Delta Dental PPO insurance Orthodontics coverage -

Complete Guide to Delta Dental PPO Orthodontics Coverage at Hardy Pediatric Dentistry & Orthodontics

Are you looking for quality orthodontic care in Erie, Colorado that accepts Delta Dental PPO insurance? At Hardy Pediatric Dentistry & Orthodontics, we understand navigating insurance coverage for orthodontic treatments can be confusing, so we’ve created this detailed guide to help you understand your Delta Dental PPO benefits for orthodontic treatments.

Our team of specialists, led by board-certified orthodontist Dr. T.C. Hardy, works closely with Delta Dental to maximize your insurance benefits and make your orthodontic treatment as affordable as possible. With our expertise in various orthodontic options, including traditional braces, clear braces, Invisalign®, and InBrace, we ensure you receive the highest quality care while making the most of your Delta Dental coverage.

Delta Dental PPO Plans That Cover Orthodontic Treatments

Delta Dental offers several insurance plans that provide orthodontic coverage, with the most comprehensive options being Delta Dental PPO Plus Premier and Delta Dental PPO Individual – Premium Plan.

Delta Dental PPO Plus Premier

The Delta Dental PPO Plus Premier plan combines two of Delta Dental’s national networks—Delta Dental PPO and Delta Dental Premier—to give members unmatched access to providers and significant cost savings. This dual-network approach offers two levels of claim savings:

  • Maximum Flexibility: Choose from orthodontists in the Delta Dental Premier network—the largest dental network in the nation
  • Greatest Value: Select an orthodontist from the Delta Dental PPO network for the highest cost savings
  • Quality Assurance: All network orthodontists must meet Delta Dental’s strict credentialing requirements

With this plan, you can confidently select any orthodontist within either network, knowing your provider meets Delta Dental’s high standards while still receiving significant cost savings compared to out-of-network care.

Delta Dental PPO Individual – Premium Plan

For those seeking the most extensive coverage, the Delta Dental PPO Premium plan offers:

  • Broader Coverage: Covers more orthodontic procedures with lower out-of-pocket costs
  • Age-Inclusive Coverage: Orthodontic benefits for both adults and children
  • Annual Deductible: $50 per person per year (must be met before plan begins coverage)
  • Annual Maximum: $2,000 total amount per person your plan will pay toward orthodontic care annually

This plan is ideal for families with multiple members needing orthodontic treatment or individuals seeking comprehensive coverage for more complex orthodontic needs.

What Orthodontic Services Does Delta Dental PPO Cover?

Understanding exactly what your Delta Dental PPO plan covers is essential for planning your orthodontic treatment. Here’s a breakdown of coverage for various orthodontic services:

Braces Coverage

The Delta Dental PPO Plus Premier and Delta Dental PPO Premium plans provide an estimated 50% coverage for traditional braces for children and adults. Key details include:

  • Waiting Period: 6 months before orthodontic coverage begins
  • Maximum Lifetime Benefit: $1,500 for orthodontic treatment
  • PPO Network Advantage: When visiting a PPO network orthodontist like Dr. T.C. Hardy, you’ll receive the full $1,500 calendar year maximum

At Hardy Pediatric Dentistry & Orthodontics, Dr. T.C. Hardy offers traditional metal braces and aesthetic options, allowing you to choose the treatment best suited for your needs and preferences while maximizing your Delta Dental benefits.

Clear Aligner Coverage (Invisalign®)

If you’re interested in Invisalign® treatment, Delta Dental typically considers this under orthodontia coverage:

  • Coverage Rate: Approximately 50% of the total Invisalign® treatment cost
  • Important Considerations:
    • Check your specific policy for confirmation that Invisalign® is covered
    • Be aware of age restrictions—some plans limit orthodontic benefits to members under 19 years of age
    • Adult coverage is available with the Delta Dental PPO Premium plan

Our Hardy Pediatric Dentistry & Orthodontics team can verify your Invisalign® coverage and explain any limitations or exclusions before beginning treatment.

