Dental

With Dental Blue, members don’t pay a deductible for check-ups or diagnostic and preventive services.
Check-ups and cleanings are covered twice per benefit period. Plus, members can visit any licensed dentist they choose. There are no “in-network” restrictions.

Members pay a $75 annual deductible and 50 percent coinsurance and are covered for both basic services like routine fillings and extractions, and major services including crowns, bridges and dentures.

Applicants can choose Dental Blue coverage for themselves, their children or the entire family. There are three convenient payment options: monthly bank draft, semiannual payment or annual payment.

Type of Coverage	Plan Benefits1
Preventive Services Routine oral exams Adult & child cleaning Bitewing x–rays Pulp testing Annual fluoride cleaning (members through 18–years–old only) Palliative emergency treatment & emergency oral examinations Other diagnostic & preventive services Sealants (members 5-15 years old only)	100%
Basic Services Routine fillings Space maintainers (members under 16–years–old) Endodontics Simple extractions Stainless Steel Crowns Oral surgery Other basic services	60%
Major Services Gingival curettage Gingivectomy and gingivoplasty Periodontal maintenance Inlays and onlays (once per 5 years) Porcelain Crowns Dentures Bridges Other major services	50%
Deductible, basic and major services	$75
Annual maximum, all services2	$1,000

1. Based on allowed amount, as determined by BCBSNC. The allowed amount may be substantially less than the provider’s actual charge. You will be responsible for the charges above the allowed amount, in addition to any deductible and coinsurance applied.

2. Annual maximum on all services is $1,000 (includes diagnostic and preventive, basic and major services).

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