only) 

Office Street Address 

 Sample: 12345 N 7TH AVE STE 123

Provider Specialty 

Authorized First Name 

Authorized Last Name 

Enter Email 

Confirm Email 


Please enter the form authorization code in the text box below.



  • If you encounter an error, click the "RESET" button to clear the page history and begin again.
  • Numeric values: Dashes, slashes, dollar signs and commas are assumed and not needed for entry.
  • Addresses: Common items should be abbreviated. For example, N (North), S (South), E (East), W (West), St (Street), Ste (Suite), 1st, 2nd, etc.
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