Use a SAMBA dental claim form and follow the instructions on the form.  Claims must be filed by December 31st of the year after the year you received services.  You are responsible for making sure that claims are filed within the timely filing deadline.

Mail claims to: SAMBA, 11301 Old Georgetown Rd., Rockville, MD  20852-2800.
Dental providers: User Payor ID 37259 for electronic claim submission.

If you have any questions, please contact a SAMBA Member Services representative at (800) 638-6589.