Understanding dental insurance can feel overwhelming. Insurance terms often leave patients unsure what they actually owe. In this article, we explain how your dental EOB and breakdown of benefits work following treatment at Elite Dental Care.
This information is helpful for new patients, existing patients reviewing a recent bill, and anyone comparing dental plans. If you need individual assistance, our billing team is happy to help.
Dental Insurance Basics for City Residents
Dental insurance is designed to reduce out-of-pocket costs while encouraging preventive care. Coverage is often divided into categories based on treatment type:
Preventive services like exams and cleanings are often covered at 100%.
Fillings and basic procedures are typically covered at a moderate percentage.
Major procedures including crowns, dentures, and implants often have lower coverage around 50%.
Most dental policies use the 100–80–50 framework.
Explore our dental treatments to better understand your care options.
Key Terms on Your Dental Breakdown of Benefits
Deductible: The portion you must pay before coverage applies.
Copay / Coinsurance: Your share of costs once insurance applies.
Allowed Amount / Negotiated Fee: The contracted rate agreed upon by in-network providers.
Annual Maximum: The yearly cap on insurance benefits.
Non-Covered Services: Treatments excluded by your policy.
Example: How Benefits Apply to Procedure_Type
This sample is for educational purposes. Your real costs depend on your policy details.
| Item | Example Amount |
| ------------------------------ | -------------------------- |
| Dentist’s standard fee | Base_Fee |
| Plan’s allowed amount | Allowed_Fee |
| Deductible applied | Deductible_Amount |
| Plan payment (Coverage_%%) | Plan_Payment |
| Patient responsibility | Patient_Responsibility |
Your insurance statement will reflect these line items.
Understanding Your Dental EOB
Your dentist sends a claim to your insurance provider.
Your insurance processes the claim and sends you an EOB.
The document outlines insurance and patient responsibilities.
This document is informational only.
Dental Insurance Questions Patients Ask
Why is there a difference between the dentist’s charge and the allowed amount?
The allowed amount is set by the insurer.
Does preventive care really cost nothing?
Many here plans cover preventive services at 100%.
What happens when I reach my annual maximum?
Additional services are paid out of pocket.
Why are some services not covered?
Coverage depends on plan rules and limitations.
Who should I contact if I disagree with my EOB?
Our office can help review your claim.
Managing Unexpected Dental Costs
Dental costs can be higher due to deductibles, annual limits, or non-covered services. Speaking with our office in advance can help avoid surprises.
Obtain benefit estimates when available.
Explore third-party financing if needed.
Plan treatments around your benefit year when appropriate.
Trusted Dental Care in City
Experienced dental team focused on patient education.
Easy access for local patients.
Acceptance of many major dental insurance plans.
See our patient reviews to learn more.