Notice

System maintenance will take place this weekend from Friday 10/16 to Sunday 10/18 where services will be limited. During this time, Claims Submissions, Eligibility Updates, Procedure code lookup, and Website information will be current as of Friday and updated once maintenance is complete. 

 

To view benefit information and claim status at any time, you can sign into your account or use our Interactive Voice Response System 24/7 at (800-452-9310).

Delta Dental PPO plus Premier™

Group #4616

PPO Network

Using a PPO dentist is considered in-network and will offer you the greatest savings on dental services and will maximize your benefits.

Premier Network

Using a Premier dentist is considered in-network and will offer you great savings on dental services. It is the largest network.

Out of Network

You have the freedom to choose any dentist that does not participate in either the PPO or Premier networks.


Plan Comparison


 
  Basic Plan  Plus Plan
Service In-Network (PPO/Premier) Out-of-Network In-Network (PPO/Premier) Out-of-Network

Calendar Year Deductible

  • Per person
  • Family Aggregate Maximum

$50
$100

 $50
$100		 $50
$100		 $50
$100
 

Preventive & Diagnostic

  • Exams (2 per calendar year per person)
  • Cleanings (4 per calendar year per person)
  • Bitewing X-Rays (1 per calendar year per person)
  • Fluoride Treatment (2 per calendar year for child<18), Sealants (Child under 18)
 80% 80% 80% 80%

Remaining Basic (after deductible)

  • Fillings, Extractions, Root Canals, (Endodontics)
  • Periodontal, Oral Surgery, Repair of Dentures
 80% 80% 80%
 80%

Crowns & Prosthodontics (after deductible)

  • Crowns, Inlays, & Gold Restorations
  • Bridgework, Full & Partial Dentures, Implants
 Not a benefit 50%

Calendar year maximum (per person)
 $1,000
  $1,000 $1,700 $1,700 

Orthodontia (adults & dependent children)

  • Coinsurance
  • Lifetime Maximum
 Not a benefit 50%
$1,700
 

TMJ

  • Coinsurance
  • Lifetime Maximum (per person)
  Not a benefit 50%
$1,700 		  
 Benefit Summaries
Download Summary

Delta Dental’s Oral Health Enhancement Option enables you to receive up to four dental cleanings and/or periodontal maintenance procedures in any combination per benefit period if you have been treated for periodontal (gum) disease in the past. For the additional dental cleanings and/or periodontal maintenance procedures to be covered, you must have had periodontal surgery or periodontal scaling and planing in the past. Details on how to qualify can be found in your benefit booklet.

Your dentist's network will impact how much you pay. Dentists that help participate in the Delta Dental PPO will have the lowest costs and will save you the most out of pocket expense. Dentists that participate in Delta Dental Premier, are participating Delta Dental dentists, but you will pay a greater portion of the cost if utilized. If you receive services from a non-participating, out of network dentists, you will pay the most out of pocket and are responsible for your coinsurance amount plus the difference between Delta Dental's approved fee and the dentist submitted fee for the claim.