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YOUR HEAL TH Login to your Delta Dental
account at deltadentalky.com
Delta Dental
Download Delta Dental Mobile in
the App Store or Google Play

*Deductible: $50 Deductible per person total per benefit year limited to a
maximum Deductible of $150 per family per benefit year. The deductible does not
apply to diagnostic and preventative services, emergency palliative treatment,
brush biopsy, X-rays, sealants, cephalometric films, photos, diagnostic casts
and orthodontic services (including surgical repositioning of teeth).

800.955.2030 | deltadentalky.com *Covered Services

DIAGNOSTIC & PREVENTIVE PLAN PAYS

Diagnostic and Preventive Services – 100%
exams, cleanings, fluoride, and space Smile! You have access to a
maintainers
large network of dentists through
Emergency Palliative Treatment – to 100% our Delta Dental benefits.
temporarily relieve pain

Sealants – to prevent decay of 100%
permanent teeth
Maximum Payment – $1,200 per
Brush Biopsy – to detect oral cancer 100% person total per benefit year on
Radiographs – X-rays 100% all services except cephalometric
films, photos, diagnostic casts
BASIC SERVICES
and orthodontic services (including
Minor Restorative Services – fillings 50% surgical repositioning of teeth).
and crown repair
$1,000 per person total per
Endodontic Services – root canals 50%
lifetime on a cephalometric films,
Periodontic Services – to treat gum 50% photos, diagnostic casts and
disease
orthodontic services (including
Oral Surgery Services – extractions 50%
and dental surgery surgical repositioning of teeth).

Major Restorative Services – crowns 50%
Waiting Period – There is a
Other Basic Services – misc. services 50%
12-month waiting period for certain
Relines and Repairs – to bridges, 50% services. Major Restorative Services,
implants, and dentures
Relines and adjustments, fixed
MAJOR SERVICES Prosthodontic Repair, Prosthodontic

Prosthodontic Services – bridges, 50% Services, and Orthodontic Services
implants, and dentures
will not be covered until after a
ORTHODONTIC SERVICES person is enrolled in the dental
Orthodontic Services – braces 50% plan for 12 consecutive months.

Orthodontic Age Limit Dependent Children to the end
of the month of age 19

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