TRICARE Dental Program

Claims

CONUS50 United States, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands Service Area

TRICARE Dental Program CONUS Claim Form

TRICARE Dental Program participating dentists will file claims on your behalf. But if you need to submit a dental claim, mail or fax the completed TRICARE Dental Program CONUS Claim Form to:

United Concordia
TRICARE Dental Program
P.O. Box 69451
Harrisburg, PA 17106

Fax: 717-635-4565

OCONUSAreas outside of the 50 United States, the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands Service Area

TRICARE Dental Program OCONUS Claim Form

TRICARE Dental Program participating dentists will file claims on your behalf. But if you need to submit a dental claim, mail or fax the completed TRICARE Dental Program OCONUS Claim Form to:

United Concordia
TRICARE Dental Program
P.O. Box 69452
Harrisburg, PA 17106

Fax: 844-827-9926

You can also submit an OCONUS claim online.

Dental Readiness

Department of Defense Active Duty/Reserve/Guard/Civilian Forces Dental Examination (DD Form 2813)

This form is used to assist active duty and National Guard and Reserve members in documenting dental health for worldwide duty. Download the form and give it to your dental provider to complete. Due to security settings, you may have to right-click and choose “Save As” to download this form. You can also download the form directly from the WHS forms page.

Enrollment

TRICARE Dental Program Enrollment/Change Authorization Form

Use this form to enroll in the TDP with United Concordia. Complete the form and mail it with your initial monthly premium payment (check, money order, or credit card) to:

United Concordia
TRICARE Dental Program
P.O. Box 645547
Pittsburgh, PA 15264-5253

You can also use this form if you need to make changes to your existing TDP enrollment.

You can also enroll online or by phone.