CDC Dental Insurance & Billing Flashcards
6 cards from real CDC practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CDC Dental Insurance & Billing flashcards as text
What is an Explanation of Benefits (EOB)?
Answer: A statement from the insurer detailing how a claim was processed, including amounts paid, denied, or applied to deductible
An EOB is a statement issued by the insurance company after a claim is processed, showing the billed amount, allowed amount, plan payment, and patient responsibility.
What is a Table of Allowances in dental insurance?
Answer: A fixed schedule specifying the maximum amount the insurer will reimburse for each dental procedure regardless of the provider's fee
A Table of Allowances assigns a fixed reimbursement amount to each dental procedure, and the insurer pays no more than that amount regardless of what the dentist charges.
What does 'dual coverage' mean in dental insurance?
Answer: A patient being covered by two separate dental insurance plans simultaneously
Dual coverage exists when a dental patient has benefits from two separate insurance plans, typically their own employer plan and a spouse's employer plan.
What is the primary role of a dental consultant working for an insurance company?
Answer: To evaluate the clinical appropriateness and insurance coverage of submitted dental claims
A dental consultant is a licensed dentist employed by the insurer to review claims and determine whether proposed or completed treatment is clinically appropriate and covered under the patient's policy.
Which type of dental plan typically requires patients to choose a primary care dentist and receive all care within a contracted provider network?
Answer: DHMO (Dental Health Maintenance Organization)
A DHMO requires enrollees to select a primary care dentist from the plan's network and obtain all dental services from contracted providers, often with lower out-of-pocket costs.
The 'birthday rule' in dental insurance is used to determine what?
Answer: Which parent's plan is primary when a dependent child is covered by both parents' dental insurance
The birthday rule states that when a child is covered under both parents' dental plans, the plan belonging to the parent whose birthday falls earliest in the calendar year is primary.