If you do not agree with Delta Dental’s determination of benefits, and you have additional information to provide, you may request reevaluation by submitting:
- Your reason for requesting reevaluation
- A copy of the claim detail section of the Delta Dental payment summary or the pre-treatment estimate
- Copies of x-rays, photos and/or clinical comments
Mail this information to the Delta Dental member company that originally processed the claim or pre-treatment estimate. Generally, Delta Dental allows one reevaluation per claim.