
What is the Dental PPO option?

The Dental PPO is provided by Delta Dental. This option offers the convenience and flexibility of visiting a Delta Dental PPO or Premier Dentist within the United States. You will receive the highest benefit coverage when you visit Delta Dental PPO dentist. For out-of-network coverage, see the Pay, Stock and Benefit Handbook.
Benefits are payable after you satisfy an annual $50 deductible per person.
Preventive and Diagnostic services
Preventive and Diagnostic services include two annual exams, routine x-rays and cleanings. The deductible is waived for all preventive and diagnostic services. These services are covered at 100% when performed by a Delta Dental PPO dentist or 90% when received from a Delta Dental Premier dentist.
Major services
Major services include complex dental work, like crowns and bridges. These services are covered at 60% and you pay the remaining 40% after the deductible – up to an annual maximum.
Orthodontic services
The Delta Dental PPO plan provides orthodontic coverage for adults and children. Orthodontic services are covered at 50% up to a lifetime benefit maximum. The network your dentist participates in will determine your annual benefit maximum.

Support for chronic conditions:
- If you or a covered family member has been diagnosed with a chronic medical condition like diabetes, cancer, or certain autoimmune diseases, you may benefit from extended covered services.
- Learn more about the SmileWay program and eligible conditions.
Contact Delta Dental
Customer service representatives are available nationwide to answer questions.
Annual Benefit Maximum
The annual benefit maximum is the maximum dollar amount a dental benefit plan will pay toward the cost of dental care for a calendar year. The network your dentist participates in will determine your annual benefit maximum.
PPO Dentist
$2,500
Premier Dentist
$2,000
Out-of-network Dentist
Major Services
Your coinsurance: 40%
Preventative and diagnostic Services
Excluded from maximum
Orthodontia Lifetime Maximum
Once the orthodontia lifetime maximum has been reached, it is no longer considered a covered dental service. The lifetime orthodontia maximum is separate from the dental annual benefit maximum. The network your dentist participates is in what determines your orthodontia maximum amount.
PPO Dentist
$2,500
Premier Dentist
$2,000
