Comprehensive Dental Coverage

As low as $42.98
SKU
Comprehensive Dental Coverage

Member Information

Social Security Number (required for insurance products)

Spouse Member Information

First Name Last Name Date of Birth
Gender Social Security Number


Child Member Information

First Name Last Name Date of Birth
Gender Social Security Number

Comprehensive 1500 - Dental Delta PPO
  • Preventive & Diagnostic Coverage - exams, cleaning, bitewing x-rays, fluoride treatment, full mouth x-rays, space maintainers (subject to frequency limitations)
  • Basic Coverage - fillings, simple extractions, root canals, periodontics, oral surgery, sealants
  • Crowns & Prosthodontics - crowns, gold restorations (over natural teeth), bridgework, full & partial dentures, repair of dentures & implants
  • Carryover Max from Delta Dental allows you to increase your benefits. Click the brochure below to learn more. 

Click here for full plan design

 

MONTHLY COMPREHENSIVE DENTAL
Employee Only $42.98
Employee + Spouse $83.91
Employee + Child(ren) $79.23
Family $127.35
  In-Network Out-of-Network

Preventive & Diagnostic

Exams; Cleanings; Bitewing X-Rays; Full Mouth X-Rays; Fluoride Treat-
ments (Frequency limitations apply); Space Maintainers

 

 

100%

 

 

80%

Basic

Fillings; Simple Extractions; Oral Surgery; Periodontics; Root Canals
(Endodontics); Sealants

 

80%

 

50%

Major

Crowns & Gold Restorations; Bridgework; Full & Partial Dentures; Repair
of Dentures; Implants

 

50%

 

50%

Annual Maximum (per person)

$1,500 $1,500

Annual Deductible

Per Person
Family Maximum
Waived For

 

$50
$150
Preventive & Diagnostic

 

$100
$300
Preventive & Diagnostic

 

Search for an in-network provider: 

  1. Click this link
  2. Select Delta Dental PPO for "your plan"
  3. Select the specialty of your choice
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