Billing · Updated 2026-09-08 · 6 min read

Delta Dental PPO vs PPO plus Premier vs PPO MAC: what's the difference?

Three Delta products sold under the PPO name pay a Premier dentist three different amounts for the same procedure — and the employer picked which one.

Delta Dental PPO, Delta Dental PPO plus Premier and Delta Dental PPO MAC are three products, and the difference between them is what a Premier dentist gets paid. On a PPO plus Premier plan, a Premier dentist is paid from the Premier maximum plan allowance. On a PPO MAC plan, every tier — Premier and non-participating alike — is paid the PPO fee, and the Premier dentist may bill the patient the difference up to the Premier allowance. Plain "Delta Dental PPO" can behave either way, because Delta lets the employer choose which basis applies to Premier dentists. As of August 2026, one Delta company published six separate fee schedules to a single contracted office and priced D0120 three different ways across them, so "the Delta fee" is not a single number even before the plan design is applied.

What we measured

Read at one Delta state company in July and August 2026. It is the structure that matters: a single Delta contract carries a grid of allowances, and which cell prices a claim is decided partly by your participation and partly by the patient's plan design.

What Delta Dental's own documents say

One Delta product sheet contrasts two of the three designs on a single page. On PPO plus Premier:

"If the network for your dental plan selection is PPO plus Premier: Payment for a PPO dentist is based on the PPO dentist's allowable fee or the submitted fee charges, whichever is less… Payment for a non-participating dentist is based on the non-participating table of allowance."

On the MAC option in the same product ladder:

"If the network for your dental plan selection is MAC PPO: Payment for a PPO dentist is based on the PPO dentist's allowable fee or the submitted fee charges, whichever is less… Payment for a Premier dentist is based on the PPO dentist's allowable fee. Members are responsible for the difference between the Premier Maximum Reimbursable Amount (MRA) and the PPO fee. Payment for a non-participating dentist is based on the PPO dentist's allowable fee."

— Delta Dental of Arizona Flex Choice Group Plan Benefit Highlight Sheet, form DDAZ-0532-rev0825, 2025. In that ladder the MAC option is the cheap end: the four plans carry annual maximums of $500, $1,000, $1,500 and $2,500, and only the richest is PPO plus Premier. The Premier ceiling carries a different name in each Delta company's documents — maximum plan allowance (MPA) in Delta's own broker material, Maximum Reimbursable Amount (MRA) on the Arizona sheet, Participating Dentist Maximum Approved Charge (PMAC) on the New Jersey and Connecticut templates — and it is the same ceiling doing the same job in all three.

Delta's small-group benefit summary templates state the consequence for a Premier office in a footnote. On the PPO template:

"Members will be subject to billing for the difference between the PPO Approved Fee and the Participating Dentist Maximum Approved Charge (PMAC). Coverage percent is based on the PPO Schedule of Fees."

On the PPO plus Premier template for the same carrier and state:

"Members will be subject to balance billing for covered services. PPO Dentist: Coverage percent is based on the PPO Schedule of Fees. Premier: Coverage percent is based on the Participating Dentist Maximum Approved Charge (PMAC). Non-participating: Coverage percent is based on the Non-Participating Dentist Maximum Approved Charge (NMAC)."

— Delta Dental NJ/CT PPO-3-A and PPO+Premier-3-A benefit summaries, 2020 template vintage. Three named allowance tables, one carrier, one small-group product family — and the plan template's name decides which one prices your claim.

Why it depends on the plan

None of this is a network fact. It is a purchasing decision, and Delta says so to the buyer:

"Under a Delta Dental PPO plan, PPO dentists are reimbursed at PPO fees and Premier dentists are reimbursed at either Premier or PPO fees. How Premier dentists are reimbursed under your PPO plan is up to you."

— Delta Dental, "PPO and Premier: How Delta Dental's dual network works", Word of Mouth, October 14 2022. The same post tells the employer what it is trading: reimbursing Premier dentists at Premier fees gives employees the lowest out-of-pocket cost but the plan pays more; reimbursing them at PPO fees costs the plan less and pushes members toward PPO dentists.

So the same Premier office, treating two patients whose cards both say "Delta Dental PPO", is paid two different amounts because two employers bought different options. No document in the sources says where that choice is printed for the office to read — that is the honest and unsatisfying answer.

A fourth design exists in the same family and is worth naming so it is not mistaken for one of these three: Delta Dental PPO Point of Service, an employer add-on that pays Premier pricing levels when a Premier-but-not-PPO dentist's fee exceeds the PPO schedule fee. That one moves the allowance up. MAC moves it down.

What to do

• Read the network line on the plan document, not the carrier name. "PPO", "PPO plus Premier", "MAC PPO", "Delta Dental PPO with Maximum Allowable Charge" and "PPO Fee (MAC Plan)" are all distinct labels for distinct payment rules.
• Load the PPO schedule and the Premier allowance separately in your practice management system, along with the hygienist and specialist variants if you bill under them. A MAC plan needs the PPO schedule to estimate and the Premier allowance to know the patient's legitimate balance.
• Ask the payer one question in these words: under this plan, is a Premier dentist reimbursed at the Premier maximum plan allowance or at the PPO fee? That single answer decides your write-off and the patient's bill.
• On a MAC plan, tell the patient before treatment that a balance to the Premier allowance is theirs and that it is not a billing error. It is a contractual feature of the plan their employer bought.
• Do not carry an estimate across two Delta patients. The plan design, not your contract, sets the allowance.

Numbers last refreshed August 2026.

All articles · Kaylie