Dental Delta Dental of Oklahoma Network PPO Plan Year Deductible $50 per person / $150 per family Preventive & Diagnostic Covered in full / Deductible waived Care Basic Care 20% After Deductible Major & Restorative Care 50% After Deductible Plan Year Maximum Per $1,500 Person Orthodontia 50% After Deductible (Children under 26) Orthodontic Lifetime $1,500 Maximum The picture can't be displayed. The picture can't be displayed. Effective: January 1, 2027 Amounts shown below are your responsibility. This table only shows in-network benefits 11 www.deltadentalok.org / 800-522-0188
2027 Employee Benefits Guide Page 10 Page 12