Additional Benefit Information Deductible waived for periodontal cleanings. Ask your dentist to submit a pre-treatment estimate to Delta Dental for any procedure that exceeds $300. This will help you estimate any out-of-pocket expenses you may incur and will confirm that the services are covered under your dental coverage. This plan is eligible for Rollover Maximum: Rollover Max dollars do not apply to orthodontic services. To qualify for Rollover Max, you must receive at least one cleaning or oral exam in the plan year. You must be enrolled for dental coverage before the 4th quarter of the calendar year and your paid claims must not exceed the maximum “threshold” amount. Your calendar year If your total yearly claims Then you can roll over this Your accumulated rollover total maximum benefit amount. don’t exceed this threshold amount to use next year, is capped at this amount. amount… and beyond. $2,000 $800 $600 $1,500