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Dental Plan

Employees can choose from the Basic Dental Plan or the Advanced Dental Plan with Orthodontic through Delta Dental.

Dental Rate Chart

Amounts listed are how much the plan pays
Limitations and exclusion may apply.
Maximum Payment – $1,500 per person total for Benefit Year on all services

1. Diagnostic & Preventive Services Include: exams, cleanings, fluoride, space maintainers, emergency treatment for temporary pain relief, sealants, x-rays
2. Basic Services Include: fillings and crown repair, bite guards and occlusal adjustments and other basic services
3. Major Services Include: Endodontic Services – root canals; Periodontic Services – to treat gum disease; extractions and dental surgery, crown, relines and repairs to bridges, implants and dentures; Prosthodontic Services – bridges, implants and dentures
4. Orthodontic Services: Braces – only available to participants under the age of 19

*When you receive services from an Out-of-Network dentist, the percentages in this column indicates the portion of Delta Dental’s Nonparticipating Dentist Fee that will be paid for those services. The fee may be less than what your dentist charges, which means you will be responsible for the difference.

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