Dental patient portion calculator
Enter the plan's numbers and the treatment. See what insurance should pay and what the patient owes, line by line, in the order insurers apply the rules.
Runs in your browser. Nothing you type is sent to Tabruns, and it asks for no patient details. An estimate, not a guarantee: the insurer decides when the claim is processed.
How the math works
For each line, in order: start from the allowed fee, use the lower fee if the plan downgrades the service, take off what's left of the deductible (preventive care skips it here, as on most plans), multiply by the category's coverage percentage, and stop at the yearly maximum left. The patient owes the billed fee minus that: the contracted fee in network, your own fee out of network.
The step-by-step version, with the same worked example, is in How to calculate a dental patient portion.
What this calculator leaves to you
Frequency limits, waiting periods, missing-tooth rules and services the plan doesn't cover can each stop the plan paying a line. Here you'd have to know that already and leave the line out. Tabruns Dental reads those from the patient's benefits page on the insurer's portal and applies them for you.
Questions
How do you calculate a dental patient portion?
Start from the allowed fee, use the downgraded fee if the plan pays the service at a cheaper rate, take off the deductible left (preventive care usually skips it), multiply by the plan's coverage percentage for the category, and cap at the yearly maximum left. The patient owes the billed fee minus that insurance amount.
What fee do I bill in network and out of network?
In network, the insurer's contracted fee, and the patient owes that fee minus insurance. Out of network, your own fee, so the patient also owes the gap between your fee and the plan's usual fee.
Why does the order of the treatment lines matter?
The deductible and the yearly maximum get used up as you go. The first lines take the deductible, and the last lines are the ones a running-out maximum stops paying.
Is the estimate a guarantee?
No. The insurer decides the final amount when the claim is processed. Frequency limits, waiting periods and missing-tooth rules can also stop the plan paying a line, so check the patient's benefits first.
Does this calculator save what I type?
No. It runs in your browser, sends nothing to Tabruns, and asks for no patient details. Close the tab and it's gone.
Skip the typing
Tabruns Dental reads coverage, deductible, maximum and limits from the benefits page you already have open, and gives the patient a dollar estimate in seconds.
Start 7-day free trial