What you pay for services.

You Pay
Preventive care

  • Exams, cleanings, fluoride treatment (under the age of 19), sealants (under the age of 14) and space maintainers (under the age of 14) — twice per calendar year
  • Bitewing X-rays — once per calendar year
  • Full mouth X-rays — once in any five-year period

$0 no deductible


  • Applies for basic and major services only

$50 per person $150 per family

Basic services

  • Fillings, amalgam (silver) and composite (white) including posterior composites, endodontics (other than molar therapy), treatment of gum disorders

20% after deductible

Major services

  • Crowns, inlays, onlays, dentures and bridgework, dental implants, extractions, and molar root canal therapy

50% after deductible


  • Dependent children under the age of 19

50% no deductible

Treatment of Temporomandibular Joint Dysfunction (TMJ)

50% after deductible

Annual benefit maximum

  • Applies for basic and major services only

$1,500 per person

Lifetime orthodontia maximum

$1,500 per child under the age of 19

What is the Allowed Amount?

Delta Dental bases payment of benefits on either its Maximum Plan Allowance or the dentist’s actual fee, whichever is less — called the “Allowed Amount.” By agreement, participating dentists accept Delta Dental’s Maximum Plan Allowance, or their actual fee if it’s less, as payment in full for covered services. Participating dentists are paid directly by Delta Dental and agree not to bill you more than the applicable coinsurance or deductible for the service.

If you use a non-participating dentist, Delta Dental sends the benefit payment directly to you. You are responsible for paying the non-participating dentist’s total fee, which may include amounts in addition to your coinsurance and deductibles, plus services not covered by the Group Dental Service Contract.