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.
Plan Benefits2
100%
60%
50%
$75
$1000
Type of Coverage
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)
Basic Services
- Routine fillings
- Space maintainers (members under 16–years–old)
- Endodontics
- Simple extractions
- Stainless Steel Crowns
- Oral surgery
- Other basic services
Major Services
- Gingival curettage
- Gingivectomy and gingivoplasty
- Periodontal maintenance
- Inlays and onlays (once per 5 years)
- Porcelain Crowns
- Dentures
- Bridges
- Other major services
Deductible, basic and major services
Annual maximum, all services2
1. Based on allowed amount, as determined by Blue Cross NC. 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).