Dental Benefits

Your dental plan allows for three free cleanings each year. You’re welcome to visit any practitioner you’d like but staying in the PPO and Premier networks will provide you with the highest level of benefits. For example, non-network providers are allowed to balance bill you for any amount they deem as “Reasonable and Customary”.

As part of the harmonization of benefits, the table below reflects the dental plan details across all companies.

Dental Benefits

Visit deltadentalaz.com or call (800) 532-6132 to find an in-network dentist near you. Remember to use your Group Number: 04409 when making an appointment.

Covered ServicesIn-Network
Annual Deductible
Individual/Family
$50/$150
Annual Maximum
Includes Basic and Major Services
$1,500 per person
Diagnostic and Preventive
Oral Exam, Cleanings, X-rays, Fluoride
No charge, covered at 100%
Basic Services
Fillings, Endodontics, Periodontics, Sealants
20%
Major Services
Crown Repair, Prosthodontics, Relines and Repairs for Bridges and Dentures
50%
Orthodontia
Adults and Children
50%
Orthodontia Lifetime Maximum$2,000 per person

Contact Us

If you have questions, contact Delta Dental at (800) 352-6132.