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Demonstrating How the Delta Dental PPOTM Plan Works

The following claim examples demonstrate how lower out-of-pocket patient costs can be achieved with Delta Dental PPO. Compare the patient’s share of costs at each network level below:

Claim Example 1: Cleaning

Dentist network status Delta Dental PPO Network Delta Dental Premier® Network Non-Contracted
Patient's share $0 $10 $30
Dentists bills (submitted charge) $75 $75 $75
Fee agreement with Delta Dental $45 $55 No fee agreement with Delta Dental
Plan payment is 100% $45 $45 $45

Claim Example 2: Crown

Dentist network status Delta Dental PPO Network Delta Dental Premier® Network Non-Contracted
Patient's share $275 $375 $600
Dentists bills (submitted charge) $875 $875 $875
Fee agreement with Delta Dental $550 $650 No fee agreement with Delta Dental
Plan payment is 50% $275 $275 $275

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