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Delta Dental PPO Schedule of Benefits CLASSIC PLAN
Under this Delta Dental PPO plan, you may visit any Provider of your choice. There are three levels of Providers to choose from who are located nationwide: PPO Participating Provider. Advantages of seeing a PPO Provider include: • Payment is based upon the PPO Provider's Allowable fee, or the fee actually charged, whichever is less.
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Schedule of Benefits (Who Pays What)
www2.deltadentalcoversme.comIf you see a provider that is not in the Delta Dental Premier or Delta Dental PPO networks, you will be responsible for all charges incurred. Find a listing of more than 1,000 Delta Dental PPO provider locations in Colorado and hundreds of thousands of Delta Dental network providers nationwide at www.DeltaDentalCoversMe.com, or call 888-899-3734.
Clear Plan from Delta Dental
www2.deltadentalcoversme.comDDNJ‐IND‐FC1‐4/2012 Underwritten by Delta Dental of New Jersey, Inc. 2 10‐DAY RIGHT TO REVIEW AND RETURN THIS POLICY Please read this Policy carefully. If You are not satisfied, You may return the Policy within 10 days after You received it. Mail it to Delta Dental at the address shown below.. Any Subscription Charges
Clear Plan Insurance Policy from Delta Dental. A new way ...
www2.deltadentalcoversme.comTissue graft procedures and removal of excess tissue. $740 . Bone surgery once per area every three years. $115 . Non‐surgical extractions. $230 . Surgical extractions. $115 . General anesthesia in conjunction with covered surgical procedures, once per treatment.
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