Take care of your dental health by making the most of your Dental Blue Select℠ plan.
Research shows a strong link between gum disease and many health conditions, including:1, 2
- Diabetes
- Osteoporosis
- Respiratory disease
- Heart disease and stroke
- Low birth weights and premature births
Dental Blue Select can help you fight gum disease. Your dental plan can give you regular and reliable access to dentists who can help.
Check your member ID card for the name of your dental plan. Some members have Dental Blue, while others have Dental Blue Select. You'll find your plan name listed on the top right and lower left corners of the card.
You can get services from any licensed dentist, but you may save money and reduce your out-of-pocket costs when you use an in-network or participating provider. Out-of-network or non-participating dentists may bill you for any charges over the allowed amount. That’s the maximum amount Blue Cross NC determines is reasonable for covered dental services.
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.
The deductible applies to all covered services (diagnostic and preventive, basic and major services), except orthodontia services when selected.
Your employer selected either the Standard, Complete or the Enhanced dental plan. Please check your Benefit Booklet or contact your Group Administrator for details on your specific dental 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
- Periodontal exam and maintenance
- Gingival curettage
- Gingivectomy and gingivoplasty
- Root Planning and periodontal scaling (once per quadrant 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
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
Limitations may apply.
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)
- Periodontal exam and maintenance
- Gingival curettage
- Gingivectomy and gingivoplasty
- Root Planning and periodontal scaling (once per quadrant 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
Limitations may apply.
Orthodontia service is an optional benefit which your employer can choose to include in coverage. Please contact your Group Administrator or refer to your Benefit Booklet to determine if Orthodontia is part of your plan.
Most dentists will file a claim on your behalf, then bill you for any charges not covered under your Blue Cross NC plan. If your dentist will not file the claim for you, pay the dentist at your visit and submit a dental claim form to Blue Cross NC for reimbursement.
Yes, you will have an ID card for your medical plan and a different ID card for your Dental Blue Select plan.
No. There is no waiting period for diagnostic and preventive services such as routine checkups and cleanings. Waiting periods may apply to basic and major services. Please refer to your Benefit Booklet for details on your specific dental plan.
No, there is no annual deductible. Dental Blue Select features a $100 lifetime deductible that applies to all services (diagnostic and preventive, basic and major services), except orthodontia services. Orthodontia services do not have a deductible.
Download the Dental Blue Select claim form, complete it and mail to:
Blue Cross NC
Dental Blue Select Claims Unit
PO Box 2400
Winston-Salem, NC 27102
Please call Dental Blue Select Claim Customer Service at 888-471-2738.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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