Blue Cross/Blue Shield of South Carolina
Avesis administers dental benefits to members of Blue Cross/Blue Shield of South Carolina Medicare Blue Saver and Medicare Blue Plans.
Below you will find an image of the ID card that members will present for services along with a description of the member's covered benefits.
Office Visit Co-Pay: $10.00 per office visit
One per year (A or B):
|A||D0120||Recall Exam||One per year|
|B||D0150||Comprehensive Exam||One per year; (for new patients only-limited to one every 3 years)|
One per year:
|A||D1110||Cleaning ages 14 through adult||One per year|
Choose One per year (A or B or C):
|A||D0270/D0272/D0273/D0274||Bitewing X-rays||One set per year|
|B||D0220||Single x-ray film and up to 3 additional
|Total of 4 films per year|
|C||D0210||Full Mouth X-rays||One set per year; allowed one every 3 years;|