Dental Comparison Chart
Delta Dental PPO plus Premier Networks
| Plan | DPPO High Plan (004623-9901) |
DPPO Low Plan (004623-9902) |
|---|---|---|
| Annual Deductible Individual/Multiple | $25/$100 | $50/$150 |
| Calendar year max | $1500 | $750 |
| Preventative & Diagnostic | 100% | 100% |
| Basic Restorative | 80% | 80% |
| Major Restorative | 60% | 30% |
| Orthodontia - Children under 19 | 100% of plan max | N/A |
| Orthodontia Lifetime Max | $1500 | N/A |
Dependents covered through end of month of 26th birthday. Non-participating dentists may balance bill.
Subscribers are responsible for the difference between the non-participating maximum plan allowance and the full fee charged by the dentist.
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