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P&D, Basic, and Major Services - Delta Dental PPO Plus Premier™ plans
Find the PPO Plus Premier plan that's best for your 10-50 enrolled group, including a new 100/50/50 plan and a new 90 UCR plan
New
PPO calendar year max$1,000, $1,500, or $2,000
per enrollee
Premier & OON calendar year max$750, $1,000, or $1,500
per enrollee
Deductible$50/$150
Per person/per family (excluding P&D)
Preventive & Diagnostic
Oral exams/evaluations100%
2 per calendar year
Cleanings100%
2 per calendar year
Bitewing X-rays100%
2 per calendar year (through age 18); 1 per calendar year (19+)
Full mouth X-rays100%
1 per 5 years
Sealants100%
1 per lifetime per tooth (through age 14)
Topical Fluoride100%
2 per calendar year (through age 18)
Space maintainers100%
1 per arch per lifetime (through age 13)
Basic Services
Fillings50%
Repeat restorations of same surface payable once in 2 years
Composite/resin restorations50%
Composite resin restorations will be covered on all teeth
Simple extractions50%
1 per lifetime per tooth
Root canal therapy50%
1 per lifetime per tooth
Periodontal maintenance50%
2 per calendar year
Scaling and root planing50%
1 per 2 years per quadrant
Periodontal surgeries50%
1 per 3 years per quadrant
Oral surgery50%
Frequencies vary by procedure code
Major Services
Single crowns50%
Replacement 1 in 5 years any other major services on the same tooth
Stainless steel crowns50%
Replacement 1 in 2 years
Crown inlay, only and veneer repairs50%
No frequency limitations
Crown replacement50%
Payable 6 months after insertion then 1 in 12 months
Post and core50%
Replacement 1 in 5 years
Inlays50%
Given alternate benefit of a composite at the restorative copay
Implants50%
Once every 60 months per tooth for ages 16 and older
Bridges50%
1 per 5 years (abutment crowns and pontics)
Dentures (complete and partials)50%
1 initial placement per 5 years
OrthodonticsNot covered
Waiting PeriodsNone
Plan Details
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PPO calendar year max$1,500, $2,000 or $5,000
per enrollee
Premier & OON calendar year max$1,000, $1,500 or $4,500
per enrollee
Deductible$50/$150 or $75/$225
Per person/per family (excluding P&D)
Preventive & Diagnostic
Oral exams/evaluations100%
2 per calendar year
Cleanings100%
2 per calendar year
Bitewing X-rays100%
2 per calendar year (through age 18); 1 per calendar year (19+)
Full mouth X-rays100%
1 per 5 years
Sealants100%
Once in a 24-month period per tooth (through age 14)
Topical Fluoride100%
2 per calendar year (through age 18)
Space maintainers100%
1 per arch per lifetime (through age 13)
Basic Services
Fillings100%
Repeat restorations of same surface payable once in 2 years
Composite/resin restorations100%
Composite resin restorations will be covered on all teeth
Simple extractions100%
1 per lifetime per tooth
Root canal therapy100%
1 per lifetime per tooth
Periodontal maintenance100%
2 per calendar year
Scaling and root planing100%
1 per 2 years per quadrant
Periodontal surgeries100%
1 per 3 years per quadrant
Oral surgery100%
Frequencies vary by procedure code
Major Services
Single crowns60%
Replacement 1 in 5 years any other major services on the same tooth
Stainless steel crowns60%
Replacement 1 in 2 years
Crown inlay, only and veneer repairs60%
No frequency limitations
Crown replacement60%
Payable 6 months after insertion then 1 in 12 months
Post and core60%
Replacement 1 in 5 years
Inlays60%
Given alternate benefit of a composite filling
Implants60%
Once every 60 months per tooth for ages 16 and older
Bridgework60%
1 per 5 years (abutment crowns and pontics)
Dentures (complete and partials)60%
1 placement per 5 years
OrthodonticsNot covered
Waiting PeriodsNone
Plan Details
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PPO calendar year max$2,000, $3,000 or $5,000
per enrollee
Premier & OON calendar year max$1,500, $2,500, or $4,500
per enrollee
Deductible$50/$150
Per person/per family (excluding P&D)
Preventive & Diagnostic
