Please refer to your Delta Dental  PPO (Point of Service) Summary of Dental Plan Benefits for your Group Number to determine the percentage payable by Delta Dental.

You can also access this information using

Delta Dental's Customer Service Number

(800) 524-0149

or visit their website at www.deltadentalmi.com

Diagnostic & Preventive

• Diagnostic and Preventive Services - services and procedures to evaluate existing conditions and/or prevent dental abnormalities or disease. These services include examinations, evaluations, prophylaxes, space maintainers, and fluoride treatments.
• Brush Biopsy- to detect oral cancer
• Radiographs - X-Rays as required for routine care or as necessary for the diagnosis of a specific condition.

Basic Services

• Oral Surgery Services - Extractions and dental surgery, including preoperative and postoperative care.
• Endodontic Services - the treatment of teeth with diseased or damaged nerves (for example, root canals).
• Periodontic Services - the treatment of diseases of the gums and supporting structures of the teeth. this includes periodontal prophylaxes).
• Relines and Repairs - relines and repairs to bridges, partial dentures, and complete dentures.
• Restorative Services-Services to rebuild and repair natural tooth structure damaged by disease or injury, Restorative services include:
  • Minor restorative services, such as amalgam (silver) fillings and composite resin (white) fillings.
  • Major restorative services, such as crowns, used when teeth cannot be restored with another filling material.

Major Services

• Prosthodontics Services -Services and appliances that replace missing natural teeth (such as bridges, endosteal implants, partial dentures, and complete dentures).

Orthodontic Services

• Orthodontic Services -Services, treatment, and procedures to correct malposed teeth (braces).
• Orthodontic Age Limit - Up to age 19

________________________________________________________________________________

• Oral exams (including evaluations by a specialist) are payable twice in any period of 12 consecutive months.
• Prophylaxes (cleanings) are payable twice in any period of 12 consecutive months. Two additional prophylaxes are payable in the same 12-month period for individuals with a documents history of periodontal disease.
• People with specific at-risk health conditions may be eligible for additional prophylaxes (cleanings) or fluoride treatment.  
• Fluoride treatments are payable once in any period of 12 consecutive months with no age limit.
• Bitewing X-rays are payable once in any period of 12 consecutive months and full-mouth X-rays ( which include bitewing X-rays) are payble once in any five-year period.
• Sealants are payable once per tooth per lifetime for first permanent molars up to age nine and second permanent molars up to age 14.  The surface must be free from decy and restorations.
• Composite resin (white0 restorations are Covered Services on posterior teeth.
• Porcelaim and resin facings on crowns are optional treatment on posterior teeth.
• Implants and implant related services are payable once per tooth in any five-year period.
• Occlusal guards are payable once per seven-year period.



Still need additional information? 

Call the Fund Office at 248-945-7374