Delta Dental PPO - Benefit Summary
Annual Maximum: $2,000
Preferred Providers (Delta Dental PPO):
Waived on Class 1 Benefits (Per Person/ Per Family): $0/$0
Class 1 - Diagnostic & Preventive:
Exams, cleaning/ fluoride/ X-rays, sealants: *70% - 100%
Class 2 - Restorative:
Fillings, endodontics, periodontics, oral surgery, general anesthesia: *70%-100%
Class 3 - Major:
Crowns, Bridges, dentures, implants: *70%
Preferred Providers (Delta Dental PPO):
Waived on Class 1 Benefits (Per Person/ Per Family): $0/$0
Class 1 - Diagnostic & Preventive:
Exams, cleaning/ fluoride/ X-rays, sealants: *70% - 100%
Class 2 - Restorative:
Fillings, endodontics, periodontics, oral surgery, general anesthesia: *70%-100%
Class 3 - Major:
Crowns, Bridges, dentures, implants: *70%
This web site is not a legal document. This web site is not a guarantee of coverage, eligibility, or provider status and is designed for informational illustration only. Benefits outlined on this web site are subject to change at any time. Please consult your benefit plan provider(s) or administrator(s) for legal documents regarding your plan and to check coverage and/or eligibility.