Our Networks

Delta Dental is one of the nation’s largest, most experienced dental benefits carriers—providing coverage to more than 80 million people across the country.

Delta Dental is one of the nation’s largest, most experienced dental benefits carriers—providing coverage to more than 80 million people across the country.
A dentist explains dental xrays to a patient

Benefits of participating dentists

  • No-hassle claims with electronic claims processing, direct deposit and EOBs
  • Patient referrals through print, telephone and online directories
  • Award-winning 24/7 customer service support for patients and staff
  • Personal office visits by our Professional Relations team members
  • Discounts on products and services from vendors you use

Networks explained

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. 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.

Delta Dental PPO™

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

Delta Dental PPO (Standard)

  • 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.

Delta Dental PPO (Point-of-Service)

  • 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.

Medicare Advantage

  • 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 PPO (Point-of-Service) and Medicare Advantage members.

Delta Dental Premier

  • 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.

Delta Dental PPO (Point-of-Service)

  • 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.

Medicare Advantage

  • 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.
     

Other plan options

Delta Dental EPO (exclusive provider organization) is a fee-for-service program, and participating dentists are listed in our closed-panel directory. Members are required to receive services from Delta Dental EPO dentists. Treatment payment is based on the applicable fee schedule and member copayments. Participating dentists receive claim payments directly from Delta Dental and collect only copayments (if any) from Delta Dental EPO members. Delta Dental EPO serves commercial and government program members and is only available in Michigan, Ohio and Indiana.​

Medicare Advantage plans are offered through health plan partners and the dental benefits are administered by Delta Dental. Participation in the Delta Dental EPO network includes participation with Medicare Advantage plans administered by Delta Dental. Medicare Advantage members must seek treatment from a participating dentist with their specific network; they do not have out-of-network benefits. A participating dentist cannot balance bill the member for any difference between his or her regular fees and the amount in the program fee schedule.​

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.

Ready to join?

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