Direct Answer: A PPO lets you see any licensed dentist and still get some benefit. A DHMO or managed care plan, including Apple Health, assigns you a provider and usually pays nothing outside its network.
About one in five calls that come into our Renton office starts the same way. Someone names their plan out loud, waits, and decides from that one answer whether the rest of the conversation is worth having.
Delta Dental PPO comes up more than any other plan, followed by GEHA, Humana, UnitedHealthcare, and Cigna. One person messaged us through the website with a single line asking whether we see patients who have Delta Dental. That was the entire message.
I get it. But the card in your hand settles a bigger question than most people realize, and the answer usually sits in three or four letters printed near the plan name. This article covers one thing: which dentists you are actually allowed to see in Washington, and what it costs if you go outside that group.
Start With the Letters on Your Card
The single most useful thing to know about your coverage is whether you have a PPO or a managed care plan. That one distinction decides whether you get to pick your dentist at all.
A PPO (preferred provider organization) lets you see any licensed dentist in Washington and still receive some level of benefit. The dollar amount changes depending on whether that office is in-network, but the plan does not shut off.
A DHMO or managed care plan works differently. You choose a primary dental provider from the plan’s own network, that office handles or authorizes your care, and the plan generally pays nothing for treatment received anywhere else.
Washington’s public employee benefits show the split clearly. State dental plans and benefits include a PPO style option where subscribers can change providers whenever they want, alongside managed care options that require picking a primary provider from a set network and will not pay claims for care outside it.
What to look for on your own card:
- The letters PPO, DHMO, DMO, or the phrase managed care near the plan name
- A line reading primary dental provider or a provider ID number, which points to managed care
- The word Apple Health or Medicaid, which is its own situation
- A customer service number on the back, which is the fastest way to confirm any of the above
Where Apple Health Fits
Apple Health is Washington’s Medicaid program, and it does include adult dental coverage. The catch is structural rather than clinical.
To use it, you generally need a dentist who is enrolled with the program or with the managed care organization administering your benefits. Not every private practice in South King County participates, and that has nothing to do with the quality of your teeth or the seriousness of your situation.
We get these calls regularly, and the conversation often ends in about fifteen seconds when someone hears we are not a match for their plan. If that happens to you, it is worth asking the office two follow-up questions before you hang up:
- Do you know of practices nearby that take this plan?
- If I ever switch plans, are you accepting new patients?
The same applies to state-sponsored and managed care plans generally. A no on network participation is not a comment on you. It is a contract question, and contracts change.
What Out-of-Network Really Means on a PPO
This is the part I wish more callers stuck around to hear. On a PPO, out-of-network does not mean no coverage. It means a different math problem.
In-network means the office has signed an agreement with your plan to accept a set fee schedule. Your share gets calculated against those pre-negotiated rates, so the numbers are predictable.
Out-of-network means no such agreement exists. The plan may pay a smaller percentage, or pay against its own allowed amount rather than the office’s fee, and the difference lands on you.
Some PPOs also run a second tier. Those offices still count as in-network, but the patient share is higher than the top tier. If someone tells you a practice is in-network, it is fair to ask which tier.
Before any major work, call the number on the back of your card and ask two specific questions:
- What is my in-network benefit rate for this procedure code?
- What is my out-of-network rate for that same code?
Compare those two numbers against the actual treatment plan. Sometimes the gap is smaller than people assume, and sometimes it is not. Either way, you are deciding with real figures instead of a guess. If your current dentist just dropped out of your network, switching practices and moving your records is more routine than it sounds.
Plan Type, Provider Choice, and What Happens Outside the Network
Here is the short version of how the three most common Washington situations differ on the one question that matters most.
| Plan type | Who you can see | If you go outside the network |
|---|---|---|
| PPO | Any licensed dentist in Washington; change anytime | Plan typically still pays, often at a lower rate, with the balance falling to you |
| PPO, second tier in-network | Offices under a secondary contract with the plan | Still counts as in-network, but your share is usually higher than top-tier offices |
| DHMO or managed care | An assigned primary dental provider from the plan’s network | Generally no payment at all; you would be responsible for the full fee |
| Apple Health (Medicaid) | Dentists enrolled with the program or its managed care organization | Care from a non-participating office is usually not covered |
Four Questions Worth Asking Before You Book
Run through these in order the next time you are trying to figure out whether an office is a fit for your plan.
