Dental Explanation of Benefits at CityCare Dental

Dental insurance often feels confusing for patients. 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.
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.
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.

Basic dental work often receives partial coverage of around 70–80%.

Major procedures including crowns, dentures, and implants often have lower coverage around 50%.

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

See common procedures we perform 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: Treatments excluded by your policy.
Example: How Benefits Apply to Procedure_Type

This sample is for educational purposes. Actual coverage depends on your specific dental plan and remaining benefits.
| 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.
How to Read Your Dental Explanation of Benefits

Your dentist sends a claim to your insurance provider.

The insurer reviews the claim and issues an EOB.

The EOB shows procedures, allowed amounts, payments, and your portion.

This document is informational only.
Dental here 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?
Coverage depends on plan rules and limitations.

Who should I contact if I disagree with my EOB?
Our office can help review your claim.

Options When Dental Bills Are Higher

Unexpected balances sometimes occur. 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 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.