BLUE SHIELD INDIVIDUAL DENTAL PLANS MONTHLY RATES DENTAL PPO DENTAL HMO Individual $34 $16 Two Party $65 $30 Family $101 $50
| SERVICE | |||
|---|---|---|---|
| Diagnostic Services | Comprehensive Oral Exams | $0 | $0 |
| Preventive Care | Cleanings every 6 months | $0 | $0 |
| Restorative Services ² | One-Surface Amalgam (filling) | $35 | $15 |
| Crown | $320 | $300 | |
| Endodontics ² | Anterior Root Canal | $156 | $155 |
| Molar Root Canal | $234 | $290 | |
| Periodontics ² | Osseous Surgery | $263 | $303 |
| Periodontal Root Planing | $65 | $75 | |
| Prosthetics ² | Bridge (per unit) | $320 | $300 |
| Complete Denture (U or L) | $388 | $400 | |
| Oral Surgery ² | Extraction (single tooth) | $37 | $30 |
| Removal of Impacted Tooth | $113 | $125 | |
| Orthodontics ² ³ | Fully banded (two year) case-child | $2350 | $2350 |
| Fully banded (two year) case-adult | $2650 | $2650 | |
| Annual maximum benefit | |||
| $1,000 per member | No Max | ||
| Annual deductible | |||
| $50 per member | No Ded |
² Dental PPO members have a three month waiting period for minor restorative services and procedures. Dental PPO & HMO members have a twelve month waiting period for major restorative services and procedures (such as crowns and orthodontics).
³ Orthodontics services are on a fixed patient copayment and do not apply to your $1,000 in-Network maximum.
You will need Adobe® Reader to view PDF documents.
Download Blue Shield Dental HMO .pdf Brochure
Download a copy of Adobe Reader from the Adobe website if needed.
Download Blue Shield Dental HMO .pdf Application
Blue Shield HMO Dentist Network Database
(You must choose a primary dentist to put on our HMO application.)
Barricks Insurance ServicesImportant Disclaimer: Answers and comments provided above are general information, and are not intended to substitute for informed professional medical, psychiatric, psychological, tax, legal, investment, accounting, governmental, or other professional advice. We do not endorse, and expressly disclaims liability for any product, manufacturer, distributor, service, health plan, or service provider mentioned or any opinion expressed in the website. Replies, comments, or information gathered on BarricksInsurance.com website may not be accurate but are intended to be helpful.
