Instructions for Dental Rate Table Request Form
Stakeholders may complete a Dental Rate Table Request Form from the Medical Resource Office (MRO). Please access the link below to fill out the online form and submit it.
While the MRO Division cannot guarantee specific delivery dates, we process all requests sequentially in the order they are received. Please notify the MRO Division if you do not receive the Arizona Dental Fee Schedule Rate Table via email within two (2) business days of your request.
Please do not file a duplicate request, as this may delay the process.
IMPORTANT:
This form must be completed in its entirety, including the agreement to Terms & Conditions. The Terms & Conditions allow for the Dental Rate Table to be circulated within the organization upon receipt.