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 Services | In-Network |
| Annual Deductible Individual/Family | $50/$150 |
| Annual Maximum Includes Basic and Major Services | $1,500 per person |
| Diagnostic and PreventiveOral Exam, Cleanings, X-rays, Fluoride | No charge, covered at 100% |
| Basic ServicesFillings, Endodontics, Periodontics, Sealants | 20% |
| Major ServicesCrown Repair, Prosthodontics, Relines and Repairs for Bridges and Dentures | 50% |
| OrthodontiaAdults and Children | 50% |
| Orthodontia Lifetime Maximum | $2,000 per person |
Contact Us
If you have questions, contact Delta Dental at (800) 352-6132.