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Dental Benefits Overview

Understanding your dental benefits can improve your health and lower your out-of-pocket expenses.

Filing a Claim

It is important to understand the steps involved in processing and paying claims. Following is the typical sequence of events involved in claims processing:

  • The dental office completes the claim form and submits it to your insurance company or administrator.
  • The insurance company / administrator checks your eligibility.
  • The procedure codes are compared to your dental plan to determine covered expenses and non-covered expenses.
  • Covered expenses are applied against your deductible, co-insurance levels and the maximum benefit.
  • Your dentist is paid. It generally takes between 7 and 20 calendar days for a dental claim to be paid.
  • You receive an EOB (Explanation of Benefits). It explains how much was paid as a benefit and how much you are responsible for. It contains all of the pertinent information concerning the claim payment and should be filed with your personal dental records. It includes:
    • Employee's name
    • Employee's ID number
    • Dentist who rendered services
    • Patient's name
    • Date processed
    • Claim reference number
    • Date services were performed
    • The tooth or area numbers
    • Procedure codes
    • Fee charged
    • PPO fee (if applicable)
    • Covered expense
    • Plan benefit
    • Description of service
    • Amount paid to dentist
    • Patient's out-of-pocket expenses
    • Amount paid towards maximum
    • Phone number and address of claim office

Author: Fluent staff
Last updated: 6/30/2020
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