Understanding dental insurance can feel overwhelming. Words such as deductible, coinsurance, and annual limits can be confusing. In this article, we explain how your dental EOB and breakdown of benefits work following treatment at Premier Dental Clinic.
This information is helpful for new patients, existing patients reviewing a recent bill, and anyone comparing dental plans. For personalized help, contact our billing team or visit our Financial & Insurance Options page.
Dental Insurance Basics for City Residents
Dental plans are structured to make preventive care more affordable. Most insurance plans use a tiered coverage system:
Routine checkups and cleanings are usually covered in full.
Basic treatments such as fillings and simple extractions are usually covered at 70–80%.
Major dental services tend to be covered at approximately 50%.
A common structure is 100–80–50 for preventive, basic, and major care.
Learn more about our services to better understand your care options.
Dental Billing Terms You Should Know
Deductible: The portion you must pay before coverage applies.
Copay / Coinsurance: The patient portion owed for covered services.
Allowed Amount / Negotiated Fee: The contracted rate agreed upon by in-network providers.
Annual Maximum: The total amount your plan will pay per year.
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 EOB will show similar information.
Understanding Your Dental EOB
After your visit, a claim is submitted to your dental insurance.
You then receive an Explanation of Benefits.
The document outlines insurance and patient responsibilities.
An EOB is not a bill.
Common Dental Billing FAQs
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 plans cover preventive services at 100%.
What happens when I reach my annual maximum?
Additional services are paid more info 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?
Start by contacting the billing team at Bright Smile Dental.
What to Do if Costs Are Higher Than Expected
Out-of-pocket expenses can increase depending on plan rules. 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.
Why City Patients Trust Healthy Teeth Dental
Experienced dental team focused on patient education.
Convenient location and flexible hours in City.
Acceptance of many major dental insurance plans.
See our patient reviews to learn more.