Coverage for dental specialists

The trees are blooming and their roots are growing. But what happens if the roots of your teeth aren’t doing so well? Learn how your dental benefits work when you’re referred to an endodontist for a root canal or when you need to see another dental specialist.

There are multiple reasons you might need to visit a specialist. Here are just a couple:
• If you have a problem with your tooth nerves or pulp, your dentist may determine that you need to see an endodontist.
• If you have issues with your gums and surrounding areas, a periodontist can provide the right care.
• For more complex or difficult problems requiring surgery in the oral cavity and maxillofacial area (the face and jaws), you may be treated by an oral surgeon.

In most cases, your dentist will refer you to a specialist, but you may not be required to have a referral for your benefits to apply. Check your plan to find out if you need a referral to see a specialist.

Once you know what kind of care you need, the best way to save on your procedure is to visit an in-network specialist. Because Delta Dental has both PPO and Premier networks, make sure the specialist you see is in your plan’s network. Some dental practitioners are only members of the Delta Dental PPOTM network, some just belong to the Delta Dental Premier® network, others participate in both networks and some don’t participate in any Delta Dental network at all. You can use the Find a Dentist tool on or Delta Dental’s free mobile app to see which network a specialist participates in.

When visiting a specialist, “pre-authorization” (also called “pre-treatment estimate” or “pre-determination”) is a useful term to know. Some plans require a pre-authorization, which is a formal decision by your coverage provider that the procedure is medically necessary.1 It is not required for most Delta Dental plans, but it’s best to check beforehand. If you do need a pre-authorization, ask your specialist to submit a request to Delta Dental. If it’s not required, you may still want to ask for a pre-authorization because it will give you a general idea of how much the procedure will cost.

With some research upfront, you can ensure you’re making a smart decision about which specialist to see to have your smile healthy again in no time.


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