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