Protect your smile with our PPO and HMO dental plans. You’ll enjoy a range of dental benefits including exams, cleanings, and x-rays.
Protect your smile with one of our PPO or HMO dental plans available directly through Blue Shield or through Covered California. No matter where you purchase your Blue Shield dental plan, you’ll enjoy a range of dental benefits including exams, cleanings, and x-rays for $0. And with some of the largest dental networks in California, you can count on the choice you expect.
Dental Standard HMO
Dental HMO
Enhanced Dental PPO 50/1250
Dental PPO
Specialty DuoSM dental + vision package*
Enhanced Dental PPO 50/2000
Enhanced Dental PPO 50/2000 Lifetime Ortho 1500
Family Dental HMO
Family Dental PPO
Age:
0-25**
26+
0-25**
26+
0-25**
26+
0-25**
26+
0-25**
26+
0-25**
26+
0-25**
26+
0-18**
19+
0-18**
19+
Monthly rates starting at:†
$12.00
$14.90
$22.80
$24.90
$32.60
$41.90
$37.60
$44.50
$42.10
$49.50
$51.10
$65.90
$55.50
$71.50
$14.00
$13.40
$28.80
$43.70
Benefit
With participating providers, members pay:1
Diagnostic and preventive services
$0
$0
0%
$02
$02
0%
0%
0%
0%
Restorative services – fillings
$20
$18
20%3
$374
$374
20%3
20%3
$25
20%
Oral surgery
$40
$34
20%3
$404
$404
20%3
20%3
$65
50%3
Removal of impacted tooth
$225
$125
50%5
$1134
$1134
50%5
50%5
$160
50%3
Root canal (anterior root canal)
$175
$155
50%5
$1564
$1564
50%5
50%5
$200
50%3
Root canal (molar)
$355
$290
50%5
$2344
$2344
50%5
50%5
$300
50%3,6
Crowns
$3506
$3006
50%5
$3205
$3205
50%5
50%5
$300
50%3,6
Orthodontics
$2,350 for under age 26, fully banded, two years
$2,650 for age 26+, fully banded, two years
$2,350 for under age 26, fully banded, two years5
$2,650 for age 26+, fully banded, two years5
Not covered
$2,350 for under age 26, fully banded, two years5,7
$2,650 for age 26+, fully banded, two years5,7
$2,350 for under age 26, fully banded, two years5,7
$2,650 for age 26+, fully banded, two years5,7
Not covered
50% ($1,500 lifetime maximum and subject to separate deductible)5,7,8
$350 for under age 19 when medically necessary, not covered for age 19+
50% for underage 19 when medically necessary, not covered for age 19+
Denture
$400
$400
50%5
$3885
$3885
50%5
50%5
$300 for under age 19, $400 age 19+
50%3,6
Calendar-year deductible
$0
$0
$50 per individual/$150 per family
$50 per individual
$50 per individual
$50 per individual/$150 per family
$50 per individual/$150 per family
$0
$75 per individual/$150 per family for up to age 19, $50 per individual for age 19+
Calendar-year benefit maximum
None
None
$1,250 per individual
$1,000 per individual
$1,000 per individual
$2,000 per individual
$2,000 per individual
None
None for under age 19, $1500 per individual age 19+
© California Physicians’ Service DBA Blue Shield of California 1999-2022. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield A-sociation. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.
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