Voluntary plan options within our Delta Dental PPO™ network
Find the PPO Voluntary plan with P&D, Basic, and Major Services that's best for your 2-9 enrolled group, including new Voluntary options
PPO calendar year maximum$500 or $750
per enrollee
per enrollee
Premier & OON calendar year maximum$500 or $750
per enrollee
per enrollee
Deductible$0
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
FillingsNot covered
Composite/resin restorationsNot covered
Simple extractionsNot covered
Root canal therapyNot covered
Periodontal maintenanceNot covered
Scaling and root planingNot covered
Periodontal surgeriesNot covered
Oral surgeryNot covered
Major Services
Single crownsNot covered
Stainless steel crownsNot covered
Crown inlay, only and veneer repairsNot covered
Crown replacementNot covered
Post and coreNot covered
InlaysNot covered
ImplantsNot covered
BridgesNot covered
Dentures (complete and partials)Not covered
OrthodonticsNot covered
Waiting PeriodsNone
Plan Details
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New
PPO calendar year maximum$1,000 or $1,250
per enrollee
per enrollee
Premier & OON calendar year maximum$1,000 or $1,250
per enrollee
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 3 years per quadrant
Oral surgery80%
Frequencies vary by procedure code
Major Services
Single crownsNot covered
Stainless steel crownsNot covered
Crown inlay, only and veneer repairsNot covered
Crown replacementNot covered
Post and coreNot covered
InlaysNot covered
ImplantsNot covered
BridgesNot covered
Dentures (complete and partials)Not covered
OrthodonticsNot covered
Waiting PeriodsMay apply
Plan Details
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If no previous comprehensive coverage exists
PPO calendar year maximum$1,000, $1,500, or $2,000
per enrollee
Premier & OON calendar year maximum$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%
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 3 years per quadrant
Oral surgery80%
Frequencies vary by procedure code
Major Services
Single crowns50%
Replacement 1 in 5 years against itself
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 PeriodsMay apply
Plan Details
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If no previous comprehensive coverage exists
New
PPO calendar year maximum$1,000, $1,500, or $2,000
per enrollee
Premier & OON calendar year maximum$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%
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
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 against itself
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 initial placement per 5 years
OrthodonticsNot covered
Waiting PeriodsMay apply
Plan Details
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If no previous comprehensive coverage exists
New
PPO calendar year maximum$1,000, $1,500, or $2,000
per enrollee
Premier & OON calendar year maximum$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 against itself
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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* 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.
