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Comprehensive Dental Benefits
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TYPE OF COVERAGE
PLAN BENEFITS5
TYPE OF COVERAGE
PLAN BENEFITS5
Preventive Services
100%
Basic Services
60%

Includes:
• Routine Oral Exams
• Adult and Child Cleaning
• Bitewing X-rays
• Selants (Members 5 to15 years old only)
• Pulp Testing
• Annual Fluoride Cleaning (Members under 18 years old only)
• Palliative Emergency Treatment
• Emergency Oral Examinations
• Other Diagnostic & Preventive Services
Includes:
• Fillings
• Space Maintainers (Members Under 16 years old only)
• Endodontics
• Simple Extractions
• Oral Surgery
• Other Basic Services
Major Services 50% Annual Maximum, All Services6 $1,000
Includes: (Per Covered Member)  
• Gingival Curettage
• Gingivectomy and Gingivoplasty
• Periodontal maintenance
• Inlays & Onlays (Once Per 5 years)
• Crowns & Bridges
• Dentures
• Other Major Services 		Waiting Periods
  • Diagnostic & Preventive Services
• Basic Services
• Major Services 		None
6 months
12 months
Annual Deductible $75
  • Waived for Preventive Services
• Will Apply Towards Basic or Major Services		  
Take Control Of Your Dental Care
Why You Need Dental Coverage
Rapid Application Process
Limitations & Exclusions
Blue Advantage
BlueOptionsHSA
Blue Medicare Supplement

Traditional insurance with
co-pays. Still BCBSNC®'s most
popular health plan.*

  

High Deductible, Tax
Advantaged Insurance. Is a
health savings account
(HSA) right for you?

 

Affordable coverage
with the best dental plan
in North Carolina.

  

For beneficiaries enrolled
in Medicare Part B.
*BCBSNC® internal data, 2006

Triangle Planning Services, Inc. is an independent authorized producer/agency licensed to sell and promote products from Blue Cross
and Blue Shield of North Carolina® (BCBSNC®). The content contained in this site is maintained by Triangle Planning Services, Inc.
Blue Cross and Blue Shield of North Carolina® is an independent licensee of the Blue Cross and Blue Shield Association.®, SM Marks
of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina.

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FOOTNOTES:
5: Based on allowed amount.
6:
 Amount maximum on all services is $1,000. (Includes diagnostic and preventive, basic and major services.)