Breakdown of Dental Benefits

Please submit all claims to:

IPM Trust
1168 E La Cadena Dr.
Riverside, CA 92507
(951) 684-1791

Please note: We are unable to provide Prudent Buyer fee schedules. You will need to contact Blue Cross directly.

  • No orthodontic care is covered – including any service relative to orthodontics such as xrays and extractions
  • Full-mouth x-rays are payable every 3 years (over the age of 13)
  • 4 bite wing and 2 additional are payable every 6 months
  • Exams & cleanings are payable every 6 months
  • Perio-Maintenance is payable every 6 months in lieu of a prophy
  • Full-Mouth Debridement is payable every 2 years
  • Root planing/scaling is payable every 2 years
  • Prosthetic replacement payable every 5 years(bridges, dentures, partials & crowns)
  • Prior extractions are a covered benefit (missing tooth clause)
  • Sealants are covered on permanent molars until age 14
    (does not include wisdom teeth)
  • Flouride is a covered benefit for adults and children every 6 months
  • Composites are covered on all teeth
  • Basic general anesthesia is covered w/ no extra minutes
  • Nitrous Oxide is not covered
  • Nightguards must be pre-authorized
  • Implants & cosmetic work are not covered
  • Claims over $200 should be pre-authorized
    Especially for Non-PPO Providers
    (claims not pre-authorized are still subject to review & delayed payment)
  • X-rays should be submitted with all dental work, except preventative
  • Perio charting should be submitted with perio work
  • There are no waiting periods