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Virginia dental plans, Washington dental plans, West Virginia dental plans, Wisconsin
dental plans, Wyoming dental plans, Abutment: The teeth on either side of a missing tooth.
Abutments are the part of the bridge used to support the replacement of the missing teeth
(pontics)., Amalgam: Silver filling. Amalgams are usually placed on the back teeth
(posterior teeth)., Anesthesia: Relieves the sensation of pain., Anterior Teeth: The front
teeth (incisors and cupids)., Arch: The upper or lower jaw., B, Back Teeth: See Posterior
Teeth, Bicuspid: The first and second bicuspids, those are the fourth and fifth teeth from
the center of the mouth to the back of the mouth. These are the back teeth that are used
for chewing, they only have two points (cusps)., Bitewing: X-ray that shows the upper and
lower teeth's biting surfaces on the same film. This x-ray shows the portion of the teeth
above the gumline., Bridge: A fixed appliance (prosthesis) that replaces missing teeth. A
bridge is a series of crowns (abutments and pontics)., Bruxism: Clenching or grinding of
the teeth., C, Calculus: The sticky film on your teeth (plaque) that has hardened. Also
known as tartar., Canal: The narrow chamber inside the root of the tooth that contains the
nerve and blood vessels., Canines: See cuspids., Caries: Correct technical term for
decay., Cleaning: See prophylaxis., Complete Series: See Full Mouth X-rays., Composite
Filling: Tooth colored filling. Insurance companies usually only allow them on the front
teeth (anterior teeth). When composites are done on the back teeth (posterior teeth) the
insurance company usually pays them as an amalgam. Composites are also known as resin
fillings., Crown: Full coverage for a tooth.When the tooth cannot be restored by a filling
a crown is usually fabricated., Curettage: Surgical scraping of bacteria from the soft
tissue. This is a periodontal procedure and is usually performed one quadrant at a time.
Procedure code 4220., Cusps: The high points on the chewing surfaces of the back teeth
(posterior teeth)., Cuspids: The third tooth from the center of the mouth to the back of
the mouth. These are the front teeth that have one rounded or pointed edge used for
biting. Also known as canines., D, Deciduous Teeth: See Primary Teeth., Denture: A
removable appliance (prosthesis) that replaces all of the teeth in either the upper or
lower jaw., Diagnostics: Procedures performed by the dentist to identify what's going on
in the mouth. The most common procedures you will deal with are the exam and x-rays
classifies as preventive., E, Edentulous: All the teeth are missing in either the upper or
lower arch., Endo: See Endodontics., Endodontics (Endo): The treatment of diseases or
injuries that affect the root tip or nerve of the tooth. The most common procedure that
you will deal with is a root canal., F, Fluorides: Topical application of a gel or liquid
that prevents decay., F.M.X.: See Full Mouth X-rays., Front Teeth: See Anterior Teeth.,
Full Mouth x-rays (F.M.X.): X-rays showing all the teeth. Includes 14 periapicals and 2 or
4 bitewings. Also known as a complete series., G, General Anesthesia: Relieves the
sensation of pain on the whole body. General anesthesia renders you unconscious., Gingiva:
The gums., I, Impaction: An unerupted or partially erupted tooth that will not fully erupt
because it is obstructed by another tooth, bone, or soft tissue., Implant: A post that is
implanted in the bone. A crown, bridge or denture is then placed over the implant,
Incisors: The central and lateral incisor, those are the first and second teeth from the
center of the mouth to the back of the mouth. These are the front teeth with the flat
edges for biting., Inlay: A laboratory processed restoration made of metal, acrylic or
porcelain. This filling does not involve the high points of the tooth (cusps)., L, Local
Anesthesia: Relieves the sensation of pain in a localized area., M, Mandible: The lower
jaw., Maxilla: The upper jaw., Molars: The first, second and third molars, those are the
sixth, seventh and eighth teeth from the center of the mouth to the back of the mouth. The
back teeth with the large chewing surface on top. They have 4 points (cusps)., N,
Nightguard: A removable acrylic appliance to minimize the effects of grinding the teeth
(bruxism) or joint problems (T.M.J.). Usually worn at night to prevent the grinding of
teeth or relieve joint pain. Also known as an occlusal guard., O, Occlusal: The chewing
surfaces of the back teeth., Occlusal Guard: See Nightguard., Onlay: A laboratory
processed restoration made of metal, porcelain or acrylic that replaces one or more of the
highest points of the tooth (cusps)., Oral Surgery (O.S.): Surgery of the mouth., Ortho:
See Orthodontics., Orthodontics (Ortho): Straightening of the teeth., O.S.: See Oral
