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 Family First Dental.
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 Insurance Works for City Patients
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.
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: read more The total amount your plan will pay per year.
Non-Covered Services: Treatments excluded by your policy.
Sample Dental Billing Breakdown 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 insurance statement will reflect these line items.
How to Read Your Dental Explanation of Benefits
Your dentist sends a claim to your insurance provider.
Your insurance processes the claim and sends you an EOB.
It lists what was covered and what you may owe.
This document is informational only.
Dental Insurance Questions Patients Ask
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 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 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.
Request a pre-treatment estimate for major procedures.
Ask about payment plans or financing options.
Plan treatments around your benefit year when appropriate.
Trusted Dental Care in City
Years of experience helping patients understand benefits.
Easy access for local patients.
Acceptance of many major dental insurance plans.
See our patient reviews to learn more.