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Dental Plan A Coverage

Type of Service covered 100%

  • Oral examinations - twice in any benefit period
  • Dental prophylaxis - twice in any benefit period
  • Topical fluoride treatment - once in any benefit period (only for children under age 14)
  • Sealants - once in 5 years for caries-free occlusal surfaces of the first & second permanent molars (only for children under age 16)
  • Space maintainers - once in 5 years that replace prematurely lost teeth (only for children under age 16)
  • Emergency palliative treatment - as needed
  • Bitewing x-rays - one set in any benefit period

The benefit maximum is $1,000 per person per year.

Dependent age limit is 19 or 25 for full-time student. Proof of student status is required.

2013 & 2012 Delta Dental Plan A Summary