Delta Dental Indemnity Dentists
This is an Indemnity plan, which allows you complete freedom of dentist choice. However, Delta Dental Premier participating dentists have agreed to file the claim for you and to accept the amount approved by Delta. Amount of claims are based on a percentage of the Usual, Customary and Reasonable Fees (UCR) charged by dentists in your area.
|Delta Dental Fee Schedule|
|Year 1||Year 2||Year 3|
|Diagnostic & Preventive Procedures*||
Routine periodic examinations twice in a calendar year.
Dental prophylaxis (teeth cleaning) twice in a calendar year.
Bitewing and full mouth x-rays.
(6 month waiting period)
Space Maintainers, recementation of crowns.
(12 month waiting period)
Pulpal therapy and root canals.
Treatment of diseases of the gums.
Extractions and other oral surgery, including pre and post operative care.
Gold restorations, crowns, bridges, partials and complete dentures.
Pontics, repair of crowns and bridges, repair of full and partial dentures.
|* Combined Deductible for Diagnostic, Basic and Major Procedures: $50 per person per calendar year.|
Annual Plan Maximum - $1000