How much does delta dental pay for a crown

Good health starts with a healthy smile, and with Delta Dental’s large networks, chances are there is a great in-network dentist just around the corner from you.

By visiting an in-network dentist for your regular check-ups and cleanings, you can receive the great dental care you need with the savings you want.

For example: A dentist may submit a $950 charge for a crown. With dental coverage, the participating dentist accepts a reduced fee of $744. That’s an immediate savings of $206! Since you have Delta Dental coverage and saw a participating dentist, Delta Dental will pay a percentage from the reduced fee, saving you even more!

How can you save by staying in network

It is important to verify what network(s) your plan uses to ensure you get the biggest benefit from your benefits. As shown below, someone with a Delta Dental PPO (Point-of-Service) plan will often have the lowest out-of-pocket costs when they choose to visit either a Delta Dental PPO or Delta Dental Premier dentist.*

*The payment example above is for illustration purposes only. Fees and reimbursements can vary by location and dentist. It does however represent how the payment is determined.

Finding an in-network dentist is pain-free

With many of our plans you can go to any licensed dentist, but you may lower your out-of-pocket costs if you choose a dentist who participates in the Delta Dental PPO networks. Dentists in our network agree to accept Delta Dental fees as full payment for covered services, while nonparticipating dentists do not have an agreement with Delta Dental and may charge more than our fees. If you go to a nonparticipating dentist, you will be responsible for the difference between Delta Dental’s allowed fee and the amount charged by the dentist.

To find an in-network dentist:

• Visit Find a Dentist. Then, choose your network from the list and enter your address and/or ZIP code in the search form.
• If you do not know what network(s) your plan uses, log in to the Member Portal. Here, you can find nearby dentists in your network, and also access claim information, review eligibility and much more.
• Call us toll free at 800-524-0149, and the automated system will provide you with a list of participating dentists near you.

Always ask your dentist if he or she is a participating dentist with your Delta Dental plan before receiving any dental services.

The Dental Care Cost Estimator provides an estimate and does not guarantee the exact fees for dental procedures, what dental benefits your plan will cover, or your out-of-pocket costs. Estimates should not be construed as financial or medical advice. For more detailed information on your dental care costs, please consult your dentist or your Delta Dental.

While more than 3 out of 4 Americans have dental insurance1, many don’t fully understand what dental insurance does and doesn’t cover. This quick guide to dental insurance can help you get a better understanding of how coverage usually works.

The purpose of dental coverage

Dental insurance is designed to help you offset the cost of your dental care and to help you maintain good overall oral health. That’s why we focus on preventive care to catch signs and symptoms of dental disease early. This could reduce the chance that you will need more complex treatment later. If an issue does arise, dental insurance will usually help cover a portion of the treatment cost, so you don’t have to pay the full bill yourself. This combination of preventive services covered at 100% and lower out-of-pocket costs makes dental insurance a valuable benefit.

What is covered: 100-80-50 coverage structure example

The emphasis on preventive coverage and sharing of costs on other procedures is reflected in the structure for most dental insurance plans. As part of this structure, an example of dental coverage may be:

• 100% of routine preventive and diagnostic care such as cleanings and exams.

• 80% of basic procedures such as fillings, root canals and tooth extractions.

• 50% of major procedures such as crowns, bridges and dentures.

Be aware that a deductible — the amount you pay before your dental insurance kicks in — may apply to these services, although it may be waived for preventive and diagnostic services. 

What may not be covered

• Select procedures: While it differs from plan to plan, some dental insurance may not cover select procedures such as orthodontia.
• Cosmetic procedures: Coverage for cosmetic dental procedures like teeth whitening may not be covered. 
• Pre-existing conditions: Some policies don’t cover certain pre-existing conditions such as missing teeth. If you had a condition before you got your dental plan, you may be required to pay treatment costs out-of-pocket.

Additional plan information

These limitations may also apply to your dental insurance:

• Waiting period: This is the period of time before you are eligible to receive benefits for all or certain dental treatments. Waiting periods are more common with individual plans2 but also apply to employer-sponsored plans in some industries. This can sometimes be waived if you prove you had no gap in your dental coverage before purchasing a plan.
• Other restrictions: In addition to some procedures not being available right away, your plan may require time limits between services like fillings, crowns and bridges on the same tooth or fluoride treatments for children. For example, a policy may only pay for a full set of X-rays once every five years3.
• Annual maximum: This is the total amount your dental insurance will pay for your coverage during a 12-month period. For instance, if your annual maximum is $1,500, you pay for all additional costs after your dental insurance has paid $1,500 for your care. However, only 2% to 4% of Americans typically exceed their annual maximums4.

Important terms to know

It helps to become familiar with the following terms to get a greater understanding of why some services are covered and others are not:

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