Dental Plans

What's Covered

You may obtain services from any licensed dentist or choose a participating network dentist. Find a dentist.

Please refer to your Benefit Booklet or contact your Group Administrator for details on your specific dental plan.

Plan Features

Network Available

You may visit any licensed dentist you wish, but you'll save out-of-pocket dental expenses if you use a participating dental provider. When you receive covered services from a participating dental provider, you're not responsible for any charges over the allowed amount. Non-participating dentists will be reimbursed at the allowed amount, but they may bill you for any charges over that amount. Find a participating dental provider.

Lifetime Deductible — $100

The deductible applies to all covered services (diagnostic and preventive, basic, and major services), except orthodontia services when selected.

Benefit Period Maximum — $1,000 or $1,500

Dental Blue Select provides a $1,000 or $1,500 annual benefit maximum per person on diagnostic and preventive, basic and major services. If Orthodontia coverage is selected, the maximum benefit for orthodontia coverage is a lifetime maximum of $1,000 or $1,500 per eligible member.

Standard and Enhanced Plans

Your employer selected either the Standard or the Enhanced dental plan. Please refer to your Benefit Booklet or contact your Group Administrator for details on your specific dental plan.

Standard Plan

Type of Coverage Plan Benefits*

Diagnostic & Preventive Services

  • Routine oral exams (once per Benefit Period)
  • Adult & child cleaning (once per Benefit Period)
  • Bitewing x-rays
  • Pulp testing
  • Annual fluoride treatment (members under 19 years old)
  • Sealants (members age 5 through 15)
  • Palliative emergency treatment & emergency oral examinations
  • Other diagnostic & preventive services
Covered at 100%

Basic Services

  • Routine Fillings
  • Simple extractions
Covered at 80%

Major Services

  • Endodontics (including root canal)
  • Periodontics including
  • Periodontal exam and maintenance
  • Gingival curettage
  • Gingivectomy and gingivoplasty
  • Root Planning and periodontal scaling (once per quandrant every 24 months)
  • Full mouth or panoramic X-rays (once every 36 months)
  • Periapical X-ray
  • Surgical teeth removal and oral surgery
  • Space maintainers (members under 16 years old)
  • Other major services
Covered at 50%

ENHANCED PLAN

Type of Coverage Plan Benefits*

Diagnostic & Preventive Services

  • Routine oral exams (twice per Benefit Period)
  • Adult & child cleaning (twice per Benefit Period)
  • Bitewing x-rays
  • Pulp testing
  • Annual fluoride treatment (members under 19 years old only)
  • Sealants (members age 5 through 15)
  • Palliative emergency treatment & emergency oral examinations
  • Other diagnostic & preventive services
Covered at 100%

Basic Services

  • Routine fillings
  • Simple extractions
  • Endodontics (including root canal)
  • Periodontics including
  • Periodontal exam and maintenance
  • Gingival curettage
  • Gingivectomy and gingivoplasty
  • Root Planning and periodontal scaling (once per quandrant every 24 months)
  • Full mouth or panoramic X-rays (once every 36 months)
  • Periapical X-ray
  • Other basic services
Covered at 80%

Major Services

  • Surgical teeth removal and oral surgery
  • Space maintainers (members under 16 years old)
  • Major Restorative Services
  • Inlays and Onlays (once per 5 years)
  • Crowns
  • Prosthodontics (Bridges, Dentures)
  • Recementation and repair of crowns, inlays, bridges
  • Dental Implants (available only on Enhanced Plan)
  • Other major services
Covered at 50%

Orthodontia Services — if selected

  • Diagnosis, examination, study models, radiographs
  • Appliance, including design, making placement & adjustment of device
  • Phase I — Minor orthodontic treatment
  • Phase II — Comprehensive orthodontic treatment
  • Covered at 50%
  • Limited to children under 19 years old
  • No deductible
  • Lifetime benefit maximum of $1,000 or $1,500

* Based on the 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.