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PPO_Choice_1500_w_ortho_NW_DP.pdf
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🔗 Source: dentalandvisionins.com
📊 Size: 34 KB
📄 Pages: 2 pages
⬇️ Downloads: 221

Summary

- Calendar Year Deductible: $50 (waived for Delta Dental PPO dentists)
- Diagnostic and Preventive Services: 100% covered
- Basic Dental Services: 80% covered
- Major Dental Services: 50% covered
- Orthodontic Benefit: 50% covered, $1500 lifetime maximum
- Calendar Year Maximum Benefit: $1500 per individual (increased to $1500 when visiting a PPO dentist)
- Frequencies: 2 exams, 2 cleanings, 2 bitewing X-rays (children), 1 bitewing X-ray (adults), 1 full mouth X-ray (every 5 years) per calendar year
- Sealants: covered on permanent 1st molars (through age 8) and 2nd molars (through age 15)
- Services not covered: cosmetic surgery, experimental procedures, hospital costs, anesthesia (except for oral surgery), extra-oral grafts, TMJ treatment.

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Description

- Calendar Year Deductible: $50 (waived for Delta Dental PPO dentists)
- Diagnostic and Preventive Services: 100% covered
- Basic Dental Services: 80%...

Technical Information

  • File Format: PDF
  • File Size: 34 KB
  • Pages: 2
  • Language: EN
  • Total Downloads: 221
  • Last Updated: 6 days ago

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