Lingual and Clear Braces Coverage

For patients seeking more discreet orthodontic options:

  • Coverage Rate: Approximately 50% coverage for lingual braces (braces placed on the back of teeth) and clear braces
  • Waiting Period: 6 months
  • Maximum Lifetime Benefit: $1,500
  • Network Savings: Full calendar year maximum of $1,500 when visiting a PPO network provider

Dr. T.C. Hardy specializes in aesthetic treatment options, including clear braces and InBrace (lingual braces), giving you access to more discreet orthodontic solutions while utilizing your Delta Dental benefits.

Retainer Coverage

Retainers are a crucial part of maintaining your orthodontic results:

  • Coverage Details: One set of post-treatment retainers for orthodontic purposes is typically covered for a lifetime with the Delta Dental PPO Premium plan
  • Replacement Considerations: Replacement retainers may not be covered or may have different coverage rates—check your specific plan details

Additional Services Covered by Delta Dental PPO

Your Delta Dental PPO coverage extends beyond just orthodontic appliances. Understanding these additional covered services can help you maximize your benefits.

Diagnostic Services Coverage

Both the Delta Dental PPO Premium and the Delta Dental PPO Plus Premier plans cover important diagnostic services:

  • X-Ray Coverage: Approximately 100% coverage for diagnostic services like bitewing x-rays and full mouth x-rays
  • No Waiting Period: These services are available immediately upon plan activation
  • Frequency Allowances:
    • Bitewing x-rays: Twice per calendar year for children under 18
    • Full mouth x-rays: Once every 5 years

At Hardy Pediatric Dentistry & Orthodontics, we utilize advanced digital x-ray technology that reduces radiation exposure by up to 90% compared to traditional x-rays, providing immediate results for faster treatment planning.

Orthodontic Consultation and Records

Initial consultations and orthodontic records are typically covered services:

  • Coverage Rate: Varies by plan, often at the same rate as diagnostic services
  • Records Included: Initial photos, x-rays, and impressions (or digital scans)
  • iTero Scanner Advantage: Our office uses the advanced iTero scanner to create precise 3D digital models of your teeth, eliminating the need for uncomfortable traditional impressions
Service PPO Plus Premier Coverage PPO Premium Coverage Waiting Period
Traditional Braces ~50% ~50% 6 months
Invisalign® ~50% ~50% 6 months
Clear/Lingual Braces ~50% ~50% 6 months
Retainers One set lifetime One set lifetime After treatment
X-Rays ~100% ~100% None
Consultations ~100% ~100% None

Why Choose Hardy Pediatric Dentistry & Orthodontics for Your Delta Dental PPO Covered Treatment

At Hardy Pediatric Dentistry & Orthodontics, we’re committed to helping you maximize your Delta Dental benefits while providing exceptional orthodontic care.

Expert Orthodontic Care

Dr. T.C. Hardy brings extensive qualifications to your orthodontic treatment:

  • Board Certified: By the American Board of Orthodontics
  • Award-Winning: Recipient of The Everett Shapiro Award in Orthodontics and Dr. Harold Berk Endowed Prize Fund for Excellence in Research
  • Published Researcher: Presented research nationally and internationally
  • Comprehensive Approach: Addresses not just aesthetics but also function, jaw relationships, and airway health

Our practice also features Dr. Cierra Randall, who graduated summa cum laude and completed her Orthodontic Residency at the University of Colorado. She offers a comprehensive approach to orthodontic care while providing numerous treatment options.

