HEALTH

Dental

Show Off Your Smile

One plan, two great networks — the Preferred Provider Organization (PPO) Plan and the Premier. Both networks cover the same services, but they differ in the amount you’ll pay for care.

what you pay for care

In Network

Out of Network

PPO
Premier
Deductible

$50 per person or
$150 per family

$50 per person or
$150 per family

Preventative Care and Diagnostic Care

Exams, X-rays, Cleanings -- Deductible Waived for Preventative Care

Paid at 100%

Paid at 100%
Basic Care

Fillings, Extractions, Root Canals

Paid at 80%

Paid at 70%
Major Care

Crowns, Bridges, Dentures

Paid at 50%

Paid at 40%

Annual Maximum Benefit

$2,000 per person per calendar year

Oral evaluations and routine cleanings don't reduce the annual maximum benefit.

Orthodontia

Adults and Children

Paid at 50%
Paid at 40%
Orthodontia

Lifetime Maximum

$2,000 per person, lifetime
Occlusal Guard Coverage
Paid at 80%
Paid at 80%
Out of Network
Deductible

$50 per person or

$150 per family

Preventative Care and Diagnostic Care

Exams, X-rays, Cleanings -- Deductible Waived for Preventative Care

Paid at 90%
Basic Care

Fillings, Extractions, Root Canals

Paid at 70%

Major Care

Crowns, Bridges, Dentures

Paid at 40%
Annual Maximum Benefit

$2,000 per person per calendar year

Oral evaluations and routine cleanings don't reduce the annual maximum benefit.

Orthodontia

Adults and Children

Paid at 40%
Orthodontia

Lifetime Maximum

$2,000 per person per calendar year
Occlusal Guard Coverage
Paid at 70%

your cost per pay period

Deductions taken from the first two pay periods per month

Per Pay Period
You Only
$7.00
You + Spouse/Domestic Partner
$15.00
You + Child(ren)
$13.50
You + Family
$21.50

Contacts

Delta Dental of Oklahoma