Delta Dental Preferred Dental Plan Benefits

Oregon Health Insurance
Call 800.884.2343 or
541.434.9613
FAX - 541.284.2994

Delta Dental Preferred PPO Dental Plan Benefits

Plan year maximum, per member

First year benefit maximum

$750

Second year benefit maximum

$1,000

Third year benefit maximum

$1,250

Plan year deductible, per member

$50

Service

Benefit

Class 1 (deductible waived**)

Examinations/x-rays

Prophylaxis

Fissure sealants
Fluoride

PPO
Network

Non-PPO
Network

100%**

80%

Class 2

Restorative dentistry

Space maintainers

80%

50%

Class 3

Oral Surgery

Endodontic

Periodontics

12-month waiting period on major services*:

Crowns

Cast restorations

Dentures and bridge work

50%

* Waiting period may be waived by creditable prior coverage from a comparable plan
** Deductible waived only in PPO network