Dental Plans


Dental care is essential to your overall health! With our plans, you have the freedom to choose any dentist from our local network of 7,000+ dentists in Massachusetts, New Hampshire, and Rhode Island - plus our extensive national network.

3 Plans to Choose From

Dental Blue 65 Preventive ($24.40 per month)

  • Pays 100% of preventive covered services

  • No calendar year maximum or deductible

 

Dental Blue 65 Basic ($37.60 per month)

  • Pays 100% of preventive services and 50% of basic services

  • $100 annual deductible and $1,000 calendar-year maximum

 

Dental Blue 65 Premier ($59.10 per month)

  • Pays 100% of preventive services, 80% of basic services, and 50% of premier services

  • $50 annual deductible and $1,000 calendar-year maximum

 

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Covered Services

Preventive

$24.40 per month

Basic

$37.60 per month

Premier

$59.10 per month

Diagnostic Services—no waiting period

  • One complete initial oral exam, including initial dental history, and charting your teeth and supporting structures (gums, bones) to evaluate their condition

  • Full mouth X-rays (seven or more films), or panoramic X-ray with bitewing X-rays, once every 60 months

  • Additional bitewing X-rays once every six months

  • Periodic or routine oral exams once every six months

  • Emergency exams Single tooth X-rays as needed

  • Study models and casts used in planning treatment once every 60 months.

Preventive Services—no waiting period

  • Routine cleaning, scaling, and polishing of the teeth once every six months

  • No waiting period for routine preventive services

Basic Services—available after six month waiting period.

 

  • Silver and white fillings for each tooth surface in each 12 months

  • Tooth extractions and biopsies

  • Periodontal scaling and root planning, once in each quadrant each 24 months

  • Periodontal surgery, once in each quadrant each 36 months

  • Periodontal maintenance, once each three months

  • Root Canals

  • Repairs of partial or complete dentures, crowns and bridges, once each 12 months

  • Rebase or reline of dentures, once each 36 months

  • Recementing of crowns, inlays, onlays and fixed bridgework, once each 12 months

  • Bite adjustment, once each 24 months

  • Services to treat root sensitivity

  • General anesthesia when administered in conjunction with covered surgical services

  • Emergency dental treatment to relieve acute pain

Major Services—available after 12 month waiting period. These services are in addition to all Preventive and Basic services listed

 

 

  • Complete or partial denture, including services to fabricate, measure, fit and adjust, once each 60 months for each arch

  • Fixed bridges, including services to fabricate, measure, fit and adjust, once each 60 months per tooth

  • Replacement of dentures and bridges, but only when they are installed at least 60 months after the initial placement, and only if the existing appliance cannot be made serviceable

  • Adding teeth to an existing bridge

  • Temporary partial dentures to replace any of the six upper or lower front teeth, but only if they are installed immediately following the loss of teeth and during the period of healing

  • Metallic, porcelain, and white resin inlays, once every 60 months per tooth

  • Replacement of crowns and metallic, porcelain and composite resin inlays/onlays once every 60 months for each tooth

  • Post and core or crown build up once every 60 months per tooth

  • Surgical placement of dental implant once per tooth per lifetime

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For Dental Blue 65 Preventive, Basic, and Premier detailed plan information, please refer to the Outline of Coverage:

Dental Blue 65 Outline of Coverage