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.
2022 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 Services||DBM Global Delta Dental||GrayWolf Dental Core||GrayWolf Dental Buy up|
|Annual Deductible (Individual/Family)||$50/$150||$50/$150||$50/$150|
|Annual Maximum Benefit||$1,500||$1,000||$1,500|
|Lifetime Orthodontia Maximum||$2,000||$1,000||$2,000|
|Preventative Services: exams, evaluations, x-rays, routine cleanings, topical fluoride, space maintainers||100%||100%||100%|
|Basic Services: sealants, fillings, stainless steel crowns, endodontics, oral surgery, simple and surgical extractions||80%||80%||80%|
|Major Services: prosthodontics, bridge and denture repair, implants, restorative||50%||50%||50%|
|Orthodontic Services (adults and children over 8)||50%||50%||50%|