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”.

2021 Dental Benefits

Visit 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

Delta Dental

Annual Deductible (Individual/Family)


Annual Maximum Benefit


Lifetime Orthodontia Maximum


Preventive Services: exams, evaluations, x-rays, routine cleanings, topical fluoride, space maintainers


Basic Services: sealants, fillings, stainless steel crowns, endodontics, periodontics, oral surgery simple and surgical extractions


Major Services: prosthodontics, bridge and denture repair, implants, restorative


Orthodontic Services
(adults and children over 8)


Contact Us

If you have questions, contact Delta Dental at (800) 532-6132.