Delta Dental has worked to improve the oral health of Americans with a national network of more than 150,000 practicing dentists and over 330,000 locations.1
Once you enroll, you’ll get coverage for diagnostic and preventative care (D&P), including routine exams, cleanings and x-rays. This plan also covers basic services like fillings and tooth extractions, as well as major restorative treatments such as root canals, crowns, inlays, dental implants, braces, bridges and dentures. **
This is the amount you will pay per person each calendar year before your plan starts making payments for covered services.
Family plan includes the primary enrollee and can include a spouse or domestic partner and eligible dependent children up to age 26.
|Diagnostic & Preventive (D & P) Services||No Waiting Period|
|Basic Services||6 months|
|Major Services||12 months|
Prices may vary by number of enrollees, age and ZIP Code. One-time enrollment fee: $10.00
|Primary enrollee, spouse or domestic partner, eligible dependent children up to age 26.
**Please consult the plan policy for descriptions.
|Annual Deductibles and Maximums||$50 per person each calendar year|
|$150 per family each calendar year|
|Annual Maximum per Calendar Year||$1,500 Per enrollee|
|Orthodontic Lifetime Maximum||$1,500|
|Covered Services||Delta Dental PPO dentists||Non-Delta Dental PPO dentists|
|Diagnostic and Preventive (D&P) Services
Exams, cleanings, x-rays and sealants
|Basic Services Fillings
emergency treatment to relieve pain
Simple tooth extractions
Bridges, dentures, implants
Crowns, inlays, onlays, cast restorations
Adults and dependent children
|Basic Services||6 Months|
|Major Services||12 Months|
Reimbursement is calculated based on maximum contract allowances. This benefit information is only a summary and is not intended or designed to replace or serve as the plan Policy. Limitations and/or waiting periods may apply for some benefits; some services may be excluded from the plan.
*These rates may not apply to you.
**Please consult the plan Policy for a description of plan benefits, limitations and exclusions. In the event of any inconsistency between this document and the plan Policy, the terms of the Policy will prevail.
Delta Dental PPOtm is underwritten by Delta Dental Insurance Company in AL, DC, FL, GA, LA, MS, MT, NV and UT and by not-for-profit dental service companies in these states: CA — Delta Dental of California; PA, MD — Delta Dental of Pennsylvania; NY — Delta Dental of New York, Inc.; DE — Delta Dental of Delaware, Inc.; WV — Delta Dental of West Virginia, Inc. In Texas, Delta Dental Insurance Company provides a Dental Provider Organization (DPO) plan.
This benefit information is only a summary and is not intended to replace or serve as the plan Policy.
Delta Dental is a registered trademark of Delta Dental Plans Association.