Employee Benefits | Delta Dental - Covered Dental Services


Site Contents	Covered Dental Services Diagnostic And Preventive Services Diagnostic - Provides the necessary procedures to assist the dentist in evaluating the conditions existing and the dental care required. Preventive - Provides the necessary procedures or techniques to prevent the occurrence of dental abnormalities or disease. Limitations Prophylaxis is a benefit only twice in a twelve (12) month period, unless special need exists. Complete mouth radiographs are a benefit only once in a three (3) year period, unless special need exists. Bite-wing radiographs are a benefit only twice in a twelve (12) month period. Topical fluoride application is a benefit only to children through age fifteen (15), and is a benefit only once in a twelve (12) month period. Restorative Services Restorative - Provides the necessary procedures to restore the teeth other than cast restorations. Limitations Allowance for amalgam on posterior (back) teeth or intraorally cured (placed and hardened completely in the mouth) resin or plastic restorations (fillings) on anterior (front) teeth may be made toward the cost of more expensive procedures or materials selected, and the patient shall be responsible for the portion of the dentist's fee in excess of the Delta allowance. Major Services Oral Surgery - Provides the necessary procedures for extractions and other oral surgery including pre- and post-operative care. Endodontics - Provides the necessary procedures for pulpal and root canal therapy. Periodontics - Provides the necessary procedures for treatment of the tissues supporting the teeth. Cast Restorations - Provides for gold restorations, crowns and jackets when teeth cannot be restored with other materials. Prosthodontics - Provides the necessary procedures associated with the construction, placement or repair of fixed bridges, partial and complete dentures. Limitations Veneers on crowns or prosthetic appliances posterior to maxillary first molars or mandibular second bicuspids are considered optional, and as such, are not a covered service. Porcelain, gold, porcelain veneer and acrylic veneer precious metal crowns over vital teeth are not a covered service for children under age twelve (12). Appliances for the replacement of the same natural teeth are a benefit only once in a five (5) year period. Replacement of an existing prosthetic appliance is a benefit only if the appliance is unsatisfactory and cannot be made satisfactory. Temporary partial dentures are a benefit only when anterior teeth are missing. Specialized techniques, precious metals for removable appliances, precision attachments, implants and associated appliances, personalization and characterization are considered optional, and as such, are not a benefit. An allowance for a standard procedure will be made toward the cost of a more complex procedure. Fixed bridges and/or cast partials are not a benefit for children under age sixteen (16), except by individual consideration. A posterior fixed bridge is not a covered service when done in connection with a removable appliance in the same arch. Charges for prosthetic appliances and periodontal treatment will be allowed only when a pre-treatment benefit determination has been made by Delta. General anesthesia is a benefit only when administered by a dentist in his/her office in connection with Oral Surgery. Veneers posterior to maxillary first molars or mandibular second bicuspids are considered optional, and as such, are not a benefit. Orthodontic Services Orthodontics - Provides the necessary procedures associated with the orthodontic movement of the teeth into proper alignment, position and occlusion. Available for employees, spouses and dependent children. Limitations Charges for Orthodontic treatment will be allowed only when a pre-treatment benefit determination, if possible, has been made by Delta. The obligation of Delta to make monthly or other periodic payments for an Orthodontic treatment plan shall cease upon termination of treatment for any reason prior to completion of the case. Orthodontic care provided in the treatment of periodontal cases is not a covered service. The obligation of Delta to make monthly or other periodic payments for an orthodontic treatment plan begun prior to the eligibility date of the patient shall commence with the first payment due following the patient's eligibility date. The maximum amount payable will apply fully to this and subsequent payment. Replacement of lost or broken appliances is a benefit once per case. The obligation of Delta to make monthly or other periodic payments for an orthodontic treatment plan shall cease upon termination of the covered person's eligibility. X-rays and surgical procedures incident to Orthodontics are not covered by Orthodontic Benefits, but may be covered under other provisions of the Plan. Delta's obligation to make monthly or other periodic payments for orthodontics for dependent children shall terminate on the date the eligible dependent child no longer meets the definition of dependent, and in any event on the termination of this agreement.
	NAVIGATION Introduction \| Welcome \| Covered Services \| Exclusions Website for Delta Dental Denver Public Schools Employee Benefits Department 900 Grant Street, Room 502 Denver, Colorado 80203 (303) 764-3371