• Home
• Dental Plans
• Dental Glossary
• Health Plans
• Group Health
• Seniors
• Contact Us

•   CLICK HERE FOR ONLINE DENTAL INSURANCE QUOTES Nation-wide   

Above for quotes Nation-wide

Below form is for California only

Anthem Blue Cross Dental Insurance
(877)566-5454 Toll Free

Anthem Blue Cross INDIVIDUAL DENTAL HMO PLAN MONTHLY RATES

	Saver SelectHMO	SelectHMO	Premier SelectHMO
Single	$11.00	$15.50	$19.50
Two Party (Subscriber & Spouse or Subscriber & Child	$21.50	$31.00	$37.50
Family (three or more) (Subscriber, Spouse & Child or Subscriber & Children)	$32.00	$46.00	$56.50

Anthem Blue Cross INDIVIDUAL DENTAL HMO HIGHLIGHTS

DENTAL SERVICE		Dental Saver	Dental	Dental Premier
		SelectHMO copays	SelectHMO copays	SelectHMO copays
Office Visit		$5	$5	$5
Diagnostic Care	Oral Exams	No Charge	No Charge	No Charge
	X-rays	No Charge	No Charge	No Charge
Preventive Care	Topical Fluoride - child	No Charge	No Charge	No Charge
	Prophylaxis - adult & child	No Charge ¹	No Charge ¹	No Charge ¹
Restorative Care	1-Surface Amalgam (filling)	$54	No Charge ²	No Charge ²
	2-Surface Amalgam (filling)	$64	No Charge ²	No Charge ²
	3-Surface Amalgam (filling)	$75	No Charge ²	No Charge ²
	4-Surface Amalgam (filling)	$89	No Charge ²	No Charge ²
Periodontal Care	Scaling/Root Planing per quadrant	$101	$101	No Charge ²
Prosthodontic Care	Denture (broken tooth repair)	$57	$57	$57
Orthodontic Care	Child	$2870	$2870	$2870
	Adult	$3045	$3045	$3045
	Retention	$210	$210	$210
Other Services	Office Visit after hours	$56	$56	$56
	Local Anesthesia	$14	$14	$14
Cosmetic Care	Resin Filling	$75	$75	$75
	Labial Veneer	$187	$187	$187
Endodontic Care	Root Canal - Anterior	$289	$289	$289
	Root Canal - Bicuspid	$341	$341	$341
	Root Canal - Molar	$459	$459	$459
	Pulpotomy	$62	$62	$62
Periodontal Care	Gingivtomy - per tooth	$72	$72	$72
	Gingivtomy - per quadrant	$194	$194	$194
	Osseous Surgery - per quadrant	$520	$520	$520
Oral Surgery	Extraction - erupted tooth or exposed root	$60	$60	No Charge ²
	Impaction - soft tissue	$136	$136	$136
	Impaction - partial bony	$176	$176	$176
	Impaction - complete bony	$200	$200	$200
Prosthodontic Care	Crowns	$432	$432	$432
	Complete Upper or Lower Dentures	$577	$577	$577
	Partial Denture	$430	$430	$430

¹ First two treatments in 12 consecutive months. All additional treatments within a 12-month period require copayments of $44 for adults and $35 for children.

² You must meet a six-month waiting period before these benefits are payable.

  Download Your Dental HMO Brochure/Application  
DOWNLOAD YOUR SelectHMO APPLICATION

PLEASE CHOOSE A PRIMARY DENTIST TO PUT ON YOUR APPLICATION.

Or you can fill in this form to have your Anthem Blue Cross HMO Dental Insurance brochure with pricing & application mailed to you. Further information on our plans is shown below. Or just call us Toll-free at 1-877-Look4Life (1-877-566-5454).

Customer Information
Full Full Name
E-mail
Street Address
City
County
State
Zip Code
Home Phone
Work Phone
FAX
Our Ages	My Age       Spouse's Age
People Covered	-- Please Select -- Me Only Me and 1 Child Me and Children Me and Spouse Family

Have you any comments or special instructions?

 

Important Disclaimer:  Answers and comments provided above are general information, and are not intended to substitute for informed professional medical, psychiatric, psychological, tax, legal, investment, accounting, governmental, or other professional advice. We do not endorse, and expressly disclaims liability for any product, manufacturer, distributor, service, health plan, or service provider mentioned or any opinion expressed in the website.  Replies, comments, or information gathered on 4dentalinsurance.net  website may not be accurate but are intended to be helpful.