Name: Perfect Smiles
Brand: Delta Dental of KY

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$32.88 /mo.

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Perfect Smiles

Plan Type PPO

Dentist Search

$32.88 /mo.

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Plan Highlights

No waiting periods
Allows access to both Delta Dental PPO and Delta Dental Premier provider networks
100% coverage with no deductible for cleanings, exams, x-rays or sealants when visiting a Delta Dental PPO provider or Delta Dental Premier provider
Includes implant coverage
Enrollment available regardless of age
Annual maximum increases to $1000 in the second year; $1250 in the third year
Prior carrier coverage may be considered to increase benefits
White fillings are covered

This dental program allows members to utilize any licensed provider. Members who choose a Delta Dental PPO network provider or a Delta Dental Premier network provider have the lowest out of pocket expenses and cannot be balance billed.

Common Procedures

Details

Fee Schedule: N/A | Dentist Search

Exams: Routine periodic examinations – two times in any 12 month period
In-Network: 100%
Out-of-Network: 100%
Preventive – No waiting period

Cleanings: Teeth Cleanings – twice in a calendar year
In-Network: 100%
Out-of-Network: 100%
Preventive – No waiting period

X-Rays: Bite-wing x-rays, one set in a 12 month period
Full mouth x-rays, once within 3 years
In-Network: 100%
Out-of-Network: 100%
Preventive – No waiting period

Fillings: Restorative Amalgam Fillings, Resin-based composite (white fillings) – once per surface in a 24 month period
In-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Basic – No waiting period

Extractions: Simple Extractions
In-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Basic – No waiting period

Crowns: In-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Major – No waiting period

Root Canals: Endodontia – treatment of the dental pulp (root canal procedures) – once in a 24 month period
In-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Major – No waiting period

Dentures: In-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Major – No waiting period

Deep Cleanings: Scaling and root planning procedures are allowed once within 24 month
In-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Major – No waiting period

Implants: The surgical placement of a endosteal (in the bone) implant and the connecting abutment
In-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Major – No waiting period

Braces / Orthodontia: Not Covered Service

Teeth Whitening: External bleaching procedures are covered once per 12 month period per arch; internal bleaching procedures are covered once per tooth per 12 month period
In-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Major – No waiting period

Additional Network Information:

Please note: Dentists who have signed participating agreements with Delta Dental of Kentucky agree to accept the Allowable Amount as payment in full for Covered Services as these terms are defined in the Certificate of Coverage. Each Covered Person is responsible for the amount of Coinsurance, Deductible, and non-covered charges. Dentists who have not signed a participating agreement may bill you directly for any amount of their charge in excess of the Allowable Amount. In cases where the dentist’s charges exceed the Allowable Amount, your coinsurance will be larger. Certain procedures require pre-authorization and/or are subject to limitations.

If you or your dependents have current dental coverage that has been in force a minimum of 12 months, you may be moved to the fully mature year three benefits. You will need to provide a certificate of credible coverage from your prior carrier (subject to review and approval by Delta Dental of KY).

This is not a contract. It is a partial list of benefits and services. For complete details, refer to your certificate.

Exclusions and Limitations
Privacy Policy
Plan Brochure

FAQ

Can I change my dentist once I am in the plan?

Yes, you may change your dentist at any time.

What is a pre-existing condition versus work-in-progress? Is it covered?

What provider options do I have?

When can I start using my Plan?

When will I receive my new member kit and what will it include?

Who can enroll in this plan?

Delta Dental of KY
PO Box 242810
Louisville, KY 40224-2810

Disclaimers & Disclosures

Delta Dental of Kentucky: Delta Dental of Kentucky offers exclusive dental options designed exclusively for individuals or families looking for coverage outside of their employers. Dental Plans are available to all Kentucky residents, regardless of age, income level or prior benefit coverage. Plans are a 12-month contract and offered to Kentucky residents only.

This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.

Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.

This site was designed to provide you with a general description of the plans you requested. Keep in mind that it does not include all the benefits and limitations outlined in the policies -- it is the insurance contract, not the general descriptions on this website, which forms the contract between you and the insurance company.

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