Advanced Technology

We leverage cutting-edge technology to enhance your orthodontic experience:

  • iTero Scanner: Creates precise 3D digital models for accurate treatment planning
  • InBrace: Truly invisible orthodontic solution that works behind the teeth
  • KLOwen: Customized braces system for faster, more comfortable treatment
  • Digital X-Rays: Reduced radiation exposure and immediate results
  • 3D Printing: On-site production of certain orthodontic appliances

Convenient Payment Options

We work closely with Delta Dental to make your orthodontic treatment affordable:

  • Insurance Verification: Our team verifies your benefits before treatment begins
  • Direct Billing: We handle insurance paperwork and submit claims on your behalf
  • Flexible Payment Plans: Options available for any out-of-pocket expenses
  • In-House Membership Plans: Alternative options if you don’t have Delta Dental coverage

Frequently Asked Questions About Delta Dental PPO Orthodontic Coverage

How do I know if my Delta Dental plan covers orthodontics?

Delta Dental PPO Plus Premier and Delta Dental PPO Individual – Premium Plan offer orthodontic coverage. However, coverage details can vary significantly between plans. To verify your specific coverage, you can:

  1. Review your plan booklet or summary of benefits
  2. Contact Delta Dental customer service using the number on your insurance card
  3. Call our office at (720) 900-3119, and our insurance coordinator can help verify your benefits

We recommend checking your coverage before beginning treatment to avoid unexpected costs and to ensure you understand any waiting periods that may apply.

Does Delta Dental cover orthodontics for adults?

Yes, the Delta Dental PPO Premium plan covers orthodontic treatment for adults and children. However, some plans may have age restrictions that limit orthodontic benefits to members under 19 years old. At Hardy Pediatric Dentistry & Orthodontics, we treat patients of all ages and can help adult patients understand their coverage options.

How does the orthodontic lifetime maximum work with Delta Dental?

Delta Dental typically provides a lifetime maximum benefit of $1,500 for orthodontic treatment. This means Delta Dental will pay up to $1,500 for your orthodontic treatment throughout your lifetime, regardless of how many treatments you may need. This is different from the annual maximum, which resets each year. Our team can explain how your specific benefits work and how to maximize them for your treatment.

What happens if I change Delta Dental plans during orthodontic treatment?

If you change insurance plans during active orthodontic treatment, your coverage may be affected. Most Delta Dental plans will prorate the remaining benefit based on the treatment time left. For example, if you’ve completed half of your treatment when switching plans, you may be eligible for half of the new plan’s orthodontic benefit. We recommend consulting with your previous and new insurance providers to understand how the transition affects your coverage.

How do I maximize my Delta Dental orthodontic benefits?

To get the most from your Delta Dental orthodontic coverage:

  1. Start treatment after your waiting period (typically 6 months) has been satisfied
  2. Choose an in-network provider like Hardy Pediatric Dentistry & Orthodontics
  3. Coordinate treatment timing if multiple family members need orthodontic care
  4. Maintain regular dental check-ups, as some plans require good dental health before covering orthodontics
  5. Ask about any additional coverage for related services, like necessary extractions

Our experienced team can help create a treatment plan that maximizes your insurance benefits while achieving the best possible outcome for your smile.

Schedule Your Delta Dental Covered Consultation Today

Ready to begin your orthodontic journey with Delta Dental coverage? Hardy Pediatric Dentistry & Orthodontics makes it easy to get started:

  • 📍 Visit Us: 3200 Village Vista Dr., Suite 110, Erie, CO 80516
  • 📞 Call: (720) 900-3119
  • 📩 Request an Appointment Online

During your consultation, Dr. T.C. Hardy or Dr. Cierra Randall will evaluate your orthodontic needs and discuss treatment options. Our team will provide a detailed breakdown of your Delta Dental coverage and any out-of-pocket expenses.

Don’t wait to achieve the healthy, beautiful smile you deserve. Contact Hardy Pediatric Dentistry & Orthodontics today to learn how we can help you maximize your Delta Dental PPO orthodontic benefits!

DISCLAIMER: This information is subject to change on behalf of the insurance company. We are providing this as an informal guide to help you determine which services at our office are covered by your insurance. For more detailed information, please see the insurance company’s website or call the customer service or member services number listed on most insurance ID cards. Updated as of April 2025. The above logo & trademarks are property of Delta Dental.