Dental Plan Comparison
For all of the dental plans, the annual maximum is $2,000 in 2022 for all benefits per person per contract year. You can find the detail of what is covered in each category below the chart.
Plan | Diagnostic and Preventive Care |
Basic Restorative Care | Major Restorative Care | Emergency Services | Orthodontics |
---|---|---|---|---|---|
DELTA DENTAL PREMIER In-network |
100% coverage | 80% coverage | 50% coverage | Emergency dental services provided same as eligible dental services | 80% coverage |
DELTA DENTAL PREMIER Out-of-network* |
50 % coverage of Allowed Amount | After $125 annual deductible, 50% of Allowed Amount coverage | No coverage | After $125 annual deductible, emergency dental services provided same as eligible out-of-network services | 50% coverage of Allowed Amount |
DELTA DENTAL PPO In-network coverage only |
100% coverage | 80% coverage | 50% coverage | In-network services provided same as any service; out-of-network services apply $50 deductible then same as any in-network service | 80% coverage |
*Out-of-network:
If you use an out-of-network provider, you will receive lower reimbursement amounts for services compared to the reimbursements you would receive from a Delta Dental In-network provider. It is strongly encouraged that your provider submit a pre-treatment estimate prior to services being received. This will prevent any surprise charges after treatment has been received. If you receive services from an out-of-network provider, you may need to:
- Pay for services up-front
- Pay more money for services than you would with an in-network dentist
- File the dental claim form with Delta Dental
- Receive reimbursements sent directly to you from Delta Dental
Learn about Allowed Amounts, approved amounts, copays, and how they affect your coverage and billing with the "How to Read Your Explanation of Benefits" guide from Delta Dental.
Compare in-network versus out-of-network costs on Delta Dental's cost example, Two Networks, More Choices (pdf). Â
What Is Covered Under Each Type of Service?
Diagnostic and Preventive Care
- Oral examinations and dental cleanings
- Two oral exams and cleanings per person per calendar year
- X-rays
- Special periodontics care
- Topical fluoride to age 19
- Space maintainers
Basic Restorative Care
- Fillings (customary restorative materials)
- Plan coverage on back teeth based on composite (white) fillings: Delta Dental PremierÂ
- Plan coverage on back teeth based on amalgam (silver) fillings: Delta Dental PPOÂ
- Plan coverage on front teeth based on composite (white) fillings: Both Plans
- Sealants to age 19
- Extractions and other oral surgery
- Periodontics (gum disease therapy)
- Endodontics (root canal therapy)
- Restorative crowns
- Inlays & onlays, repair of crown
Major Restorative Care
- Fixed or removable bridgework
- Implants as alternative treatment
- Full or partial dentures
- Denture relines or rebases
Orthodontics Coverage
- Limited to dependents up to age 19
- Separate $2,800 lifetime maximum per covered dependent that does not start over if you change plans
Dental Plan Availability
Yes:Â Plan is available
No:Â Not available
Base Plan:Â Base Plan for this county
County | Delta Dental PPO | Delta Dental Premier |
---|---|---|
Aitkin | Yes | Yes - Base Plan |
Anoka | Yes - Base Plan | Yes |
Becker | Yes | Yes - Base Plan |
Beltrami | Yes | Yes - Base Plan |
Benton | Yes | Yes - Base Plan |
Big Stone | No | Yes - Base Plan |
Blue Earth | Yes | Yes - Base Plan |
Brown | Yes | Yes - Base Plan |
Carlton* | Yes - Base Plan | Yes - Base Plan |
Carver | Yes - Base Plan | Yes |
Cass | Yes | Yes - Base Plan |
Chippewa | Yes | Yes - Base Plan |
Chisago | Yes - Base Plan | Yes |
Clay | Yes | Yes - Base Plan |
Clearwater | Yes | Yes - Base Plan |
Cook | No | Yes - Base Plan |
Cottonwood | Yes | Yes - Base Plan |
Crow Wing | Yes | Yes - Base Plan |
Dakota | Yes - Base Plan | Yes |
Dodge | No | Yes - Base Plan |
Douglas | Yes | Yes - Base Plan |
Faribault | Yes | Yes - Base Plan |
Fillmore | Yes | Yes - Base Plan |
Freeborn | Yes | Yes - Base Plan |
Goodhue | Yes | Yes - Base Plan |
Grant | No | Yes - Base Plan |
Hennepin | Yes - Base Plan | Yes |
Houston | Yes | Yes - Base Plan |
Hubbard | Yes | Yes - Base Plan |
Isanti | Yes - Base Plan | Yes |
Itasca | Yes | Yes - Base Plan |
Jackson | Yes | Yes - Base Plan |
Kanabec | Yes - Base Plan | Yes |
Kandiyohi | Yes | Yes - Base Plan |
Kittson | Yes | Yes - Base Plan |
Koochiching | Yes | Yes - Base Plan |
Lac Qui Parle | Yes | Yes - Base Plan |
Lake | Yes - Base Plan | Yes |
Lake of the Woods | No | Yes - Base Plan |
Le Sueur | Yes | Yes - Base Plan |
Lincoln | No | Yes - Base Plan |
Lyon | Yes | Yes - Base Plan |
Mahnomen | Yes | Yes - Base Plan |
Marshall | No | Yes - Base Plan |
Martin | Yes | Yes - Base Plan |
McLeod | Yes - Base Plan | Yes |
Meeker | Yes | Yes - Base Plan |
Mille Lacs | Yes | Yes - Base Plan |
Morrison | Yes | Yes - Base Plan |
Mower | Yes | Yes - Base Plan |
Murray | No | Yes - Base Plan |
Nicollet | Yes | Yes - Base Plan |
Nobles | Yes | Yes - Base Plan |
Norman | No | Yes - Base Plan |
Olmstead | Yes | Yes - Base Plan |
Otter Tail | Yes | Yes - Base Plan |
Pennington | Yes | Yes - Base Plan |
Pine | Yes | Yes - Base Plan |
Pipestone | Yes | Yes - Base Plan |
Polk | Yes | Yes - Base Plan |
Pope | Yes | Yes - Base Plan |
Ramsey | Yes - Base Plan | Yes |
Red Lake | No | Yes - Base Plan |
Redwood | Yes | Yes - Base Plan |
Renville | Yes | Yes - Base Plan |
Rice | Yes | Yes - Base Plan |
Rock | Yes | Yes - Base Plan |
Roseau | No | Yes - Base Plan |
Scott | Yes - Base Plan | Yes |
Sherburne | Yes - Base Plan | Yes |
Sibley | Yes | Yes - Base Plan |
St. Louis | Yes - Base Plan | Yes |
Stearns | Yes | Yes - Base Plan |
Steele | Yes | Yes - Base Plan |
Stevens | Yes | Yes - Base Plan |
Swift | No | Yes - Base Plan |
Todd | Yes | Yes - Base Plan |
Traverse | Yes | Yes - Base Plan |
Wabasha | Yes | Yes - Base Plan |
Wadena | Yes | Yes - Base Plan |
Waseca | No | Yes - Base Plan |
Washington | Yes - Base Plan | Yes |
Watonwan | Yes | Yes - Base Plan |
Wilkin | Yes | Yes - Base Plan |
Winona | Yes | Yes - Base Plan |
Wright | Yes - Base Plan | Yes |
Yellow Medicine | Yes | Yes - Base Plan |
*Carlton Northern area: Delta Dental PPO. Carlton Southern area: Delta Dental Premier.