This example shows your estimated cost for a cleaning* if you have Blue Dental PPO Standard. With this plan, we cover 80 percent of the cost of a cleaning in network, 50 percent out of network. Other plans may cover different amounts. Remember, PPO and Blue Par Select dentists accept our approved amount. Out-of-network dentists don't. So you're responsible for paying the difference between the dentist's charge and the amount we approve.

Blue Dental PPO Standard estimated cost example
Payment Categories PPO (in-network) dentist Blue Par Select dentist Out-of-network dentist
Dentist's fee $76 $76 $100
Our approved amount for this service $53 $76 $76
We pay $42.40 $38 $38
You pay $10.60 $38 $62

*The cost of the cleaning is based on prices in Southwest Michigan. Costs may vary around the state.