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Basics of Dental Benefit Plans

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Each Delta Dental plan is a personalized contract between patients and the insurer. In order to provide accurate estimates of your out of pocket expense, we’ll need to review your specific policy. However, in most cases, patients with coverage through Delta Dental, receive some combination of the following benefits:

  • Preventive services – 80 to 100% coverage for dental checkups, teeth cleanings, dental sealants, and other preventive care to keep smiles whole and healthy
  • Restorative options – 50 to 80% coverage for conservative restoration options like tooth-colored fillings, dental crowns, dentures, and services to repair smile function
  • Orthodontics (when elected) – 20 to 70% coverage for traditional orthodontics and other smile alignments options like clear braces
  • Miscellaneous treatments – 10 to 50% coverage for dental sedation, mouthguards, and other treatments as outlined by your individual policy

Maximize Your Delta Dental Coverage

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Because Delta Dental focuses coverage on preventive care, the easiest way to maximize your benefits is to visit our office for six month dental exams. These checkups and teeth cleaning visits give us the opportunity to diagnose and begin treatment in the earliest stages to ensure patients maintain the optimal level of healthy oral structure. Attending regular checkups is also the best way to prevent the need for advanced dentistry treatments that receive lower percentages of coverage from your Delta Dental policy.

In-Network VS Out of Network Dentistry

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For health maintenance organization (HMO) insurance plans, you’ll need to visit an in-network dentist to receive any benefit coverage. Patients with preferred provider organization (PPO) plans have more flexibility to receive coverage for treatment at most dental offices. In-network dentists have standing agreements with the insurer to charge fees deemed fair and average to ensure patients only ever need to pay the out of pocket costs of dental care. You will still receive coverage if you visit an out of network dentist, but you will need to pay the difference in pricing between your plan’s cost and that charged by the dentist. Most dentists do their utmost to keep prices within a fair range, but when you visit an in-network practice, you won’t need to worry about any additional out of pocket costs.