What is an Explanation of Benefits (EOB)?

An Explanation of Benefits is the statement that a dental carrier sends to the patient — and sometimes to the dental office — after a claim is processed. It outlines exactly how the carrier evaluated the claim and how much it paid.

A typical EOB lists each procedure that was billed, the provider's submitted charge, the carrier's allowed amount (the in-network negotiated rate), the amount the plan paid, any deductible or coinsurance applied, and the patient's responsibility. It also notes denials with reason codes when applicable.

EOBs are not bills. The actual bill comes from the dental office. EOBs simply tell the patient what the plan did with the claim, so the patient can reconcile it against the practice's billing. Patients sometimes mistake an EOB for a bill and pay the wrong party — front desks should be ready to explain this.

EOBs are also important documents for the practice. They confirm payment, identify denials that need to be appealed, and provide evidence for coordination of benefits when a secondary claim is submitted. Practices should retain EOBs as part of their billing records.

Many carriers have moved to electronic EOBs accessed through a patient portal or sent via secure email. Some still mail paper versions. Either way, reviewing EOBs is a normal part of confirming that benefits were applied correctly.