Dental Claim Forms

Dental Services Claim Form - Columbia Service Center
Dental Services Claim Form - Greenville Service Center
Dental Services Claim Form - State Dental Plan

BlueEssentialsSM Dental Reimbursement Form

All 2016 BlueEssentials plans for individuals and families include dental coverage. To use this benefit:

  1. Visit your dentist.
  2. Save your receipt and/or bill.
  3. Submit the reimbursement form and a copy of your receipt and/or bill any of these ways:
    • Email: G&
    • Fax: 803-264-0172
    • Mail: BlueCross BlueShield of South Carolina, G&I Claims, AX-H12, P.O. Box 100300, Columbia, SC 29202

Download the BlueEssentials Dental Reimbursement Form.