Dental insurance often feels confusing for patients. 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 Bright Smile Dental.
This guide is ideal for new patients, returning patients checking a bill, or those evaluating dental insurance options. If you need individual assistance, our billing team is happy to help.
How Dental Insurance Works for City Patients
Dental plans are structured to make preventive care more affordable. Most insurance plans use a tiered coverage system:
Preventive care is commonly paid at 100% by dental plans.
Basic treatments such as fillings and simple extractions are usually covered at 70–80%.
Crowns and other major treatments usually receive the lowest coverage level.
Most dental policies use the 100–80–50 framework.
Learn more about our services to better understand your care options.
Common Dental Insurance Terms Explained
Deductible: The portion you must pay before coverage applies.
Copay / Coinsurance: The patient portion owed for covered services.
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: Procedures not covered under your plan.
Sample Dental Billing Breakdown for 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 EOB will show similar information.
Dental EOB Explained Simply
After your visit, a claim is submitted to your dental insurance.
The insurer reviews the claim and issues an EOB.
The EOB shows procedures, allowed amounts, payments, and your portion.
This document is informational only.
Common Dental Billing FAQs
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?
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?
We can assist you in contacting your insurance provider.
What to Do if Costs Are Higher Than Expected
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 click here available.
Explore third-party financing if needed.
Plan treatments around your benefit year when appropriate.
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