Dental Benefits
Delta Dental PPO offers access to a large network of dentists and services that cover most diagnostic, preventive and restorative dental needs, as well as orthodontia for you and your family.
Dental Benefits
Employee Only
- Semi-Monthly Cost
- $10.25
Employee + Spouse
- Semi-Monthly Cost
- $15.48
Employee + Child(ren)
- Semi-Monthly Cost
- $14.08
Employee + Family (Spouse & Child(ren)
- Semi-Monthly Cost
- $25.48
Calendar Year Deductible (waived for preventive services)
- PPO Network
- $50 person
- Premier Network
- $50 per person
- Out of Network*
- $50 per person
Calendar Year Benefit Maximum
- PPO Network
- $2,500 per person
- Premier Network
- $2,000 per person
- Out of Network*
- $1,700 per person
Diagnostic & Preventive Care (cleaning/exam)
- PPO Network
- Covered in Full
- Premier Network
- 10%
- Out of Network*
- 10%
Basic & Restorative Services (fillings, extractions, root canals)
- PPO Network
- 10%
- Premier Network
- 10%
- Out of Network*
- 10%
Major Services (crowns, bridges, dentures)
- PPO Network
- 50%
- Premier Network
- 50%
- Out of Network*
- 50%
Orthodontia (adults & dependent Children)
- PPO Network
- 50%
- Premier Network
- 50%
- Out of Network*
- 50%
Orthodontia Lifetime Maximum
- PPO Network
- $2,500 per person
- Premier Network
- $2,000 per person
- Out of Network*
- $1,500 per person
- *For out-of-network services, members pay applicable coinsurance plus any amount that exceeds the usual, customary and reasonable charge as determined by Delta Dental.
Plan Notes
- Delta Dental PPO offers access to a large network of dentists for diagnostic, preventive and restorative care, plus orthodontia.
- You save more when you stay in-network.