Delta Dental PPO™ Individual Premium Plan
Find plan availability & pricing in your area by entering in your ZIP code below:
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1-877-242-1463
Find plan availability & pricing in your area by entering in your ZIP code below:
Delta Dental PPO Individual Premium Plan is a plan that covers a percentage of your costs for covered dental services. Once you enroll, you’ll get coverage for diagnostic and preventive care, including exams, cleanings and x-rays. Plus the premium plan also includes specialty coverage for implants, crowns and root canals. ***Plus, receive savings on LASIK eye surgery through Qualsight and hearing benefits through Amplfon.
| Benefit | In-network | Out-of-network |
| Individual Annual Deductible | $50 Per Person | $50 Per Person |
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Family Annual Deductible |
$150 Per Family | $150 Per Family |
| Annual Benefit Maximum | $2,000 Per Person | $2,000 Per Person |
Find plan availability & pricing in your area by entering in your ZIP code below:
Enter Your ZIP Code to View Dentist Listing:
| Eligibility | ||||||||||||
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Primary enrollee, spouse or domestic partner, eligible dependent children up to age 26. **Please consult the plan policy for descriptions |
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| Deductibles and Maximums | ||||||||||||
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| Covered Services |
Delta Dental PPO dentists |
Non-Delta Dental PPO dentists |
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Diagnostic and Preventive (D&P) Services Exams, cleanings, x-rays and sealants |
100% | 100% | ||||||||||
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Basic Services Fillings, emergency treatment to relieve pain |
80% | 80% | ||||||||||
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Cosmetic Services Teeth whitening and mouth/night guards |
80% | 80% | ||||||||||
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Endodontics |
50% | 50% | ||||||||||
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Periodontics Gum treatments |
50% | 50% | ||||||||||
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Oral Surgery Tooth extractions |
50% | 50% | ||||||||||
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Prosthodontics Bridges, dentures, implants |
50% | 50% | ||||||||||
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Major Services Crowns, inlays, onlays, cast restorations |
50% | 50% | ||||||||||
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Orthodontics Adults and dependent children |
50% | 50% | ||||||||||
| Waiting Periods | ||||||||||||
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Reimbursement is calculated based on maximum contract allowances. This benefit information is only a summary and is not intended or designed to replace or serve as the plan Policy. Limitations and/or waiting periods may apply for some benefits; some services may be excluded from the plan.
Find plan availability & pricing in your area by entering in your ZIP code below:
This is the total amount per person your plan will pay toward the cost of dental care each year.
This is the amount you must pay per person each year before your plan starts making payments for services. There is a separate deductible for orthodontics.
Visit any licensed dentist, anywhere. You'll generally save the most by visiting a dentist from our PPO network. These dentists agree to reduced fees, and won’t charge you more than your expected share of the bill. They also complete your claim forms and can advise you on questions about your share of the payment. You can use Find a Dentist on this page to easily locate a PPO dentist.
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