Aetna - Dental Claim Form & Instructions Accessible PDF - Aetna - Dental Claim Form & Instructions 2026

1. Click ‘Get Form’ to open the Aetna - Dental Claim Form in our editor.
2. Begin by filling out blocks 1–22 with your personal information, including your employer's name, policy number, and your Aetna ID number.
3. Complete blocks 23–27 only if you have other dental coverage. This ensures all relevant insurance information is captured.
4. Sign the authorization to release information in block 28. This is crucial for processing your claim.
5. If you want benefits paid directly to your dentist, sign block 29. Make sure all signatures are clear and legible.
6. For dentists, check the box for 'STATEMENT OF SERVICES RENDERED' and complete blocks 30-48 with detailed service descriptions and fees.
7. Once completed, review the form for accuracy before submitting it to Aetna Dental at the provided address.

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