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Delta Dental
in-network
dentist
Submitted fee
Maximum
approved fee
$950.00
$744.00
Coverage level
50%
Amount Delta
Dental pays
Amount
you pay
$372.00
$372.00
61% decrease
from the dentists
submitted fee
The payment example above is for illustration purposes only. Fees and reimbursements
can vary by location and dentist. It does however represent how the payment is determined.
Delta Dental offers the dental benefits you need at an affordable price
Diagnostic and preventive careNo waiting periods or deductibles.
Annual maximum$1,000 annual maximum per covered person per benefit year.
No annual maximum limit on pediatric EHB.
Low deductible$50 deductible per covered person per benefit year.
Deductible only applies to basic and major services.
Exceptional customer serviceSpecialized representatives are available to assist you at (800) 971-4108.
Secure online access 24/7Delta Dentals secure online Individual Account Manager is a fast, secure way to locate
participating dentists, review your claims, access benefit information and more.
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Submitted
fee
Maximum
approved fee
Amount
Delta Dental pays
Amount
you pay
$100.00
$70.00
$56.00
$14.00
$100.00
$90.00
$72.00
$18.00
Nonparticipating dentist
$100.00
$87.00
$69.60
$30.40
The payment example above is for illustration purposes only. Fees and reimbursements
can vary by location and dentist. It does however represent how the payment is determined.
Start smiling
brighter today
with Delta Dental!
PA 10/13