Benefits

Insurance benefit rules (CoInsurance, Deductible, Limitations, WaitingPeriod, etc.) for plans. Per OpenDental API.

What are Benefits in OpenDental?

Benefits define insurance coverage rules—BenefitType (ActiveCoverage, CoInsurance, Deductible, CoPayment, Exclusions, Limitations, WaitingPeriod), CoverageLevel (Individual, Family), Percent/MonetaryAmt, TimePeriod, QuantityQualifier/Quantity, and optional CovCatNum (coverage category), CodeNum/procCode/CodeGroupNum, TreatArea. Benefits are attached to PlanNum (InsPlan) or PatPlanNum (patient-specific override). Empty Percent/MonetaryAmt = -1. See Benefits for details.

BenefitNum	PlanNum	PatPlanNum	BenefitType	CoverageLevel	CovCatNum	Percent	MonetaryAmt	TimePeriod	QuantityQualifier	Quantity	CodeNum	procCode	CodeGroupNum	TreatArea	Actions

Search & Update Benefit

Select a benefit to update or delete:

BenefitNum	BenefitType	CoverageLevel	Percent	MonetaryAmt	Actions

Update Benefit

All fields optional. PlanNum/PatPlanNum cannot be changed.

Benefit #-

CovCatNum, BenefitType, CoverageLevel

CovCatNum

BenefitType

CoverageLevel

Percent, MonetaryAmt

Percent

MonetaryAmt

TimePeriod, QuantityQualifier, Quantity

TimePeriod

QuantityQualifier

Quantity

CodeNum, procCode, CodeGroupNum, TreatArea

CodeNum

procCode

CodeGroupNum

TreatArea

Benefits

Benefits

Create Benefit

Required

Optional - Amounts & Percent

Optional - Time & Quantity

Optional - Procedure Code (CovCatNum=0 only)

Result:

Search & Update Benefit

Select a benefit to update or delete:

Update Benefit

CovCatNum, BenefitType, CoverageLevel

Percent, MonetaryAmt

TimePeriod, QuantityQualifier, Quantity

CodeNum, procCode, CodeGroupNum, TreatArea

Result:

Benefits

Create Benefit

Required

Optional - Amounts & Percent

Optional - Time & Quantity

Optional - Procedure Code (CovCatNum=0 only)

Result:

Search & Update Benefit

Select a benefit to update or delete:

Update Benefit

CovCatNum, BenefitType, CoverageLevel

Percent, MonetaryAmt

TimePeriod, QuantityQualifier, Quantity

CodeNum, procCode, CodeGroupNum, TreatArea

Result:

Benefits - GET Response

All Fields:

Create Benefit - POST

All Fields:

Update Benefit - PUT

All Updatable Fields: