How do I read the Dental Explanation of Benefits (EOB)?

When you have services that are provided and processed through your Guardian dental plan we will issue you an Explanation of Benefits (EOB). Here is a sample Guardian Dental EOB. The following table provides definitions to help you understand it.

EOB Field Name	EOB Field Name Description
Submitted/ADA  Code/Description	The American Dental Association (ADA) code submitted by the provider and a description of the services performed.
Alt Code	If the benefits were based on an alternate code, that code will be listed here.
Tooth No.	The code listed indicates where the service was performed. 1-32: Indicates an adult tooth A-T: Indicates a child tooth UR: Teeth in the upper right jaw UL: Teeth in the upper left jaw LL: Teeth in the lower left jaw LR: Teeth in the lower right jaw UA: Teeth in the upper jaw (upper arch) LA: Teeth in the lower jaw (lower arch) FM: Full mouth For a visual representation of these, refer to How do I read a tooth chart?
Date of Service	The date the procedure was performed
Submitted Charge	The charge for the service as submitted by your provider
Considered Charge	The maximum amount that will be considered by Guardian for the service;The amount may be lowered when a discount for using an in-network provider is applied.
Covered Charge	The amount that will be applied to the plan’s benefits; The amount may be lowered when there is a non-covered service or when an out-of-network provider is used.
Deductible Amount	The amount applied to the deductible; This amount must be paid by the patient. Guardian will consider benefits once the deductible is satisfied.
Coverage Percent	This is the percentage amount the patient is required to pay for each service according to the terms of the plan. For example, if the plan's co-insurance provision is 80%, Guardian will consider 80% of the cost of the service and the patient must pay the 20% balance to the provider. This is calculated after the deductible is met and any applicable discounts are applied.
Benefit Amount	The amount the plan paid for the service

The following additional information may be included on a Dental EOB.

EOB Field Name	EOB Field Name Description
Year to Date Information	This section may include: The individual deductible met for the policy year The maximum met for the policy year Note: The maximum is the amount Guardian pays for the year. The member is responsible for any amount over the maximum.
Remarks	This section may include the following information: An indication that a participating in-network provider was used Information indicating a procedure was denied Information describing that a procedure was not covered in full The amount used and available in the patient’s Maximum Rollover Account