Contact us
Register
Sign in
Search

Notice

Our offices will be closed on Monday, May 26, 2025, in observance of Memorial Day. Warm wishes to you and your family as we honor and remember the brave men and women who have sacrificed in service of our nation. 


From Friday May 23rd through Friday, August 29, 2025: Customer Service hours will be 8:00 AM – 6:30 PM EST Monday through Thursday and 8:00 AM - 1:00 PM EST on Friday.

To view benefit information and claim status at any time, you can sign into your account or use our Interactive Voice Response System 24/7 at 800-452-9310.

Pediatric Essential Health Benefits Plans

Basic PPO Pediatric


 
More Details
Hide Details
Starting at
$24.30
Benefit Summary
PPO annual maximumNone
per covered person
Premier & OON annual maximumNone
per covered person
PPO annual out of pocket maximum
 $350/$700
 
Premier & OON annual out of pocket maximumNo limit
 
PPO deductible$135/$405
Applied to P&D
Premier & OON deductible$135/$405
Applied to P&D
             Preventive & Diagnostic
Oral exams/evaluations100%
 
Cleanings100%
 
Bitewing X-rays100%
 
Sealants100%
Age limits apply
Topical fluoride100%
Age limits apply
In-office A1C diabetes testing100%
 
                     Basic Services
Composite (white) fillings50%
 
                     Major Services
Endodontics50%
 
Periodontics50%
 
Oral surgery50%
 
Crowns50%
 
Inlays/onlays50%
 
Prosthodontics (dentures, bridges, implants)50%
 
Denture repairs50%
 
Orthodontics (medically necessary)50%
 
Orthodontics (not medically necessary)Not covered
 
Waiting periodsNone
 
Plan Details Collapse

Enhanced PPO Pediatric


 
More Details
Hide Details
Starting at
$34.60
Benefit Summary
PPO annual maximumNone
per covered person
Premier & OON annual maximumNone
per covered person
PPO annual out of pocket maximum
 $350/$700
 
Premier & OON annual out of pocket maximumNo limit
 
PPO deductible$35/$105
Not applied to P&D
Premier & OON deductible$35/$105
Not applied to P&D
             Preventive & Diagnostic
Oral exams/evaluations100%
 
Cleanings100%
 
Bitewing X-rays100%
 
Sealants100%
Age limits apply
Topical fluoride100%
Age limits apply
In-office A1C diabetes testing100%
 
                     Basic Services
Composite (white) fillings80%
 
                      Major Services
Endodontics50%
 
Periodontics50%
 
Oral surgery50%
 
Crowns50%
 
Inlays/onlays50%
 
Prosthodontics (dentures, bridges, implants)50%
 
Denture repairs50%
 
Orthodontics (medically necessary)50%
 
Orthodontics (not medically necessary)Not covered
 
Waiting periodsNone
 
Plan Details Collapse

Basic PPO Plus Premier Pediatric

More Details
Hide Details
Starting at
$31.30
Benefit Summary
PPO & Premier annual maximumNone
per covered person
Out of network annual maximumNone
per covered person
PPO & Premier annual out of pocket maximum$350/$700
 
Out of network annual out of pocket maximumNo limit
 
PPO & Premier deductible$135/$405
Applied to P&D
Out of network deductible$135/$405
Applied to P&D
             Preventive & Diagnostic
Oral exams/evaluations100%
 
Cleanings100%
 
Bitewing X-rays100%
 
Sealants100%
Age limits apply
Topical fluoride100%
Age limits apply
In-office A1C diabetes testing100%
 
                      Basic Services
Composite (white) fillings50%
 
                      Major Services
Endodontics50%
 
Periodontics50%
 
Oral surgery50%
 
Crowns50%
 
Inlays/onlays50%
 
Prosthodontics (dentures, bridges, implants)50%
 
Denture repairs50%
 
Orthodontics (medically necessary)50%
 
Orthodontics (not medically necessary)Not covered
 
Waiting periodsNone
 
Plan Details Collapse

Enhanced PPO Plus Premier Pediatric

More Details
Hide Details
Starting at
$45.70
Benefit Summary
PPO & Premier annual maximumNone
per covered person
Out of network annual maximumNone
per covered person
PPO & Premier annual out of pocket maximum$350/$700
 
Out of network annual out of pocket maximumNo limit
 
PPO & Premier deductible$35/$105
Not applied to P&D
Out of network deductible$35/$105
Not applied to P&D
             Preventive & Diagnostic
Oral exams/evaluations100%
 
Cleanings100%
 
Bitewing X-rays100%
 
Sealants100%
Age limits apply
Topical fluoride100%
Age limits apply
In-office A1C diabetes testing100%
 
                      Basic Services
Composite (white) fillings80%
 
                      Major Services
Endodontics50%
 
Periodontics50%
 
Oral surgery50%
 
Crowns50%
 
Inlays/onlays50%
 
Prosthodontics (dentures, bridges, implants)50%
 
Denture repairs50%
 
Orthodontics (medically necessary)50%
 
Orthodontics (not medically necessary)Not covered
 
Waiting periodsNone
 
Plan Details Collapse

This is a summary of deductible, coinsurance, out-of-pocket limits, and other components of plan design. All coverage provisions, limitations and exclusions can be found in the group contract and certificate of coverage. Some Covered Services for Pediatric Enrollees require that you obtain a Prior Authorization from us before the service is performed. The covered dental services that require Prior Authorization are described in the certificate of coverage. Where Prior Authorization is required but not obtained, Delta Dental can apply a penalty of up to 50% of the charges that would otherwise be covered.

 

Transparency in coverage