Orthodontic Case Submissions
Please submit your orthodontic cases for review to:
Delta Dental of New Jersey, Inc.
P.O. Box 222
Parsippany, NJ 07054
Your orthodontic case submissions must include the following:
1. A completed standard ADA claim form
a. Treatment plan
b. Treatment time
c. Total case fee
d. Initial case fee
e. Retention fee
Diagnostic photographs are required, including three facial photographs (profile, frontal, and smiling), and five intraoral photographs (frontal, right lateral, left lateral, and maxillary and mandibular occlusal).
A properly completed and scored Salzmann Malocclusion Severity Assessment form
A panoramic and/or cephalometric radiograph
Additional documentation from referring general dentists, pediatric behavioral health or mental health providers, or a statement that no other documentation was presented
A narrative description of any severe deviation(s) affecting the mouth and/or underlying structures that would not be evident from the diagnostic materials provided
In lieu of photographs, properly trimmed study models, bite registration (will not be returned)
Cases submitted for review without the documentation listed above will be returned to the submitting office.
The following references correspond to the sample Salzmann Scoring Sheet which follows this section.