Understanding your Delta Dental implant coverage can help you plan for long-term dental restorations with confidence. Delta Dental coverage for dental implants typically covers a portion of major procedures once you meet your deductible and any waiting periods. By familiarizing yourself with plan details, waiting periods, criteria for medical necessity, and cost-sharing features, you can minimize surprises and maximize your benefits.
Delta Dental implant coverage
Covered procedures
Most Delta Dental plans classify dental implants as “major services,” covering a percentage of the implant surgery, abutment, and crown components. Coverage often includes:
- Surgical placement of a single implant
- Prefabricated or custom abutments used for crowns
- Implant-supported crowns
In many plans, implant surgery and prosthetic components are covered at 50% of the allowed amount after the deductible is met (Delta Dental). You pay half the cost of each covered procedure.
Excluded treatments
While Delta Dental plans cover implant procedures, you may encounter exclusions or limits on:
- Implant coverage for congenitally missing teeth or spacing due to tooth migration
- Replacement of implants or implant crowns outside the replacement frequency
- Services not coded correctly (for example, coding an implant crown as a fixed partial denture)
Incorrect coding can lead to denials. Ensuring your provider uses the proper codes for abutment-supported and implant-supported crowns helps you avoid unexpected out-of-pocket charges (Delta Dental coding guide).
Plan options and types
PPO and Premier plans
Delta Dental offers two main networks: Delta Dental PPO and Delta Dental Premier. Both plans cover dental implants, but in-network dentists accept negotiated fees, lowering your out-of-pocket costs. Key differences include:
| Feature | PPO plan | Premier plan |
|---|---|---|
| Network size | Smaller | Larger |
| Fee discounts | 10–20% off usual fees | 5–15% off usual fees |
| Out-of-network flexibility | Partial reimbursement | Broader coverage |
| Typical implant coverage | 50% after deductible | 50% after deductible |
Choosing an in-network provider can reduce your costs substantially. If you prefer broader flexibility, Premier plan coverage may suit you better.
Discount direct plans
Delta Dental Patient Direct and similar discount plans are not insurance but give you access to reduced fees. You pay a membership fee and then receive discounts on implants, crowns, and other services at participating dentists. There are no waiting periods or deductibles, but you bear 100% of the discounted fee.
Waiting periods and limits
Standard waiting periods
Most Delta Dental plans impose a waiting period before major services like implants and crowns are covered. Typical waiting periods are:
- Preventive and diagnostic: none
- Basic restorative (fillings): 6 months
- Major restorative (crowns, bridges, implants): 6 to 12 months (Delta Dental waiting periods)
If you need same-day crowns, check our guide on same day crown with delta dental to understand your plan’s timing.
Waived and graduated benefits
Some plans waive waiting periods if you had comparable coverage within 30 to 60 days before the new plan’s effective date. Others offer graduated benefits, where coverage for major services increases over time—for example, 25% in year one, 50% in year two, and 80% in year three.
Coverage criteria and exclusions
Medical necessity guidelines
Delta Dental requires that implants be “medically necessary” to replace missing teeth for proper function and oral health. Common criteria include:
- Loss of a permanent tooth due to decay, trauma, or extraction
- Adequate bone structure to support an implant
- Implants as an alternative to bridges or removable dentures that compromise adjacent teeth
Consult your dentist to document medical necessity. This helps secure coverage, especially if your plan has a “missing tooth clause” excluding pre-existing gaps (Ramliaoui DDS).
Alternative treatment clause
If your policy contains an alternative treatment clause, Delta Dental may cover dentures or bridges instead of implants. You can then request an allowance or alternate benefit toward implant costs. Ask your provider for a pre-treatment estimate to compare out-of-pocket expenses for each option.
Out-of-pocket costs breakdown
Deductibles and annual maximums
Delta Dental plans usually have an annual deductible of $50 to $100 per person. After meeting the deductible, you share costs according to your plan’s coinsurance—often 50% for major services. Plans also impose an annual maximum benefit, typically $1,000 to $2,500, which caps the total amount paid by the insurer each year.
Allowance and alternate benefits
When coverage for implants isn’t available or is limited, Delta Dental may apply an alternate benefit based on the cost of a comparable service, such as a fixed bridge. For example, if a bridge costs $2,000 and an implant procedure costs $3,500, your plan might apply the bridge allowance toward your implant, reducing your covered amount.
Claims and billing process
Coding and documentation
Correct coding ensures your claim processes smoothly. Key codes include:
- D6010: Surgical placement of implant body
- D6057: Custom abutment
- D6058: Prefabricated abutment
- D2740: Crown
Avoid coding abutments as single crowns or attaching implant-supported crowns incorrectly. Your dentist’s billing team should reference Delta Dental’s coding guidelines to minimize denials (Delta Dental coding guide).
Pre-treatment estimates
Request a pre-treatment estimate at no cost with Delta Dental PPO and Premier plans. This estimate outlines your share of the costs, helping you budget for surgery, abutment, and crown components. If you’re considering a same-day crown, pair your implant treatment plan with same day crown with delta dental guidance.
Delta Dental versus competitors
Plan comparison table
Compare key features of Delta Dental with leading alternatives for implant coverage:
| Insurer | Waiting period | Coverage % after deductible | Annual maximum | Notes |
|---|---|---|---|---|
| Delta Dental PPO | 6 months | 50% | $2,000 | In-network fees discounted, waived if prior comparable plan |
| Aetna | 6–12 months | 50–80% | $1,500–$2,000 | Flexible in/out-of-network, see aetna coverage for dental implants |
| Cigna | 12 months | 50% | $1,200 | No waiting for crown with certain plans, see in-network same day crown dentist cigna |
| BCBS | 12 months | 50–80% | $1,000–$1,500 | Some plans waive crown waiting, see bcbs same day dental crown provider |
Competitor highlights
- Aetna offers varied coinsurance tiers and broad PPO network.
- Cigna plans may cover emergency same-day crowns with no wait; explore emergency same day crown with insurance.
- BCBS networks often include local specialists for same-day crowns and implant dentistry.
Maximize your insurance benefits
Timing and plan selection
To reduce out-of-pocket costs:
- Enroll before you need major work to start the waiting period clock early
- Choose in-network dentists for fee discounts
- Confirm waiting period waivers if you held prior coverage
Review your plan’s benefit year start date and schedule treatment early in the year to use your full annual maximum.
Financing alternatives
If your plan does not fully cover implants, consider:
- Health savings accounts (HSA), health reimbursement arrangements (HRA), or flexible spending accounts (FSA)
- Personal financing or dental payment plans offered by your provider
- Medicaid or Medicare Advantage options—for single tooth replacement, see medicaid-coverage-for-single-tooth-replacement and tooth implant with medicaid dental
- Discount membership plans like Delta Dental Patient Direct
By combining insurance benefits with other financing tools, you can make implants and same-day crowns more affordable.
Understanding your Delta Dental implant benefits and plan details empowers you to pursue lasting dental restorations with confidence. Speak with your dentist and plan representative to confirm coverage, request pre-treatment estimates, and schedule procedures that fit your budget and oral health goals. For more on finding in-network providers and comparing implant coverage, explore our resources on dental implant with insurance coverage.