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Understanding Your Dental Explanation of Benefits

An Explanation of Benefits, or EOB, is a document you’ll receive when your claim is processed.

Your Dental Explanation of Benefits (EOB) from Horizon Blue Cross Blue Shield of New Jersey helps you understand how your dental plan pays claims. Register and sign in to Member Online Services at to view, download and print your EOB.

A sample explanation of benefits document


Tooth # – Surface

The tooth number and surface(s) on which services were performed.


Service Date

The date that services were provided to the patient.


Proc. Code

The dental procedure code used to describe the procedure/service.


Procedure Description

A brief explanation of each service.


Submitted Amount

Amount billed to Horizon BCBSNJ by the dentist or facility.


Approved Amount

The amount we approved for payment based on your plan benefits prior to the deductible, coinsurance, copayment or other member cost sharing, if applicable.


Allowed Amount

The amount your Horizon BCBSNJ plan allows for the services performed.


Network Savings

The difference between the submitted amount and the approved amount.


Deductible Amt.

The amount you pay each year before your Horizon BCBSNJ dental plan starts to pay for covered services.


Cov. %

The percentage of the approved amount covered by insurance based on your plan benefits


Patient Owes

The amount the patient must pay to the dentist or facility, including deductible, copayment and coinsurance.


Plan Payment

The amount Horizon BCBSNJ pays the dentist or facility based on your plan benefits.


Other Insurance Coverage Paid

The amount paid by another insurance carrier, if applicable.


Current Plan Payment

The total amount paid to you, your dentist or facility for the services performed