Many patients struggle to understand dental insurance. Terms like deductibles, copays, annual maximums, and coverage percentages are hard to follow. This page walks you through how dental billing and EOBs work at Elite Dental Care.
Whether you are new to our office or reviewing a recent statement, this guide can help. If you need individual assistance, our billing team is happy to help.
How Dental Coverage Works in City
Dental insurance is designed to reduce out-of-pocket costs while encouraging preventive care. Coverage is often divided into categories based on treatment type:
Routine checkups and cleanings are usually covered in full.
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.
Key Terms on Your Dental Breakdown of Benefits
Deductible: An initial out-of-pocket amount required by your plan.
Copay / Coinsurance: A flat fee or percentage you pay after the deductible.
Allowed Amount / Negotiated Fee: The amount used by your plan to calculate benefits.
Annual Maximum: The total amount your plan will pay per year.
Non-Covered Services: Treatments excluded by your policy.
Dental Insurance Example for 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 EOB will show similar information.
Understanding Your Dental EOB
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.
FAQs About Dental Billing at Healthy Teeth Dental
Why is there a difference between the dentist’s charge and the allowed amount?
Plans calculate benefits using negotiated rates.
Does preventive care really cost read more nothing?
Preventive visits usually require no payment when in network.
What happens when I reach my annual maximum?
You may be responsible for full costs afterward.
Why are some services not covered?
Plans may exclude or limit certain treatments.
Who should I contact if I disagree with my EOB?
Start by contacting the billing team at Elite Dental Care.
Managing Unexpected Dental Costs
Unexpected balances sometimes occur. We encourage patients to contact us before treatment when possible.
Request a pre-treatment estimate for major procedures.
Ask about payment plans or financing options.
Timing care may help maximize benefits.
Why City Patients Trust Elite Dental Care
Years of experience helping patients understand benefits.
Easy access for local patients.
Works with a wide range of insurers.
Read what our patients say to learn more.