Above for quotes Nation-wide

Below form is for California only

Anthem Blue Cross Dental Insurance 
(877)566-5454 Toll Free
Anthem Blue Cross SENIOR DENTAL HMO PLAN MONTHLY RATES (Age 65+)
  Saver SelectHMO SelectHMO Premier SelectHMO
Single $10 $14.50 $18
Two Party
(Subscriber &
Spouse		 $20 $29 $35.50

Anthem Blue Cross SENIOR DENTAL HMO PLAN BENEFIT SUMMARY (Age 65+)
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 Adult $3045 $3045 $3045
Retention $300 $300 $300
Other Services Office Visit after hours $56 $56 $56
Local Anesthesia $14 $14 $14
General Anesthesia $150 $150 $150
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

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

** 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 Senior 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).
Coverage Requested
Our Ages 65+   My Age       Spouse's Age  
People Covered
                                        Click here for information on Senior Dental PPO
                                        Click here for information on DeltaDental Senior Dental HMO

Customer Information
Full Name
E-mail
Street Address
City
County
State
Zip Code
Home Phone
Work Phone
FAX

Have you any comments, questions or special instructions?

 

Home        Individual & Family Senior Health Group Health Term Life Dental Plans   Contact Us

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Barricks Insurance Services
13900 NW Passage #302, Marina Del Rey, CA 90292
Phone:   (310) 827-7286    |   Fax:   (310) 827-0256
Toll-Free 1-877-Look4Life  (1-877-566-5454)

©1995  Barricks Insurance Services. CA License #0383850
Licensed in AL, AR, AZ, CA, CO, CT, FL, GA, IA, IL, IN, KS, KY,
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