USA Benefits

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Dental

 Dental Base Plan Dental Buy-Up Plan

 

Delta Dental PPO, Delta Dental Premier and 
Out-of-Network Dentist
Delta Dental PPO, Delta Dental Premier and
Out-of-Network
Deductible $50/person
$150/Family
$50/Person
$150/Family
Benefit Maximum
(calendar year)
 Plan pays $2,000/Person

Plan pays $3,000/Person

Diagnostic and Preventive Services*
(oral exams, cleanings, X-rays)
No copay or deductible No copay or deductible 
Basic Services
(oral surgery, fillings, root canals, etc.)
You pay 20% You pay 20% 
Major Services
(crowns, onlays, gum treatment, cast restorations, etc.)
You pay 50% You pay 40% 
Prosthodontic
(bridges, full and partial dentures)
You pay 50% You pay 40%  
Dental Guards
(once every three years)
You pay 50%, Plan pays $500
maximum/Person
You pay 50%, Plan pays $500
maximum/Person  
Retainer Replacement 
(once every five years)
You pay 50%, Plan pays $500
maximum/Person
You pay 50%, Plan pays $500
maximum/Person 
Implants You pay 50%, Plan pays $2,000
lifetime maximum/Person
You pay 40%, Plan pays $3,000
annual maximum/Person
Orthodontic Benefits
(adults and children)
You pay 50%, Plan pays $2,000
lifetime maximum/Person
You pay 40%, Plan pays $3,000
lifetime maximum/Person
Reimbursement is based on PPO-contracted fees for PPO dentists, Premier-contracted fees for Premier dentists, and enhanced-program allowance for out-of-network dentists. Balance billing may still apply for out-of-network dentists.
  • View 2024 network comparison here.