BlueDental Choice

Network

Non-Network

You Choose Network Dentist or Non-Network Dentist

Copays

Coinsurance

Sample Procedures Below (ADA Code)

Usual Fees

Your Cost

Your Cost

PREVENTIVE CARE - No Deductible - No Waiting Period

20% Usual Fees

Complete Oral Evaluation (0150)

$70

$0

$14

Four Bitewing Xrays (0274)

$50

$0

$10

Cleaning (Adult 1110 or Child 1120) 

$74 or $51

$10

$15 or $10

Children Fluoride Treatment (1203)

$30

$0

$6

BASIC CARE - $50 Deductible/Year/Person - No Waiting Period

40% Usual Fees

Amalgam Silver Filling (One Surface 2140)

$127

$15

$51

Routine Simple Extraction (7140)

$137

$17

$55

Resin White Filling (Two Surfaces 2331)

$165

$26

$66

Reline Partial (Upper 5740, Lower 5741)

$277

$34

$111

Stainless Steel Crown Primary (2930)

$229

$37

$92

Space Maintainer Fixed Unilateral (1510)

$303

$47

$121

Remove Complete Bony Impacted Tooth (7240)

$443

$64

$177

MAJOR CARE - $50 Deductible/Year/Person - 12 Month Waiting Period

60% Usual Fees

Periodontal Root Scaling Quadrant (4342)

$109

$46

$65

Gingivectomy/Gingivoplasty Quadrant (4210)

$586

$142

$352

Root Canal Bicuspid (3320)

$767

$231

$460

Pontic Porcelain Fused Metal, Two Surfaces (6241)

$830

$288

$498

Porcelain Noble Metal Crown (2752)

$916

$302

$550

Upper Partial Resin Base (5211)

$1,117

$296

$670

Complete Denture (Upper 5110, Lower 5120)

$1,323

$382

$794

                   Maximum Benefit - $1,000 Per Year Per Person

               Plus 20% Bonus Savings on Network Orthodontic and Cosmetic Care

                This is not a Discount Plan, but a Blue Cross insured program offering dental care via Copays or Coinsurance.

                However, as illustrated above, costs are much lower with Network Providers verses Non-Network Providers.

                  Notice also, even if your Dentist does not participate, you can still save money per the Usual Fees schedule.

                    For comparison, Discount Plans promote lower rates, higher copays, less providers and network only coverage.

                 Click Here for List of Network Dentists

                       Under Age 65, Monthly Bank Draft Rates:

                    Individual $23.03; Spouse $20.61; Couple $43.64; Children $28.93; Parent + Children $51.96; Family $72.57

                       Over Age 65, Monthly Bank Draft Rates:

                    Individual $26.05; Spouse $23.63; Couple $49.68

                   It takes about a month to get a Policy and ID card

                        LIMITATIONS

                   Prosthodontics for pre-existing missing teeth, veneer restorations and implants are excluded.

                   Repair/replacement of pre-existing broken crowns, bridges, partials or dentures have a 5-year wait.

                    Costs for early Major Care or treatment of Pre-existing Conditions is Enrollee's Responsibility.

                SAVE and SMILE