Dental Plans

Compare Delta Dental Standard Plan, Delta Dental Enhanced Plan and Aetna DMO side-by-side

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	Delta Dental Standard Plan	Delta Dental Enhanced Plan	Aetna DMO
Dentists
Dentist Directory	Click here to search the Delta Dental Dentist Directory * Select "Delta Dental PPO" or "Delta Dental Premier" from the menu.	Click here to search the Delta Dental Dentist Directory * Select "Delta Dental PPO" or "Delta Dental Premier" from the menu.	Click here to search the Aetna DMO Dentist Directory * Select "Dental Maintenance Organization (DMO)" from the plan menu.

	Delta Dental Standard Plan	Delta Dental Enhanced Plan	Aetna DMO
Costs
Your Monthly Premium Cost	Employee Only $15.82 Employee & Spouse $43.15 Employee & Children $34.73 Employee & Family $53.63	Employee Only $30.88 Employee & Spouse $77.79 Employee & Children $63.36 Employee & Family $95.82	Employee Only $24.05 Employee & Spouse $59.03 Employee & Children $66.67 Employee & Family $100.10

	Delta Dental Standard Plan	Delta Dental Enhanced Plan	Aetna DMO
Features
Member savings	You pay nothing for diagnostic and preventive services when services are provided by a Delta Dental PPO^SM dentist. You pay 20% of the fee when diagnostic and preventive services provided by a Delta Dental Premier® dentist.	You pay nothing for diagnostic and preventive services when services are provided by a Delta Dental PPO^SM dentist or by a Delta Dental Premier dentist.	You pay $10 office visit copay for all covered services that are provided by a primary care dentist.
Dentist network	You can use any dentist. Pay less when using a PPO dentist. Pay more when using a Delta Dental Premier dentist; pay the most if you use a non-participating dentist.	You can use any dentist. Pay less when using a PPO dentist. Pay more when using a Delta Dental Premier dentist; pay the most if you use a non-participating dentist.	Participants must designate and seek care from an Aetna Primary Care Dentist (PCD). Services done by specialists are covered only if ordered/referred by the primary care dentist and authorized by Aetna Dental. Your cost for specialist care depends upon the specialist's fee.
Filing claims	No claims paperwork except for non-participating dentists.	No claims paperwork except for non-participating dentists.	No claims paperwork except for non-participating dentists for emergency care.
Teeth cleaning	Two cleanings per calendar year. Additional exam and cleaning services for pregnant women.	Two cleanings per calendar year. Additional exam and cleaning services for pregnant women.	Two cleanings per calendar year.
Teeth whitening	Not covered	Not covered	Not covered
Orthodontics	Not covered	You pay 25% of charges; maximum benefit limited to $2,000 lifetime for children under age 19	You pay 50% of charges; no maximum benefit limit; available for eligible dependent children only if the appliance is placed prior to age 20.

