Our Networks

Delta Dental offers dentists the flexibility of participating with one or more of our networks, which serve a variety of commercial, Medicaid, Medicare Advantage, and Medicare and Medicaid dual program members.

Delta Dental offers dentists the flexibility of participating with one or more of our networks, which serve a variety of commercial, Medicaid, Medicare Advantage, and Medicare and Medicaid dual program members.

Delta Dental PPO™

Serves Delta Dental PPO (Standard), Delta Dental PPO (Point-of-Service) and Delta Dental Medicare Advantage™ members.

Delta Dental PPO (Standard)Delta Dental PPO (Point-of-Service)Medicare Advantage
  • A preferred provider organization program and a fee-for-service program.
  • No balance-billing on covered services.
  • Dentists file claims for members.
  • Popular with employers, so dentists who participate in this network may see an increase in patients.
  • Prior approval is not required to refer a patient to a specialist.
  • Combines the characteristics of Delta Dental Premier and Delta Dental PPO into one flexible program.
  • Members who do not go to a participating Delta Dental PPO dentist can still receive treatment from a Delta Dental Premier dentist, but often at a higher out-of-pocket cost.
  • Offered through health plan partners with dental benefits administered by Delta Dental.
  • Members must seek treatment from a participating dentist with their specific network; they do not have out-of-network benefits.
  • No balance-billing on covered services.

Delta Dental Premier®

Serves Delta Dental Premier, Delta Dental PPO (Point-of-Service) and Delta Dental Medicare Advantage members.

Delta Dental PremierDelta Dental PPO (Point-of-Service)Medicare Advantage
  • A fee-for-service program.
  • No balance-billing above the approved Delta Dental Premier fee (reviewed annually).
  • Members are responsible for their copayment and deductible (if any).
  • Dentists file claims for members.
  • Prior approval is not required to refer a patient to a specialist.
  • Combines the characteristics of Delta Dental Premier and Delta Dental PPO into one flexible program.
  • Members who do not go to a participating Delta Dental PPO dentist can still receive treatment from a Delta Dental Premier dentist, but often at a higher out-of-pocket cost.
  • Offered through health plan partners with dental benefits administered by Delta Dental.
  • Members must seek treatment from a participating dentist with their specific network; they do not have out-of-network benefits.
  • No balance-billing on covered services.

Delta Dental EPO™

Serves Delta Dental EPO members.

Delta Dental EPO
  • An exclusive provider organization (EPO) and fee-for-service program.
  • Members must receive care from participating Delta Dental EPO dentists.
  • Dentists file claims and receive payments directly from Delta Dental; collect only copayments (if any) from members
  • Participation includes Medicare Advantage plans administered by Delta Dental that use the EPO network.

Other networks and programs

Including Delta Dental's Special Healthcare Needs Benefit.

Special Healthcare Needs Benefit

This Delta Dental benefit reduces barriers to care by providing members with special healthcare needs enhanced benefits.

What’s included?

  • Additional visits to the dentist’s office and/or consultations that can be helpful prior to the first treatment to help patients learn what to expect and what is needed for a successful dental appointment. Additional exam benefits will be allowed for this purpose.
  • Up to four total dental cleanings in a year.
  • Treatment delivery modifications, including anesthesia and nitrous oxide, necessary for dental staff to provide oral healthcare for patients with sensory sensitivities, behavioral changes, severe anxiety or other barriers to treatment.
     

Using the benefit

  • Before rendering services, check the member’s procedure eligibility in the Dental Office Toolkit to verify coverage.
  • If the member’s record has already been updated to allow services under this benefit, there will be a “Special Healthcare Needs Benefit” message.
  • If there is not a message but the member says their plan includes this benefit and they have a qualifying special healthcare need, you should include code D9997 on the initial claim submission. After the first claim processes, the member’s record will update and you will not need to include the code for that member in the future.
  • There is no age limit on these benefits. Note that the “Special Healthcare Needs Benefit” is different from the “Handicap” attribute.
Dentist checking patient's teeth

Ready to join?

Our professional relations representatives are available to provide you with information about participating in each Delta Dental network, facilitate the contracting process and assist staff with Delta Dental claims administration.

Learn more

 

Evidence-based dentistry

Through our Research and Data Institute, we closely monitor and assess scientific findings to make evidence-based improvements to our plan designs. Many of these changes work to address patients with specific high-risk health conditions, where oral disease may put their systemic health at risk.

High-risk medical conditions

Members with certain high-risk medical conditions can receive enhanced coverage. This includes those with diabetes and gum disease, pregnant women with gum disease, patients with kidney failure, those with compromised immune systems and patients with certain health conditions.

Early detection of oral cancer

This benefit covers a diagnostic test called the BrushTest (oral brush biopsy), which can detect oral cancer and abnormal cells that may become cancerous.

High-risk cardiac conditions

This benefit was developed to help at-risk individuals better maintain oral health to reduce bacteria levels in the mouth to lower their risk for infective endocarditis. This enhanced benefit includes coverage of up to four teeth cleanings per benefit year for those with heart conditions that place them at high or moderate risk for developing infective endocarditis.