PR-1 on a dental EOB: the patient’s deductible, and how to post it
PR-1: Deductible amount. What it means on a dental claim, why dental offices get it, what to do, and whether the patient owes it.
By Dr. Salem Sayegh, general dentist, Glendora, California ·
The short answer: PR-1 means part of the allowed amount was applied to the patient’s deductible, so the patient owes it. It shows up most on the first claims of a new benefit year. Post it to the patient balance. The deductible, coinsurance (PR-2) and copay (PR-3), plus the plan payment, should add up to the allowed amount.
| Code | PR-1 (adjustment reason code) |
|---|---|
| Group | PR, patient responsibility: the patient owes it |
| Meaning | Applied to the patient’s deductible |
| Is it a denial? | No |
| Bill the patient? | Yes |
| Worth a second look when | The deductible appears again after it was already met this year |
Why dental offices get PR-1
- First claims of a new benefit year, which may be the calendar year or the plan’s own year.
- A family deductible not yet met.
- A plan with a separate deductible for basic and major services.
- Some plans waive the deductible on preventive care; if a PR-1 appears on a cleaning, check the plan.
What PR-1 looks like on an EOB
| Procedure | Billed | Allowed | Paid | Adjustments |
|---|---|---|---|---|
| D2392 (two-surface posterior composite) | $260.00 | $180.00 | $104.00 | CO-45 $80.00, PR-1 $50.00, PR-2 $26.00 |
The $50 deductible comes off first, then the patient pays 20% of the remaining $130 ($26). The plan pays $104. $104 + $50 + $26 = $180, the allowed amount.
What to do about PR-1
- Post the PR-1 amount to the patient balance.
- Check the arithmetic: plan payment plus PR amounts should equal the allowed amount.
- If a deductible appears after it was met, check the benefit year and the deductible already applied, and ask the payer to reprocess.
- Collect estimated deductibles at the visit early in the year, so the balance does not age.
Can you bill the patient for PR-1?
Yes. PR-1 is the patient’s deductible, and it is billable to the patient.
Questions about a specific EOB line?
Ask Sai Biller, our free dental insurance chatbot. Type the codes and amounts from the line, leave out patient details, and it explains what happened and what to do next. For offices posting every day, Sai for Dentists reads each EOB line as it posts, checks the allowed amount against your contracted fee and lists every denial, downgrade and underpayment for your team.
Sources
- X12 claim adjustment reason codes and remittance advice remark codes. Meanings here are paraphrased; see X12 for the official wording.
- American Dental Association, CDT: Code on Dental Procedures and Nomenclature. Procedure labels here are our own short descriptions.
- Payers apply these codes differently. Your contract and each payer’s provider manual decide what applies to your office.
Common questions
What is the difference between PR-1, PR-2 and PR-3?
PR-1 is the deductible, PR-2 is coinsurance (the patient’s percentage), and PR-3 is a fixed copay. All three are patient responsibility.
Do dental deductibles apply to cleanings?
Many dental plans waive the deductible for preventive and diagnostic services, but not all. Verify the plan before telling the patient they owe nothing.
