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Group plan comparison

	Standard plan	Complete plan	Enhanced plan
Preventive (100%): No waiting period	Routine exams and cleaning (1 per benefit period) Bitewing X-rays (1 per benefit period) Fluoride treatment for members under 19 only (1 per benefit period) Emergency treatment for pain Sealants for children ages 5-15	Routine exams and cleaning (2 per benefit period) Bitewing X-rays (1 per benefit period) Fluoride treatment for members under 19 only (1 per benefit period) Emergency treatment for pain Sealants for children ages 5-15	Routine exams and cleaning (2 per benefit period) Bitewing X-rays (1 per benefit period) Fluoride treatment for members under 19 only (1 per benefit period) Emergency treatment for pain Sealants for children ages 5-15
Basic services (80%): Six-month waiting period for Standard and Complete plans; No waiting period for Enhanced plan	Simple restorative services (fillings) Simple tooth removal	Simple restorative services (fillings) Simple tooth removal	Simple restorative services (fillings) Simple tooth removal X-rays of the roots of teeth X-rays (full mouth or panorex - 1 per 36 months) Endodontics (includes root canals) Periodontics
Major services (50%): 12-month waiting period for all plans	Endodontics (including root canal) Periodontics Surgical tooth removal and oral surgery Medically appropriate anesthesia Space maintainers X-rays of the roots of teeth X-rays (full mouth or panorex - 1 per 36 months)	X-rays of the roots of teeth X-rays (full mouth or panorex - 1 per 36 months) Endodontics (includes root canals) Periodontics Surgical tooth removal and oral surgery Medically appropriate anesthesia Space maintainers Major restorative services (crowns/inlays) Prosthodontics (bridges/dentures) Denture relines (over 6 months old) Recementation and repair of crowns, inlays, bridges, dentures	Surgical tooth removal and oral surgery Medically appropriate anesthesia Space maintainers Major restorative services (crowns/inlays) Dental implants Prosthodontics (bridges/dentures) Denture relines (over 6 months old) Recementation and repair of crowns, inlays, bridges, dentures
Orthodontia	Not available	Not available	Available as an option. Children under 19 only 12-month waiting period No deductible 50% coverage $1,000 lifetime maximum
Lifetime deductible	$100	$100	$100 (except Orthodontia)
Annual maximum	$1,000 (all services combined)	$1,000 (all services combined)	$1,000(all services combined, except orthodontia)
Prior coverage credit (takeover)	Not available	Yes	Yes
Add/Termination dates	First of the month	First of the month	First of the month

Like most health care plans, Dental Blue Select has some limitations and exclusions.

Payment is based upon allowable charges in the area in which service is rendered. This is only a partial listing of benefits. For costs and further details of coverage, including exclusions, limitations and terms under which the policy may be continued in force, contact Blue Cross and Blue Shield of North Carolina.