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Apex Oral Surgery Estimator (COB & Provider Yield)

Apex Oral Surgery: Comprehensive COB Estimator

Date of Estimate:

⚕️ Medical Insurance (Primary OON) Coordinate with Medical

Remaining Deductible ($):

Medical Co-insurance (%):

🦷 Primary Dental Insurance

Primary Plan:

Rem. Deductible ($):

Rem. Annual Max ($):

Primary Payout: $0.00 / $1500.00

🦷 Secondary Dental Insurance Add Secondary

COB Rule:

Secondary Plan:

Rem. Deductible ($):

Rem. Annual Max ($):

Secondary Payout: $0.00 / $1500.00

	✓	Procedure	CPT	Med Billed ($)	Med?	Med Pays	Pri Fee ($)	Pri Cov%	Pri Pays	Pri Max	Sec Fee ($)	Sec Cov%	Sec Pays	Patient Pays

Total Pri. Dent Billed: $0.00

Est. Medical Payment: $0.00

Est. Primary Dent. Payment: $0.00

Expected Patient Responsibility: $0.00

Total Est. Provider Collection: $0.00

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