Delta Dental PPO Plus Premier™ Plan Comparison
Group #9533
PPO Network
Using a PPO dentist is considered in-network and will offer you the greatest savings on dental services and will maximize your benefits.
Premier Network
Using a Premier dentist is considered in-network and will offer you great savings on dental services. It is the largest network.
Out of Network
You have the freedom to choose any dentist that does not participate in either the PPO or Premier networks.
Plan Comparison
| Basic Plan | Enhanced Plan | |||||
|---|---|---|---|---|---|---|
| Service | In-Network (PPO/Premier) | Out-of-Network | In-Network (PPO/Premier) | Out-of-Network | ||
|
Preventive & Diagnostic * Exams, Cleanings, Bitewing x-rays (each twice in a calendar year) * Fluoride Treatment (twice per calendar year, children to age 19) * Sealants * Space Maintainers |
100% | 100% | 100% | 100% | ||
Remaining Basic * Fillings, Extractions * Endodontics (root canal) * Periodontics, Oral Surgery |
60% |
60% | 80% | 80% | ||
Crowns & Prosthodontics * Crowns, Gold Restorations * Bridgework * Implants * Full & Partial Dentures * Repair of Dentures |
40% | 50% |
50% | |||
Calendar Year Maximum (per patient, does not apply to Preventive & Diagnostic) |
$1,,000 |
$2,000 |
$2,000 | |||
|
* Per Person $50 |
$100 $200 |
$100 $200 |
$50 $100 |
$50 $100 |
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Orthodontics Benefits full comprehensive treatment (Adult & Child) * Lifetime Maximum (per patient) $1,000 |
Not Applicable Not Applicable |
50% $2,000 |
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