FREE 9+ Sample Dental Claim Forms in PDF | MS Word

Every day insurance companies receive a lot of claims for dental expenses. This is why, as is the case with Medical Claim Forms, the use of Dental Claim Forms is important in unifying the submission of these claims so that processing claims submitted by members can be easier, faster, and more seamless. We live in a fast-paced world, and companies are always coming up with newer and more effective methods to perform their daily tasks and procedures.

You may browse through our sample forms below. They are in PDF format and are easy to download for use as basis for your own Dental Claim Forms. There is no need to come up with your own forms from scratch. You can save on time and energy by just downloading the samples we have in this article.

Sample Dental Insurance Claim Form

Dental Choice Claim Form in PDF

Standard Dental Claim Form

Blank Dental Claim Form

Principal Dental Claim Form

Target Audience of Dental Claim Forms

• Dental insurance companies use Dental Claim Forms to be filled out by their insured members who want to file a claim for dental expenses. This is so that they can double-check if the treatment is covered under the member’s insurance policy.
• Dentists or dental hygienists, and dental clinics can also provide Dental Claim Forms to their patients to help them submit a claim to their dental insurance provider. Aside from this, they also have the responsibility of providing necessary information and supporting documents that the patient will have to submit to substantiate the claim.
• Employers who provide their employees with dental insurance can also provide them with Dental Claim Forms, just as much as dental clinics can.

Dental plans can be purchased either with a medical insurance plan or as a standalone. They also usually have a six-month to one-year waiting period before standard procedures can be covered. This is done so that the dental insurance company can still profit from a new account, and also to discourage people who only get dental insurance prior to an impending procedure they need to have. You may also look at our other forms, such as Quit Claim Deed Forms and Travel Claim Forms, for more samples and information.

Public Service Dental Claim Form

Accidental Dental Claim Form

Dental Benefit Claim Form

Dental Billing Claim Form Example

Dental Expense Claim Form

Categories of Covered Dental Procedures

There is a hierarchy that dental insurance companies follow when it comes to paying for certain dental procedures. This allows a reasonable and fair coverage for each of their members.

• Preventive procedures: Most dental insurance policies cover 100% of dental expenses for preventive care, such as annual visits for oral prophylaxis.
• Basic procedures: This includes treatments for gum disease, tooth extractions, dental fillings, and root canal treatments. For these procedures, dental insurance policies cover about 70 to 80 percent of the expenses, and the patient will have to settle the rest of the balance.
• Major procedures: This includes crowns, bridges, inlays, and dentures. For these procedures, it is highly likely that the patient will pay more than what the insurance policy will cover.

Each insurance policy has different regulations and specifications. There are dental insurance policies that will consider a major procedure as only a basic one, and will therefore cover more of the expenses than other insurance policies do. Dental insurance policies vary, which is why it is the insured member’s responsibility to know more about their dental insurance coverage. You may also see our Health Care Claim Forms for submitting claims for medical expenses.