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BlueDental Choice

Combined Life Dental

Preventive ServicesBlue Cross Blue Shield Logo

Oral Evaluations Exams
Prophylaxes (Cleanings)- Adult/Child
Fluoride Treatment-Child
Bite wing X-rays
Series/Panoramic Sealants

Pays 100% In-Network, 100% Out-of-Network

Basic Services

Space Maintainers
Amalgam Restorations (Silver Fillings)
Resin-Based Restorations - Anterior and Posterior
Extractions - Routine and Surgical
Root Canal Therapy
Periodontal Treatment

Pays 100% In-Network, 80% Out-of-Network

Major Services

Crowns- Single Restorations
Osseous Surgery
Complete Dentures
Partial Dentures
Fixed partial dentures (Bridges)

Pays 60% In-Network, 50% Out-of-Network

Rates as of 10-01-2013 - 09-30-2014

Employees Only


Employee + Family


Employee + Children


Employee + Spouse


The Finance Office will provide your deduction for 24 pay periods.

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