	Delta Dental Standard Plan	Delta Dental Enhanced Plan	Aetna DMO
Services
Maximum yearly benefit	$1,000 per person	$2,000 per person	No limit on yearly benefit
Deductible (person/family)	$50/$100	$50/$100	No deductible
Orthodontic lifetime benefit	Not covered	$2,000 per person lifetime	No lifetime maximum
	Delta Dental Standard Plan	Delta Dental Enhanced Plan	Aetna DMO
Preventative Dentistry
Coverage	No deductible	No deductible	No deductible
Oral examinations	0% PPO / 20% Premier & Non-Participating Providers	0% PPO / 0% Premier & Non-Participating Providers	$10 copay* Limited to 4 visits per calendar year
Cleaning of teeth — prophylaxis cleanings	0% PPO / 20% Premier & Non-Participating Providers	0% PPO / 0% Premier & Non-Participating Providers	$10 copay* Limited to 2 treatments per calendar year
X-rays (full mouth, bitewings, other films)	0% PPO / 20% Premier & Non-Participating Providers	0% PPO / 0% Premier & Non-Participating Providers	$10 copay* Bitewings limited to 2 sets per calendar year; Vertical bitewings limited to 1 set every 3 rolling years; Entire series including bitewings or panoramic films is limited to 1 set every 3 rolling years.
Emergency office visit for pain relief	0% PPO / 20% Premier & Non-Participating Providers	0% PPO / 0% Premier & Non-Participating Providers	$10 copay*
Topical fluoride treatment	0% PPO / 20% Premier & Non-Participating Providers	0% PPO / 0% Premier & Non-Participating Providers	$10 copay* Limited to one treatment per calendar year for covered persons under age 18
Space maintainers	0% PPO / 20% Premier & Non-Participating Providers	0% PPO / 0% Premier & Non-Participating Providers	$10 copay*
Pit and fissure sealants (under age 14 only)	0% PPO / 20% Premier & Non-Participating Providers	0% PPO / 0% Premier & Non-Participating Providers	$10 copay* Limited to 1 application per tooth every 3 rolling years for permanent molars only
	Delta Dental Standard Plan	Delta Dental Enhanced Plan	Aetna DMO
Basic Dentistry
Coverage	Coverage starts after you pay deductible	Coverage starts after you pay deductible	No deductible
Fillings ("silver" and "white" non-molar)	20% PPO / 20% Premier & Non-Participating Providers	10% PPO / 20% Premier & Non-Participating Providers	$10 copay*
Extractions — simple	20% PPO / 20% Premier & Non-Participating Providers	10% PPO / 20% Premier & Non-Participating Providers	$10 copay*
Endodontics — root canal care	40% PPO / 50% Premier & Non-Participating Providers	40% PPO / 50% Premier & Non-Participating Providers	$10 copay*
Periodontics — gum disease non-surgical care	20% PPO / 20% Premier & Non-Participating Providers	10% PPO / 20% Premier & Non-Participating Providers	$10 copay* Subject to frequency limitations. Root planing & scaling limited to 1 full mouth treatment per 1 rolling year.
	Delta Dental Standard Plan	Delta Dental Enhanced Plan	Aetna DMO
Major Dentistry
Coverage	Coverage starts after you pay deductible	Coverage starts after you pay deductible	No deductible
General anesthesia*	40% PPO / 50% Premier & Non-Participating Providers	40% PPO / 50% Premier & Non-Participating Providers	$10 copay*
Oral surgery	40% PPO / 50% Premier & Non-Participating Providers	40% PPO / 50% Premier & Non-Participating Providers	$10 copay*
Periodontics — gum disease surgical care	40% PPO / 50% Premier & Non-Participating Providers	40% PPO / 50% Premier & Non-Participating Providers	$10 copay* Subject to frequency limitations. Periodontal maintenance following surgical therapy limited to 2 treatments per calendar year.
Crowns	40% PPO / 50% Premier & Non-Participating Providers	40% PPO / 50% Premier & Non-Participating Providers	$10 copay* Prosthetic replacement is limited to once every 5 rolling years.
Inlays/onlays	40% PPO / 50% Premier & Non-Participating Providers	40% PPO / 50% Premier & Non-Participating Providers	$10 copay*
TMJ — Temporomandibular joint dysfunction: occlusal devices/occlusal guards (night guards)	Not covered	Not covered	Not covered
	Delta Dental Standard Plan	Delta Dental Enhanced Plan	Aetna DMO
Prosthetic Dentistry
Coverage	Coverage starts after you pay deductible	Coverage starts after you pay deductible	No deductible
Standard, full, or partial dentures	40% PPO / 50% Premier & Non-Participating Providers	40% PPO / 50% Premier & Non-Participating Providers	$10 copay* Prosthetic replacement is limited to once every 5 rolling years.
Bridges	40% PPO / 50% Premier & Non-Participating Providers	40% PPO / 50% Premier & Non-Participating Providers	$10 copay* Prosthetic replacement is limited to once every 5 rolling years.
Implants	40% PPO / 50% Premier & Non-Participating Providers	40% PPO / 50% Premier & Non-Participating Providers	Not covered
	Delta Dental Standard Plan	Delta Dental Enhanced Plan	Aetna DMO
Orthodontics
Coverage	Not covered	No deductible	No deductible
Who is eligible for service	Not covered	Children under age 19	Children only (Appliance must be placed before age 20); no referral to orthodonist needed
You pay	Not covered	25% up to $2,000 lifetime maximum	50%, no lifetime maximum in network; $800 lifetime maximum out of network
Limitations	Not covered	In the event orthodontia treatment is being provided by a dentist who does not participate with Delta Dental, claims submitted will be processed as non-participating provider claims.	Not covered if orthodontia service began prior to Aetna DMO coverage
	Delta Dental Standard Plan	Delta Dental Enhanced Plan	Aetna DMO
Special Provisions and Limitations
