Compare Your Options with Delta Dental

The following chart depicts the three plans offered to you under Delta Dental. When treatment is provided in-network by a Delta Dental PPO (DPO in Texas) network dentist your cost shares will be substantially lower. Your total out-of-pocket costs will increase when your care is provided by an out-of-network dentist.

Plan Summary and Comparison
Plan Summary of Benefits Network Percentage
Service Category Standard Enhanced Comprehensive
In Network Out of Network In Network Out of Network In Network Out of Network
Year 1+ Year 1+ Year 1 Year 2+ Year 1 Year 2+
Diagnostic1 100% 80% 100% 80% 100% 100% 80% 80%
Preventive1 100% 80% 100% 80% 100% 100% 80% 80%
Basic Restorative 50% 30% 50% 30% 60% 60% 40% 40%
Major Restorative2 NAB NAB NAB NAB NAB 50% NAB 30%
Endodontics NAB NAB 50% 30% 50% 50% 30% 30%
Periodontics NAB NAB 50% 30% 50% 50% 30% 30%
Oral Surgery2, 3 50% 30% 50% 30% 50% 50% 30% 30%
Prosthodontics2 NAB NAB NAB NAB NAB 50% NAB 50%
General Services NAB NAB NAB NAB 50% 50% 30% 30%
Orthodontics4 NAB NAB NAB NAB NAB NAB NAB NAB
Deductible $50 $50 $501 $501 $0 $0 $501 $501
Annual Maximum $500 $500 $1,000 $1,000 $1,500 $1,500 $1,500 $1,500

1The deductible is waived for diagnostic and preventive under the Enhanced plan; under the Comprehensive plan the deductible is waived for diagnostic and preventive for out-of-network and there is no deductible in-network.

2The waiting period is twelve (12) months for major restorative, oral surgery and prosthodontics under the Comprehensive plan. All covered services under the Standard and Enhanced plans are available in Year 1.

3Simple extractions are the only services covered as oral surgery under the Standard and Enhanced plan, and the only services covered in the first 12-months under the Comprehensive plan.

4Orthodontia is not a benefit (NAB) under all plans.

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