What to dental benefits cover?
Answers to common questions about dental benefits
Everyone has a different level of knowledge of their dental benefits. To make sure you’re making the most of your plan (or using it in the first place!), let’s address a few common questions.
Most dental plans place an emphasis on preventive coverage and sharing of costs. They usually cover:
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100% of routine preventive and diagnostic care such as cleanings, X-rays, and exams
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80% of basic procedures such as fillings, root canals, and tooth extractions
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50% of major procedures such as crowns, bridges, and implants
Depending on your plan, select procedures, cosmetic procedures such as teeth whitening, and certain pre-existing conditions may not be covered.
82% of adults agree that having dental benefits is essential to protecting oral and overall health.1
How do I know if a dentist is covered by my plan?
You can easily locate an in-network dentist near you on Delta Dental’s website (deltadental.com) or mobile app. You’ll want to stay in-network to maximize your benefits, savings, and convenience! This is because in-network dentists agree to charge discounted rates for their services, and they file claims and any other paperwork for you.
Can you explain some of the terminology used in my plan?
Let’s review a few terms that are helpful to know:
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Deductible: A dollar amount that you must pay toward covered services before Delta Dental’s benefits are paid.
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Coinsurance: The percentage of the costs of services paid by you. For example, a benefit that is paid at 80% by the plan creates a 20% coinsurance obligation for you.
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Annual maximum benefit: The total dollar amount that a plan will pay for dental care for an individual member or family member (under a family plan) for a specified benefit period, typically a calendar year.
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Lifetime maximum benefit: The maximum amount a plan will pay over the course of a lifetime. It may apply to an individual or a family and typically applies to specific treatments such as orthodontic treatment.
Want to learn more about your dental plan? Delta Dental members can review full plan details by logging into deltadental.com.
1The 2023 State of America’s Oral Health and Wellness Report (n.d.) from https://www.deltadental.com/content/dam/ddpa/us/en/state-of-america%27s-oral-health-and-wellness-report/DDPA_State%20of%20Oral%20Health%20Report_2023-Release_FINAL.pdf
