Delta Dental PPO
This is a PPO plan. Delta Dental PPO participating dentists have agreed to file the claim for you and to accept the amount approved by Delta. Benefits for all dentists are based on Delta Dental’s reduced PPO fee schedule. PPO dentists will file the claim with Delta Dental. There is no balance billing for PPO dentists.
|Delta Dental Fee Schedule|
|* Combined Deductible for Diagnostic, Basic and Major Procedures: $50 per person per calendar year.|
|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.
Annual Plan Maximum - $1000