Ask Sai Biller what an EOB line means, which CDT code and narrative a payer expects, why a claim was denied, how much to write off, or how to coordinate two plans. Answers are written for office managers and billers.
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Hi, I'm Sai Biller. Ask me a dental insurance question: reading an EOB, CDT codes and narratives, denials and appeals, write-offs, coordination of benefits, or reconciling deposits.
General reference information, not advice on a specific claim. Verify against the payer's EOB and your contract. Powered by our dental billing engine.
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Need help with a specific claim? Sai for Dentists works on patient data under a business associate agreement with each office.
An explanation of benefits (EOB) is the statement a dental plan sends after it processes a claim. For each procedure it lists the fee you submitted, the amount the plan allows, anything applied to the deductible, what the plan paid, and what the patient owes.
An EOB is not a bill. Your office uses it to post the insurance payment to the patient's ledger, record any contractual write-off, and work out the patient's remaining balance.
They describe the same payment in three forms.
The EOB is the readable statement, on paper or as a PDF in the payer portal. The ERA (electronic remittance advice, the 835 transaction) carries the same line-by-line detail as structured data that software can post automatically. The EFT is the money itself: the deposit that lands in your bank account.
One EFT deposit often covers many patients, so each deposit has to be matched to the EOB or ERA that explains it.
For an in-network plan, the write-off is your office fee minus the plan's contracted allowance. You agreed to that allowance, so the difference can't be billed to the patient.
Example: your fee is $150 and the plan allows $100. The write-off is $50. If the plan covers the procedure at 80%, it pays $80 and the patient owes $20.
Post the write-off at the same time as the payment so the ledger shows the true patient balance. For out-of-network plans there is usually no contractual write-off.
Work one deposit at a time. Find the EOB or ERA with the same payer, date and total as the deposit, then confirm that the payments posted to patient ledgers from that EOB add up to the deposit amount.
A single deposit often pays several claims across several patients, so the total to match is the EOB total, not any one claim. When the numbers differ, the usual causes are a claim that was never posted, a payment posted to the wrong patient, or a payer refund or offset taken out of the deposit.
Start with the reason code and remarks on the EOB. They tell you which of the common causes applies: missing information (X-rays, a narrative, perio charting), an eligibility problem, a frequency or age limit, a missing-tooth or waiting-period clause, or a coordination-of-benefits question.
If information was missing, send a corrected claim with the attachment. If you believe the plan applied its rules incorrectly, file an appeal with supporting documentation. Either way, note the payer's filing deadline, which is printed on the EOB or in the provider manual.
The primary plan processes the claim first and issues its EOB. You then send the claim to the secondary plan with the primary EOB attached, and the secondary plan decides what it will pay toward the remainder.
Which plan is primary follows standard rules: the plan covering the patient as an employee comes before one covering them as a dependent, and for children the birthday rule usually applies. How much the secondary pays depends on its coordination method, so read the secondary EOB before billing the patient for any balance.
