Sentry 2019 Dental Benefits Guide

Your Dental Benefits

Delta Dental Premier

Non-Contracted Dentist

Benefit Plan Design

Delta Dental PPO

Individual Annual Maximum

$1,750

Deductible – Individual / Family

$50 / $150

Diagnostic and Preventive Services (deductible does not apply) Two exams, two cleanings, fluoride treatments, X-rays, sealants, space maintainers Basic Services (deductible applies) Emergency treatments, fillings, endodontics, periodontics, extractions Major Restorative Services (deductible applies) Crowns, inlays, onlays, bridges, dentures, implants, repairs to bridges and dentures

X

X 100%

80%

X 50%

Orthodontic Services (deductible does not apply)

50% Up to $1,750 (Children and Adult)

X Discounted fees. Saves money, not as much as PPO.

Discounted fees. Saves you the most money.

No discounted fees. No savings.

Network Information