How It Works

Healthy Kids Dental enrollees must receive treatment from a dentist who participates in Delta Dental’s Healthy Kids Dental program.

Participating dentists agree to accept Delta Dental’s payment for covered services as payment in full, and do not charge the enrollee. If a service is not covered by Healthy Kids Dental, the dentist must discuss the fees and payment plan with the enrollee or responsible party before treatment is rendered.

The dentist submits claims to Delta Dental, and Delta Dental sends payment to the dentist.

Reimbursement to all participating dentists for covered services rendered to HKD enrollees is based on the Delta Dental PPO (formerly DeltaPreferred Option) fee schedule. Eligibile HKD enrollees can receive treatment from any Delta Dental Premier participating dentist who agrees to accept the lesser of the submitted fee or the amount in the current fee schedule as full payment for covered services. the dentist cannot balance bill the enrollee for any difference between his or her regular fees and the amount in the fee schedule. This schedule is, on average, 66 percent to 89 percent higher than traditional Medicaid reimbursement.