Dental Comparison Chart

Delta Dental PPO plus Premier Networks
Plan DPPO HIGH 004623-9901
DPPO LOW 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%
OrthodontiaChildren 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.