Questions about charges for Dental preventive care that appeared not to be preventive

Hey everyone,

Thanks to your help, I’ve more or less figured out how regular medical insurance work and decided to start getting to know dental insurance. I’m new to the US health system and have never been to a US dentist before.

My dental says it covers 100% preventive care so I decided to start easy and have just a cleaning. I found a clinic in my area through the dental in-network list and made an appointment online with a comment that I want preventive care.

Before the visit, they gave me paperwork to fill out where in the reason visit section I wrote by hand: preventive care only.

During the visit, I was told that dental cleaning also includes evaluation which also requires new x-rays (I brought my old 2019 x-ray). I said that they can do only what is included in preventive care because I am only trying the clinic and the insurance and want it to be fully covered. The assistant looked through some list on the wall and said that yes, those X-rays are considered preventive.

So I was done x-rays (orthopantomogram and a bunch of bitewings) then evaluation then cleaning and that’s it.

Guess how this story ends? Like all of them! Upon checkout, I’m getting a receipt for the x-ray covered only 70%. On my question of why I have to pay anything if my preventive is fully covered, they explained there is one x-ray (orthopantomogram specifically) that isn’t covered as preventive and asked whether I’m paying now or later. Paid $24.90 (30% of $83) and left.

Statement of services rendered:

Comprehensive oral evaluation$40Perio Charting$83Prophylaxis-adult$60

And the following math:

Current Credits: $24.90 + Current Charges: $183 = New balance $158.10 – Dental Ins Est 158.10 = Please Pay 0.

Now I’m seeing my newly arrived EOB which raises some more questions:

Service code, descriptionYour Dentist submittedNegotiated feeAllowed AmountInsurance paidYou owe your dentistD0150, Comprehensive oral evaluation$110$40$40$40$0D0210, Complete set radiographic images$179.00$83.00$83.00$0, $83.00 applied to deductible.$83.00D1110, Prophylaxisadult$132.00$60.00$60.00$60.00$0Totals$421.00$183.00$183.00$100.00$83.00

Okay, they made an orthopantomogram that I didn’t ask for, and appeared it is only covered 70%, and only after the deductible. I totally get it.

My questions:

But is it correct that 2 different x-rays from different categories are charged together?

Is it okay that they didn’t show me the full bill that they submitted to the insurance?

Is there anything I can do to appeal the new $83 bill? If yes, whom to address: the clinic or the insurance? Can I ask to split the D0210 code into separate Xrays to reduce the bill?

I have had a few successful attempts of appealing wrongly billed claims in regular medical but know nothing about dental.

Thanks again for any of your advice.