Preventive and Comprehensive Dental Services
Prominence Health Plan is pleased to partner with Delta Dental to provide optional preventive and comprehensive dental services through some of our health plans at an additional charge.*
Nevada Dental Evidence of Coverage
Texas Dental Evidence of Coverage
Preventive dental services include cleanings. There is no copayment for the office visit for preventive services.**
Comprehensive dental benefits include:
| Benefit | Plan Coverage |
|---|---|
| Basic Restorative | 70% |
| Oral Surgery | 50% |
| Simple Extractions | 50% |
| Endodontics | 50% |
| Surgical Periodontics | 50% |
| Non-Surgical Periodontics | 50% |
| Major Restorative | 50% |
| Prosthodontics — Fixed and Removable | 50% |
| Denture Repair and Relining | 70% |
| Deductible (does not apply to Diagnostic and Preventive Services) | ||
|---|---|---|
| Per Patient/Calendar Year | $50 | |
You must visit a dentist in the Delta Dental network to receive covered plan services. Services received from providers outside this network may not be covered.
* In Texas, preventive dental services are included as part of the base plan. Monthly premiums for the optional dental coverage are: Nevada—$29; North Texas—$23; South Texas—$22.
** Limitations apply.
For more information, contact Delta Dental customer service at 855-643-8414 (TTY:711) 8 a.m. – 8 p.m., Monday through Friday.
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Last update 9/26/2018