Delta Dental PPO Plus Premier™ Enhanced
Group #9533
| Service | Delta Dental PPO Plus Premier™ Enhanced plan |
|---|---|
| Calendar year maximum (per person) | $2,000 |
| Calendar year deductible (waived on Preventive & Diagnostic) | |
| Per person | $50 |
| Family aggregate | $100 |
| Preventive & Diagnostic | |
| Exams, Cleanings, Bitewing X-Rays (each twice in a calendar year) | 100% |
| Fluoride treatment (twice in a calendar year, children to age 19) | 100% |
| Sealants | 100% |
| Space Maintainers | 100% |
| Remaining Basic | |
| Fillings, Extractions | 80% |
| Endodontics (root canal) | 80% |
| Periodontics, Oral surgery | 80% |
| Crowns & Prosthodontics (after deductible) | |
| Crowns, gold restorations (over natural teeth) | 50% |
| Bridgework | 50% |
| Implants | 50% |
| Full & Partial dentures | 50% |
| Repair of Dentures | 50% |
| Orthodontics (Adult and Dependent Children) | |
| Co-insurance | 50% |
| Lifetime maximum (per person) | $2,000 |
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.
