Dental Plan Availability and Comparison

For all of the dental plans, the annual maximum benefit is $2,000 per person per calendar year, and the lifetime orthodontic maximum is $2,800 per dependent. You can find the detail of what is covered in each category below the chart.

*Out-of-network Providers (Delta Premier only): Reimbursement is based on 50% of the Allowed Amount

If you use an out-of-network provider, you will receive significantly 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

Need help? Find answers to your questions with these frequently asked questions 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) is based on plan:
  • Back teeth
    • Amalgam (silver) fillings: Delta Dental PPO
    • Composite (white) fillings: Delta Dental Premier
  • Front teeth
    • Composite (white) fillings: Delta Dental PPO and Premier
• Sealants to age 19
• Extractions and other oral surgery
• Periodontics (gum disease therapy)
• Endodontics (root canal therapy)
• Restorative crowns
• Inlays and onlays
• Repair of a 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.