Our PPO dental plans cover a range of dental services including exams, X-rays, fillings, crowns, and root canals. Most plans also cover orthodontia and dental implants.
These plans can be purchased direct from Blue Shield, with the exception of the Blue Shield Family Dental PPO plan. That plan can only be purchased from Covered California.
Fixed dollar copays for services give you clear sight into what you’ll pay for services. Blue Shield pays up to $1,000 for services each year.
Combines the Dental PPO plan with a vision plan to offer you a convenient package to meet both your dental and vision needs.
You pay a fixed percentage of costs for services, which makes your out-of-pocket expenses more predictable. Blue Shield pays up to $1,500 for services each year, so this plan ideal if you need more coverage.
Offers the highest level of coverage for more complex dental needs, including orthodontia. Blue Shield pays up to $2,000 for services each year.
Provides the same benefits as the Enhanced Dental PPO 50/2000 Lifetime Ortho 1500 plan, but without the orthodontia coverage. This helps lower the premium if you don’t need orthodontia benefits.
Covers most services at a fixed 50%. Annual cleanings, exams, and X-rays are $0, while fillings are covered at 80%. Blue Shield pays up to $1,500 for services each year for members age 19 and older. For those under age 19, there is no annual benefit limit.
| Dental PPO Plan | Specialty Duo Dental + Vision Package* | Dental PPO 1500 | Enhanced Dental PPO 50/2000 | Enhanced Dental PPO 50/2000 Lifetime Ortho 1500 | Blue Shield Family Dental PPO | |
|---|---|---|---|---|---|---|
Deductible and plan maximum | ||||||
| Calendar year deductible | $50 per individual | $50 per individual | $50 per individual | $50 for Individual $150 for Family | $50 for Individual $150 for Family | $75 per individual / $150 per family for under age 19 $50 per individual for adults |
| Calendar year benefit maximum | $1,000 | $1,000 | $1,500 | $1,500 | $2,000 | No maximum for under age 19 $1,500 per individual for adults |
Benefits | ||||||
| Oral exam | $0 No waiting period | $0 No waiting period | $0 No waiting period | 0% No waiting period | 0% No waiting period | $0 No waiting period |
| X-rays | $0 No waiting period | $0 No waiting period | $0 No waiting period | 0% No waiting period | 0% No waiting period | $0 No waiting period |
| Routine cleanings | $0 No waiting period | $0 No waiting period | $0 No waiting period | 0% No waiting period | 0% No waiting period | $0 No waiting period |
| Fillings | $35 - $100 3-month waiting period† | $35 - $100 3-month waiting period† | $35 - $100 3-month waiting period† | 20% 6-month waiting period† | 20% 6-month waiting period† | 20% No waiting period† |
| Tooth removal - simple | $40 3-month waiting period† | $40 3-month waiting period† | $40 3-month waiting period† | 20% 6-month waiting period† | 20% 6-month waiting period† | 50% No waiting period for under age 19 6-month waiting period for adults† |
| Tooth removal - surgical | $63 3-month waiting period† | $63 3-month waiting period† | $63 3-month waiting period† | 20% 6-month waiting period† | 20% 6-month waiting period† | 50% No waiting period for under age 19 6-month waiting period for adults† |
| Root canals | $156 - $234 3-month waiting period† | $156 - $234 3-month waiting period† | $156 - $234 3-month waiting period† | 50% 12-month waiting period† | 50% 12-month waiting period† | 50% No waiting period for under age 19 6-month waiting period for adults† |
| Deep gum cleanings | $32 - $65 3-month waiting period† | $32 - $65 3-month waiting period† | $32 - $65 3-month waiting period† | 50% 12-month waiting period† | 50% 12-month waiting period† | 50% No waiting period for under age 19 6-month waiting period for adults† |
| Complete denture (upper) | $388 6-month waiting period† | $388 6-month waiting period† | $388 6-month waiting period† | 50% 12-month waiting period† | 50% 12-month waiting period† | 50% No waiting period for under age 19 6-month waiting period for adults† |
| Complete denture (lower) | $388 6-month waiting period† | $388 6-month waiting period† | $388 6-month waiting period† | 50% 12-month waiting period† | 50% 12-month waiting period† | 50% No waiting period for under age 19 6-month waiting period for adults† |
| Denture repairs | $43 - $75 6-month waiting period† | $43 - $75 6-month waiting period† | $43 - $75 6-month waiting period† | 50% 12-month waiting period† | 50% 12-month waiting period† | 50% No waiting period for under age 19 6-month waiting period for adults† |
| Crowns | $160 - $320 6-month waiting period† | $160 - $320 6-month waiting period† | $160 - $320 6-month waiting period† | 50% 12-month waiting period† | 50% 12-month waiting period† | 50% No waiting period for under age 19 6-month waiting period for adults† |
| Implant | $612 6-month waiting period† | $612 6-month waiting period† | $612 6-month waiting period† | 50% 12-month waiting period† | 50% 12-month waiting period† | Not covered |
| Orthodontics (child) | $2,350 6-month waiting period† | $2,350 6-month waiting period† | $2,350 6-month waiting period† | Not covered | 50% 12-month waiting period† | 50% No waiting period† |
| Orthodontics (adult) | $2,650 6-month waiting period† | $2,650 6-month waiting period† | $2,650 6-month waiting period† | Not covered | 50% 12-month waiting period† | Not covered |
* Underwritten by Blue Shield of California Life & Health Insurance Company.
† Benefit is subject to a deductible.
This page provides details on plan deductibles, copayments, and coinsurance amounts for common services when using in-network dental providers. It is not a contract. For complete plan details, refer to the Evidence of Coverage (EOC) available under Individual and Family plan documents, or call us at (888) 256-3650.