How to download a claim form?

  1. Download the Bento ADA claim form below.
  2. Fill out the form providing the patients Bento Member ID.
  3. Send it to Bento. Claim forms can be faxed or mailed to Bento.

Fax: (855) 214-4888

Mail: Bento Dental PO Box 9028 Boston, MA 02114

Download Claim Form

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