Submit X-rays and Documentation

Use this secure web form to submit supporting claim documentation on existing claims to Delta Dental of Arizona. Supporting claim documentation may include items like narratives, X-rays or periodontal charts.

Note: If you need to submit supporting claim documentation on a new claim, please use the claim attachment tool in the Dental Office Toolkit.

Tips For Using This Tool

Understanding new vs. existing claims:

  • New claim: A claim submitted within the last 24 hours.
  • Existing claim: A previously submitted claim that requires additional documentation.

Use this tool when:

  • You received a request for additional information to process an existing  claim
  • You need to submit a document so we can process your patient’s existing claim

Do not use this tool when:

  • You need to submit a document for a new claim. Instead, use the claims attachment tool in the Dental Office Toolkit.

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)