Fraud and Abuse Form

Delta Dental of Colorado (Find another state)

Feedback Form

If you have questions or concerns regarding information on your Explanation of Benefits, dental treatment received, or the billing practices of a provider you have received treatment from while covered by Delta Dental, please complete the following form. You may also report your concerns by calling us at 1-800-610-0201. *Required

Your Information

Your name*

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Patient name*

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Email*

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Phone (xxxxxxxxxx)*

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Dental Provider Information

Dentist's name*

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