Dental Benefits

Dental insurance offers coverage for preventive care like routine exams, cleanings, and X-rays as well as basic and major services like fillings, extractions, root canals and crowns.

Keep in mind that your costs will generally be lower if you choose an in-network dentist. To find an in-network dentist, please visit www.deltadentalmo.com. Out-of-network providers can balance bill or bill you for the difference between the provider’s charge and the allowed amount.

	In-Network
Calendare Year Deductible (waived for Preventive Care) (Individual/Family)	$50 / $150
Annual Maximum Benefit per Person	$2,500
Type I - Preventative Services Oral exams, cleanings (2 per year), X-rays, Periodontal Maintenance, sealants (to age 16), space maintainers (to age 16) and fluoride treatment (to age 16)	100%
Type II - Basic Services Emergency palliative treatment, fillings, and simple extractions	80%
Type III - Major Services Bridges, crowns (inlays/outlays), dentures, Endodontics, General anesthesia, Nonsurgical and surgical Periodontics, oral surgery and surgical Extractions	50%
Type IV - Orthodontia Services Available for all eligible participants	50%
Orthodontia Lifetime Maximum (provided for both Adults & Children)	$2,000

	BOUNTIFUL per 26 Pay Period Cost	SKYHOOK Pay Period Cost
Employee	$12.28	$6.14
Employee + Spouse	$25.10	$12.55
Employee + Child(ren)	$30.42	$15.21
Family	$46.96	$23.48

Downloads

Summary of Benefits

Delta Dental Quick Facts

Group Number

11240172

Provided By

Delta Dental of Missouri

Provider Website

https://www.deltadentalmo.com/

Customer Service

800.392.1167

Resources

Frequently Asked Questions