Dental Plan Availability and 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.

*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).  

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 Premier 
  • Plan coverage on back teeth based on amalgam (silver) fillings: Delta Dental PPO 
  • 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

Yes: Plan is available
No: Not available
Base Plan: Base Plan for this county

*Carlton Northern area: Delta Dental PPO. Carlton Southern area: Delta Dental Premier.