Dental
Delta Dental
Dental Benefits are Combined with the Medical Insurance
Diagnostic and Preventive - 100% no deductible or maximum
- Oral exams and cleanings (twice in a plan year)
- Fluoride treatment (twice in a plan year for dependents under age 19)
- Bitewing x-rays (twice in a plan year)
- Full mouth or panorex x-rays (once each three years)
- Emergency treatment
- Space maintainers
- Sealants (only for non-carious, non-restored 1st and 2nd permanent molars for dependent children under age 19. Limited to one application per tooth.
Comprehensive Option - covers diagnostic and preventive services above
Primary Dental Care - 80% deductible applies
- Restorative (silver or tooth colored filings, stainless steel crowns and other restorative services)
- Oral surgery (simple extractions and other minor surgical procedures)
- Endodontic (root canal therapy and other Endodontic services)
- Periodontics (scaling and root planing, soft tissue and bony surgery, including grafts and other periodontic services)
- Denture repair and recementation of existing crows, bridges and dentures
Major Dental Care - 50% deductible applies
- Crowns (single crowns, inlays and onlays)
- Prosthodontics (partials or complete dentures and fixed bridges)
- Dental implants
Orthodontic Benefits
- Removable fixed appliance therapy and comprehensive therapy - 50% no deductible
Annual Benefit Maximum - $1,500/member
Annual Deductible - $25 member / $75 family
Lifetime Orthodontic Maximum - $1,500/member