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Login to Your Dental Blue Select Portal
Once you do, you will be able to:
- Manage your plan
- View your benefit booklet
- View claims and statements
Have questions? Dental Blue Select FAQ
Want to know what's covered?
Have more questions? Contact us.
Find a Dentist
You're free to visit any licensed dentist, but you can save money by choosing a participating dental provider.
What's Covered
Plan Features | Description |
---|---|
Network Available |
You may obtain services from any licensed dentist. Save out-of-pocket dental expenses by using a participating dental provider. Non-participating dentists may bill you for any charges over the allowed amount. |
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
Diagnostic & Preventive Services Covered at 100%
-
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
Basic Services Covered at 80%
-
Routine Fillings
-
Simple extractions
Major Services Covered at 50%
-
Endodontics (including root canal)
-
Periodontics including
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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
Orthodontia Services (if selected) Covered at 50%
-
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
Complete Plan
Diagnostic & Preventive Services Covered at 100%
-
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
Basic Services Covered at 80%
-
Routine fillings
-
Simple extractions
Major Services Covered at 50%
-
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
-
Other major services
Orthodontia Services (if selected) Covered at 50%
-
Diagnosis, examination, study models, radiographs
-
Appliance, including design, making placement & adjustment of device
-
Phase I — Minor orthodontic treatment
-
Phase II — Comprehensive orthodontic treatment
* Limited to children under 19 years old
* No deductible
* Lifetime benefit maximum of $1,000 or $1,500
Enhanced Plan
Diagnostic & Preventive Services Covered at 100%
-
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
Basic Services Covered at 80%
-
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
Major Services Covered at 50%
-
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
Orthodontia Services (if selected) Covered at 50%
-
Diagnosis, examination, study models, radiographs
-
Appliance, including design, making placement & adjustment of device
-
Phase I — Minor orthodontic treatment
-
Phase II — Comprehensive orthodontic treatment
* 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 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.