Medical Providers

Medical Providers

Enroll your office today to receive reimbursements from Delta Dental, determine patient eligibility and submit claims.

To enroll your office with Delta Dental, please complete and submit the following forms to us by mail or fax.

You also have the option of enrolling in Direct Deposit by submitting the Direct Deposit form located here.

After you submit the forms above, you can check the status of your application by contacting our Provider Services team by phone (800) 238-3439 or by email to

Once you've completed the enrollment process, you'll be eligible for reimbursement for the following services:

  • D0120 - Periodic Oral Evaluation
  • D1206 - Topical Application of Fluoride Varnish

You'll also be able to take advantage of our electronic services; including, registering on our website to view patient benefits and calling our Interactive Voice Response (IVR) system.

To submit claims:

  • Use Health Insurance Claim Form (HCFA-15000 or electronic version (837P).
  • Submit claims to: Delta Dental of Washington, P.O. Box 75983, Seattle, WA 98175-0983.

Oral Health Training is available. Washington Dental Service Foundation provides an in-office Continuing Medical Education (CME) course to train primary care medical providers to deliver oral health preventive services to children during well-child checks. If you're interested in having an in-office training (over a lunchtime), please contact Madlen Caplow at or (206) 473-9542, or visit for more information.

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