Dental Explanation of Benefits at Elite Dental Care

Understanding dental insurance can feel overwhelming. Terms like deductibles, copays, annual maximums, and coverage percentages are hard to follow. In this article, we explain how your dental EOB and breakdown of benefits work following treatment at Healthy Teeth Dental.
This guide is ideal for new patients, returning patients checking a bill, or those evaluating dental insurance options. You can also visit our Financial Options page for one-on-one support.
Dental Insurance Basics for City Residents

Dental insurance is designed to reduce out-of-pocket costs while encouraging preventive care. Many plans follow a standard coverage structure:

Preventive care is commonly paid at 100% by dental plans.

Fillings and basic procedures are typically covered at a moderate percentage.

Major dental services tend to be covered at approximately 50%.

Most dental policies use the 100–80–50 framework.

See common procedures we perform to better understand your care options.
Key Terms on Your Dental Breakdown of Benefits

Deductible: An initial out-of-pocket amount required by your plan.

Copay / Coinsurance: Your share of costs once insurance applies.

Allowed Amount / Negotiated Fee: The maximum fee your insurance recognizes for a service.

Annual Maximum: The maximum benefit available in a benefit year.

Non-Covered Services: Treatments excluded by your policy.
Example: How Benefits Apply to Procedure_Type

These numbers are examples and not exact quotes. Final amounts vary by insurance plan.
| 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 dental Explanation of Benefits will list similar details.
How to Read Your Dental Explanation of Benefits

The dental office submits billing to your insurer.

Your insurance processes the claim and sends you an EOB.

The document outlines insurance and patient responsibilities.

An EOB is not a bill.
Dental Insurance Questions Patients Ask

Why is there a difference between the dentist’s charge and the allowed amount?
Insurance plans set contracted fee limits.

Does preventive care really cost nothing?
Routine care is often fully covered.

What happens when I reach my annual maximum?
Insurance stops paying once the maximum is reached.

Why are some services not covered?
Plans may exclude or limit certain treatments.

Who should I read more 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.

Ask about payment plans or financing options.

Plan treatments around your benefit year when appropriate.

Trusted Dental Care in City

Commitment to clear communication and preventive care.

Easy access for local patients.

Acceptance of many major dental insurance plans.

See our patient reviews to learn more.