BlueChoice HealthPlan

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Summary of Preventive Dental Benefits

Preventive Dental is automatically included in all CarolinaADVANTAGE plans and covers an allowed amount per benefit period for exams and cleanings at any licensed dentist.

Preventive Dental, one exam: initial $27/periodic $20

Preventive Dental, one cleaning: adult $40/child $31

Members should send a completed Member Claim Form and the paid receipt from their dentist to BlueChoice HealthPlan. We will reimburse you for the allowed amount.

Members should complete and send this form to:

BlueChoice HealthPlan
P.O. Box 6170
Columbia, S.C. 29260-6170