A New Washington Rule About Same-Day Treatment
There is a recent change worth knowing about. Under Senate Bill 5351, signed in 2025, dental-only plans in Washington are barred from denying coverage for procedures solely because they were performed on the same day, subject to certain exceptions. The law also gives dental plan carriers annual reporting duties on premiums and dental loss ratio.
The Washington State Dental Association supported it partly for a practical reason. There are cases where treating more of the mouth in one visit is better for the patient than splitting the same work across three appointments.
For someone driving in from Kent, Tukwila, Burien, or Newcastle, that difference is measured in mornings off work. Plan specifics still vary, so it is not a blanket promise that everything gets bundled into one chair time. But it removes one arbitrary reason a claim used to come back denied.
We wrote more about the reporting side of that law in a separate piece on what Washington’s dental loss ratio law means for your coverage.
Why Two Offices Quote Different Numbers for the Same Crown
Roughly one in twelve calls we take is someone comparing quotes, usually holding a number they got somewhere else. I understand the instinct, and I also understand why the numbers rarely line up.
I will not print dollar figures here, because a figure without your specific situation attached to it is close to meaningless. What actually moves the cost of a crown or a root canal:
- Which tooth it is. A front tooth and a back molar are different procedures with different codes.
- How much healthy tooth structure is left. Less structure can mean added steps before a restoration will hold.
- Whether a crown follows the root canal. Those are two separate treatments and two separate line items.
- Whether a specialist is involved. Endodontic and periodontal work is coded differently than general treatment.
- Your plan’s allowed amount and remaining benefits. Two people with the same tooth and the same treatment can owe very different amounts.
The only way to see real numbers before you commit is a pre-treatment estimate, sometimes called a predetermination. The office submits the planned codes to your insurer, and the plan responds with what it expects to pay. Any office can be asked for one.
It helps to know what you are reading when it comes back. Our breakdown of the D-codes on your dental estimate walks through that line by line. Annual maximums, deductibles, and benefit timing are a whole separate conversation, covered in our guide to how dental insurance works in Washington.
Frequently Asked Questions About PPO vs DHMO Dental Plans in Washington
How do I tell if I have a PPO or a DHMO?
Look at the front of your card for the letters PPO, DHMO, or DMO, or for a line naming a primary dental provider. If a specific office or provider ID is printed there, you are almost certainly on a managed care plan. When the card is unclear, call the number on the back and ask directly.
If a dentist is out-of-network with my PPO, should I just find someone else?
Not automatically. On a PPO, your plan typically still pays something out-of-network, so the real question is how big the gap is for the specific treatment you need. Ask your insurer for both the in-network and out-of-network rates for the procedure codes involved, then decide with actual numbers.
Can I switch from a DHMO to a PPO whenever I want?
Usually not mid-year. Plan type is generally set during open enrollment through your employer or the state, though qualifying life events can open a window. What you can often change at any time on a managed care plan is your assigned primary provider, as long as the new one is inside that network.
Does in-network mean my visit is fully covered?
No. In-network means the office agreed to the plan’s fee schedule, which makes your share predictable, not zero. Deductibles, coinsurance percentages, waiting periods, and annual maximums all still apply on top of that.
Why did my plan pay less than the office estimated?
Estimates are built on what the plan says it should pay; the final claim is what it actually paid. Differences often come from an unmet deductible, a benefit maximum that was already partly used, a frequency limit on a service, or a code that was adjusted after review. A pre-treatment estimate narrows that gap considerably.
Still Not Sure What Your Card Actually Covers?
One thing network rules tend to do is scatter your care across separate offices, sometimes sending Renton and South King County patients into Seattle for periodontal surgery or a root canal. At Cedar Dental Group, Dr. Jaewon Kim, a board-certified periodontist, and Dr. Joe Dutner, our in-house endodontist and President of the American Board of Endodontics, handle that work in the same building, and we accept most major PPO plans with payment plan options for patients without insurance.
If you want help reading your own benefits before deciding anything, you can reach us at 425-430-0400 or at cedardentalgroup.com.
