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Current Location:  Delta Dental of Arizona >Individual Plans >Covered Services August 27, 2008
 

We are committed to improving oral health as an important part of overall health. Better oral health from a trusted leader is just a click away. Sign up today!

Coverage Options Option 1 Option 2 Option 3
Annual Maximum
(benefit year)
$1500 $1000 $1000
Deductible
(benefit year)
(per person, applies to all services)
$50 $75 $100
Covered Dental Services Option 1 Option 2 Option 3
Type 1 Preventative Services 100% 90% 70%
Exams (limited to 2 per person in benefit year)
Cleanings (limited to 2 per person in a benefit year)
Fluoride Treatments (limited to 1 per person in a benefit period, under age 16)
Space Maintainers (under age 14)
Sealants (under age 15)
     
Type 2 Basic Services 50% 50% 50%

Bitewing X-rays (limited to 1 set per person in a benefit year)
X-rays (full mouth/ panoramic – limited to 1 per person in 60 months)
Simple Extractions
Fillings

     
Type 3A Major Services - 12 month waiting period* 50% 40% 30%
Gum Disease Treatment
Root Canals
Surgical Extractions
General Anesthesia
Denture Relines and Rebases, Adjustments
Repairs to Crowns, Dentures and Bridges
     
Type 3B Major Services – 24 month waiting period* 50% 40% 30%
Special Restorative
Crowns
Complete and partial dentures
Fixed Bridgework
     
Monthly Premium Rates
Three-month premium payment required to enroll
     
Individual Only $38.38$30.14$23.69
Individual + Family $87.36$70.48$54.78

* If within the past 60 days you have been covered under a Delta Dental group plan, and had at least 12 months of continuous coverage under that plan, waiting periods may be waived.


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