Key limitations	Periodic examinations of the full mouth and cleanings are limited to once in any 6-month period or twice in any 12-month period. Bitewing x-rays are limited to once in any 6-month period or twice in any 12-month period. Sealants are a benefit limited to age 14 once in any 36-month period on unfilled permanent first and second molars. Space maintainers are a benefit up to age 14. General anesthesia is a covered benefit when done in conjunction with covered oral surgery procedures with 3 or more simple extractions and/or with surgical extractions for patients over 19, or with 1 or more simple extractions and/or surgical extractions for patients under 19.	Periodic examinations of the full mouth and cleanings are limited to once in any 6-month period or twice in any 12-month period. Bitewing x-rays are limited to once in any 6-month period or twice in any 12-month period. Sealants are a benefit limited to age 14 once in any 36-month period on unfilled permanent first and second molars. Space maintainers are a benefit up to age 14. General anesthesia is a covered benefit when done in conjunction with covered oral surgery procedures with 3 or more simple extractions and/or with surgical extractions for patients over 19, or with 1 or more simple extractions and/or surgical extractions for patients under 19.	Services done by specialists are covered only if ordered by the primary care dentist and authorized by Aetna Dental. Your cost for specialist care depends upon the specialist's fee. Office visits for oral exams limited to 4 visits per calendar year. Prophylaxis (cleaning) limited to 2 treatments per calendar year. Topical fluoride application limited to 1 treatment per calendar year and to covered persons under age 18. Sealants, per tooth limited to 1 application every 3 rolling years for permanent molars only. Bitewing X-rays limited to 2 sets per calendar year. Entire series including bitewings or panoramic films limited to 1 set every 3 rolling years. Vertical bitewing X-rays limited to 1 set every 3 rolling years. Periodontal scaling and root planing also subject to frequency limitations. Prosthetic replacement is limited to once every 5 rolling years. Root Planing & Scaling limited to 1 full mouth treatment per 1 rolling year. Periodontal maintenance following surgical therapy limited to 2 treatments per calendar year.
Work in progress when you join	Certain services for which work began prior to Delta Dental coverage are not covered; see EOC	Certain services for which work began prior to Delta Dental coverage are not covered; see EOC	Certain services for which work began prior to Aetna DMO coverage are not covered; see EOC
Predetermination of benefits	The dentist is encouraged to submit a list of any planned procedures that cost more than $300 and Delta Dental responds with a predetermination of benefits outlining the coverage, the member cost responsibility and any plan limitations. This is intended to help prevent unnecessary or unauthorized services.	The dentist is encouraged to submit a list of any planned procedures that cost more than $300 and Delta Dental responds with a predetermination of benefits outlining the coverage, the member cost responsibility and any plan limitations. This is intended to help prevent unnecessary or unauthorized services.	Predetermination is recommended for Periodontal services.
Replacement of applicances including dentures and bridges	Prosthodontic device replacement — like dentures and bridges — covered once in five years.	Prosthodontic device replacement — like dentures and bridges — covered once in five years.	Only covered if person needs tooth replacement/addition due to 1 or more teeth that need to be extracted after the device was installed.
Out-of-area emergencies	You can use any dentist — you are never out-of-area. You pay least amount when using a Delta Dental PPO dentist or Premier dentist. You pay more when using a non-participating dentist. Emergency services are handled as any other claim.	You can use any dentist — you are never out-of-area. You pay least amount when using a Delta Dental PPO dentist or Premier dentist. You pay more when using a non-participating dentist. Emergency services are handled as any other claim.	Aetna provides a $100 maximum benefit for out-of-area emergency care
Teeth bleaching	Not covered	Not covered	Not covered

	Delta Dental Standard Plan	Delta Dental Enhanced Plan	Aetna DMO
Top 5 Services Cost **
Teeth cleaning and oral exam Typical Price $116 PPO dentist $155 Premier dentist	You Pay PPO: No cost Premier: About $31	You Pay PPO: No cost Premier: No cost	$10 copay*
Full mouth x-ray Typical Price $78 PPO dentist $95 Premier dentist	You Pay PPO: No cost Premier: About $19	You Pay PPO: No cost Premier: No cost	$10 copay*
Amalgam (silver) filling Typical Price $85 PPO dentist $125 Premier dentist	You Pay PPO: About $17 Premier: About $25	You Pay PPO: About $9 Premier: About $25	$10 copay*
Tooth extraction Typical Price $89 PPO dentist $100 Premier dentist	You Pay PPO: About $18 Premier: About $20	You Pay PPO: About $9 Premier: About $20	$10 copay*
Crown (stainless steel) Typical Price $150 PPO dentist $225 Premier dentist	You Pay PPO: About $60 Premier: About $113	You Pay PPO: About $60 Premier: About $113	$10 copay*

* Aetna DMO coverage is for primary care dentists; see EOC for using services provided by specialists

** Costs are for Washington, DC area