Oral exams/evaluations100%
2 per calendar year
Cleanings100%
2 per calendar year
Bitewing X-rays100%
2 per calendar year (through age 18); 1 per calendar year (19+)
Full mouth X-rays100%
1 per 5 years
Sealants100%
Once in a 24-month period per tooth (through age 14)
Topical Fluoride100%
2 per calendar year (through age 18)
Space maintainers100%
1 per arch per lifetime (through age 13)
Basic Services
Fillings80%
Repeat restorations of same surface payable once in 2 years
Composite/resin restorations80%
Composite resin restorations will be covered on all teeth
Simple extractions80%
1 per lifetime per tooth
Root canal therapy80%
1 per lifetime per tooth
Periodontal maintenance80%
2 per calendar year
Scaling and root planing80%
1 per 2 years per quadrant
Periodontal surgeries80%
1 per 2 years per quadrant
Oral surgery80%
Frequencies vary by procedure code
Major Services
Single crowns50%
Replacement 1 in 5 years any other major services on the same tooth
Stainless steel crowns50%
Replacement 1 in 2 years
Crown inlay, only and veneer repairs50%
No frequency limitations
Crown replacement50%
Payable 6 months after insertion then 1 in 12 months
Post and core50%
Replacement 1 in 5 years
Inlays50%
Given alternate benefit of a composite filling
Implants50%
Once every 60 months per tooth for ages 16 and older
Bridges50%
1 per 5 years (abutment crowns and pontics)
Dentures (complete and partials)50%
1 placement per 5 years
OrthodonticsNot covered
Waiting PeriodsNone
Plan Details
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New
PPO calendar year max$1,500, $2,000, or $2,500
per enrollee
Premier & OON calendar year max$1,000, $1,500, or $2,000
per enrollee
Deductible$50/$150
Per person/per family (excluding P&D)
Preventive & Diagnostic
Oral exams/evaluations100%
2 per calendar year
Cleanings100%
2 per calendar year
Bitewing X-rays100%
2 per calendar year (through age 18); 1 per calendar year (19+)
Full mouth X-rays100%
1 per 5 years
Sealants100%
1 per lifetime per tooth (through age 14)
Topical Fluoride100%
2 per calendar year (through age 18)
Space maintainers100%
1 per arch per lifetime (through age 13)
Basic Services
Fillings80%
Repeat restorations of same surface payable once in 2 years
Composite/resin restorations80%
Composite resin restorations will be covered on all teeth
Simple extractions80%
1 per lifetime per tooth
Root canal therapy80%
1 per lifetime per tooth
Periodontal maintenance80%
2 per calendar year
Scaling and root planing80%
1 per 2 years per quadrant
Periodontal surgeries80%
1 per 3 years per quadrant
Oral surgery80%
Frequencies vary by procedure code
Major Services
Single crowns50%
Replacement 1 in 5 years any other major services on the same tooth
Stainless steel crowns50%
Replacement 1 in 2 years
Crown inlay, only and veneer repairs50%
No frequency limitations
Crown replacement50%
Payable 6 months after insertion then 1 in 12 months
Post and core50%
Replacement 1 in 5 years
Inlays50%
Given alternate benefit of a composite at the restorative copay
Implants50%
Once every 60 months per tooth for ages 16 and older
Bridges50%
1 per 5 years (abutment crowns and pontics)
Dentures (complete and partials)50%
1 initial placement per 5 years
OrthodonticsNot covered
Waiting PeriodsNone
Reimbursement for dentists that are not in the Delta Dental network is based on up to the 90th percentile of the UCR
Plan Details
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* These are benefit highlights only. Additional exclusions and limitations may apply. Monthly premiums shown are examples only of our lowest monthly rates per employee for employee only coverage. Actual rates vary based on plan choice, your location, and number of people insured. For full details of plans, benefits and pricing, please contact one of our account executives.
Delta Dental of New Jersey is a part of Delta Dental Plans Association. Through our national network of Delta Dental companies, we offer dental coverage in all 50 states, Puerto Rico and other U.S. territories.
