Dental insurance often feels confusing for patients. Terms like deductibles, copays, annual maximums, and coverage percentages are hard to follow. This guide explains how your dental billing breakdown of benefits and dental Explanation of Benefits (EOB) work after your visit at Premier Dental Clinic.
Whether you are new to our office or reviewing a recent statement, this guide can help. You can also visit our Financial Options page for one-on-one support.
How Dental Coverage Works in City
Dental plans are structured to make preventive care more affordable. Most insurance plans use a tiered coverage system:
Preventive services like exams and cleanings are often covered at 100%.
Basic treatments such as fillings and simple extractions are usually covered at 70–80%.
Major dental services tend to be covered at approximately 50%.
Most dental policies use the 100–80–50 framework.
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: A flat fee or percentage you pay after the deductible.
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: Procedures not covered under your plan.
Dental Insurance Example for Procedure_Type
The following example is for illustration only. 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 website | Patient_Responsibility |
Your insurance statement will reflect these line items.
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.
It lists what was covered and what you may owe.
The EOB does not require payment.
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 plans cover preventive services at 100%.
What happens when I reach my annual maximum?
You may be responsible for full costs afterward.
Why are some services not covered?
Some procedures are not included under specific policies.
Who should I contact if I disagree with my EOB?
We can assist you in contacting your insurance provider.
What to Do if Costs Are Higher Than Expected
Out-of-pocket expenses can increase depending on plan rules. Planning ahead can reduce unexpected costs.
Obtain benefit estimates when available.
Ask about payment plans or financing options.
Plan treatments around your benefit year when appropriate.
Why Patients Choose Our Dental Office
Years of experience helping patients understand benefits.
Serving City and surrounding areas.
Works with a wide range of insurers.
Read what our patients say to learn more.