Submitting a Dental Claim

How to Submit a Dental Claim


The Supplemental Benefit Fund (SBF) is not an insurance company and does not participate with any dentist. However, most dentists will handle the claims and paperwork for you. If you need to file a claim yourself, please see below for submission details.

 

If you do need to file a claim form:

  1. Download and print the form below. Claim forms are also available in your school or by calling the SBF Officer at (716) 881-5462.
    • Supplemental Benefit Fund Dental Claim Form
  2. Complete the patient and subscriber information on the claim form.
  3. Attach a copy of the dentist's Statement of Treatment, including the dentist's name, complete phone number, and a description of each service that the dentist performed.
    • Please see the “Important note” below.
  4. Make a copy for your records.
  5. Mail the original copies to the address printed on the form.

We usually process claims within six (6) weeks unless additional information is required from you or the dentist.

Important Note: A Statement of Treatment or similar document you receive from your dentist may not include enough information for us to process the claim. It is best to ask a dental office staff member for the dentist and treatment information and to enter it directly onto the claim.

In addition to the dentist's name, address and phone number, and a description of each service, its procedure code and fee, we also need the Tax Identification Number (TIN) and the State License Number.

S5 Box

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