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Below form is for California plan only

Anthem Blue Cross Dental logo  Anthem Blue Cross Dental Insurance 
Phone (310) 678-6315
In-network only
Annual Deductible $25 $50/$150 None
Waived for diagnostic & preventive services Yes No Yes No N/A
Annual Maximum $500 $1,250 No
Diagnostic & Preventive Services such as Cleanings, exams & X-rays 100% 80% 100% 80% No copayment for these services, a $5 office visit copayment will apply
Fillings 80% 60% 80% 60% No copayment for most fillings
Other Minor Restorative Not covered Copayments ranging from $31 to $187 depending on procedure
Oral Surgery Not covered 50% Copayments for most commonly performed procedures range
from $36 to $223
Endodontics 50% - limited to pulpotomies
on primary teeth only
50% Copayments:
Anterior root canal² - $289
Molar root canal² - $459
Periodontics Not covered 50% Gingivectomy² -per tooth-
$72 copayment
Prosthodontics 50% - limited to stainless steel crowns
on primary teeth only
50% Copayment:
Crown² - $432
Partial denture² - $430
Orthodontics Not covered Children only 50%,
$100 Deductible, $500 per year/
$1,000 lifetime maximum
Child-$2,870 copay
Adult-$3,045 copay
Retention-$210 copay
In-Network Reimbursement Dental Blue 100 fee schedule Dental Blue 100 fee schedule Dental SelectHMO
fee schedule
Out-of-Network ¹ Reimbursement Dental Blue 100 fee schedule Dental Blue 100 fee schedule None
Waiting Periods No waiting period for cleanings, exams & X-rays; 6 month waiting period for all other covered services No waiting period for cleanings, exams & X-rays; 6 month waiting period for basic services; 12 month months for major services 6 month waiting period for fillings for which there is no member copayment
Evidence of Coverage DentalBlue Basic
Evidence of Coverage
DentalBlue Enhanced
Evidence of Coverage
Evidence of Coverage
Brochures Dental Blue PPO Brochure SelectHMO Brochure
Applications Dental Blue PPO Application SelectHMO Application

¹ While Dental Blue PPO plan members can see any dentist they want, they do have the potential for lower costs when they choose a dentist in the Dental Blue 100 network. This is because in-network dentists have agreed to accept our fee schedule for services rendered. If a member chooses to see a dentist outside the Dental Blue 100 network, they can be balance billed the difference between our in-network negotiated rates and their dentist's rates.
² Chart reflects copayments when services are rendered by a participating dental office. Amounts may differ if services are obtained through a participating specialty office.

PRINT & MAIL Application - Anthem Blue Cross Dental Blue PPO Application

PRINT & MAIL Application - Anthem Blue Cross Dental SelectHMO Application

Anthem Blue Cross Dentist Database

Or you can fill in this form to have your Anthem Blue Cross Dental Insurance brochure with pricing & application mailed to you. Further information on our plans is shown below. Or just call us at (310) 678-6315.
Anthem Blue Cross PPO Dental Insurance Coverage Requested
Our Ages
(under age 65)
  My Age or DOB       Spouse's Age  
People Covered
Plan wanted

Customer Information
Full Full Name
Street Address
Zip Code
Home Phone
Work Phone

Have you any comments or special instructions?


Oral Health and Diabetes Flyers

Oral Health and Pregnancy Flyers

Dental HMO (Dental Health Maintenance Organization) plans also referred to as pre-paid plans, require you to choose one dentist or dental facility to coordinate all of your oral health needs. If you need to see a specialist, your primary care dentist will refer you; specialty care may require preauthorization. A typical DHMO-type plan doesn't have any deductibles or maximums. Instead, when you receive a dental service, you pay a fixed dollar amount for the treatment (a "copayment"). Often, diagnostic and preventive services have no copayment, so you pay nothing for these services. However, generally if you visit a dentist outside of the network, you may be responsible for the entire bill. Typically, the least expensive of dental plans.

Dental PPO (Dental Preferred Provider Organization) plans offer a network feature and usually offer a balance between lower costs and dentist choice. PPO dentists participate in the network thereby agreeing to accept contracted fees as payment in full rather than their usual fee for patients with the PPO. When you visit a PPO dentist, you typically pay a certain percentage of the reduced rate (called coinsurance) and the plan pays the rest. The percentage usually varies by the type of coverage such as diagnostic and preventive, major services. While you typically have the lowest out-of-pocket costs if you visit a PPO dentist, the plan allow you to visit the dentist of your choice, even if they are not in the network. Typically, the most expensive of dental plans.

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Barricks Insurance Services
276 N El Camino Real #6, Oceanside, CA 92058
Phone:   (310) 678-6315

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