Surgery., P, P.A.: Common dental language for a periapical. See Periapical., Palate: Roof
of the mouth., Panorex: An x-ray taken outside of the mouth that shows all the teeth on
one film., Partial Denture: A removable appliance (prosthesis) that replaces some of the
teeth in either the upper or lower jaw., Pedo: See Pedodontics., Pedodontics (Pedo): The
treatment of children's teeth., Periapical: An x-ray that shows the whole tooth (above and
below the gumline). Also known as a single film or P.A., Perio: See Periodontics., Perio
Charting: Measures the depth that the gums have detached from the side of the tooth
forming a pocket (perio pocket)., Periodontal Maintenance: Cleaning of the teeth following
periodontal treatment, includes perio charting. Procedure code 4910. Also known as a perio
prophy or perio recall., Periodontics (Perio): The treatment of diseases of the gum or
bone (supporting structure)., Perio Pocket: The pocket that forms when the gums detach
from the side of the tooth., Perio Prophy: See Periodontal Maintenance., Perio Recall: See
Periodontal Maintenance., Permanent First And Second Molars: The adult first and second
molars, they are the sixth and seventh teeth from the center of the mouth to the back of
the mouth. Does not include the third molar (wisdom tooth)., Permanent Molars: The adult
first, second and third molars., Permanent Dentition: See Permanent Teeth., Permanent
Teeth: The adult teeth. Also known as the permanent dentition., Plaque: A sticky film on
the teeth. If it is not removed by brushing it can harden into calculus., Pontic: The part
of a bridge that replaces the missing teeth., Posterior Teeth: The back teeth (Bicuspids
and molars)., Preventive: Procedure performed to prevent decay and gum disease. The
procedures that Trojan classifies as preventive are the exam, x-rays and prophys. The exam
and x-rays are also known as diagnostic procedures., Primary Dentition: See Primary
Teeth., Primary Teeth: The baby teeth. Also known as the primary dentition. The baby teeth
are replaced by the adult teeth (permanent teeth), Prophy: See Prophylaxis., Prophylaxis:
Cleaning the teeth. Also known as a prophy., Prosthodontics: A fixed or removable
appliance to replace missing teeth. Example: bridges, dentures and partials. Sometimes
single crowns are considered prosthetics., Prosthetic Replacement: How old does the crown,
bridge, partial or denture have to be before it can be replaced? They usually must be
unserviceable also., Prosthodontics: Dealing with the replacement of missing teeth., Q,
Quadrant: One of the four equal sections of the mouth. The upper right, upper left, lower
right or the lower left., R, R.C.T.: See Root Canal Therapy., Resin Filling: See Composite
Filling., Restorative: Procedures performed to restore the missing part of the teeth. Some
insurance companies only consider the fillings to be restorative, others consider the
fillings, crowns, bridges and dentures to be restorative., Root Canal Therapy (R.C.T.):
The nerve of the tooth is removed from the canal inside the root and replaced with a
filling material, Root Planing: Deep cleaning of the teeth to remove calculus below the
gumline. This is not a prophylaxis. This is a periodontal procedure and is usually
performed one quadrant at a time. Procedure code 4341., S, Sealant: Clear application of
acrylic placed over the biting surface of the tooth to prevent decay. Most insurance
companies only allow these on permanent teeth., Single Film: See Periapical., T, Tartar:
See Calculus., Temporomandibular Joint (T.M.J.): Temporo (temporal bone), mandibular
(lower jaw). This is the connecting hinge between the lower jaw and base of the skull.
Also known as T.M.J.. T.M.J. treatment is sometimes paid under medical., Third Molar: See
Wisdom Tooth., T.M.J.: See Temporomandibular Joint., V, Virgin Teeth: Teeth that have no
decay or fillings., W, Wisdom Tooth: The third molar, this is the eighth tooth from the
center of mouth to the back of the mouth. Wisdom teeth are often impacted (obstructed from
erupting) and have to be extracted., Allowable Charges: The maximum dollar amount on which
benefit payment is based for each dental procedure., B, Beneficiary: A person who receives
benefits under a dental benefit contract., Benefit: The amount payable by a third party
toward the cost of various covered dental services or the dental service or procedure
covered by the plan., Benefit Booklet: A booklet or pamphlet provided to the subscriber
which contains a general explanation of the benefits and related provisions of the dental
benefit program. Also known as a "Summary Plan Descriptions.", C, Capitation: A
capitation program is one in which a dentist or dentists contract with programs' sponsor
or administrator to provide all or most of the dental services covered under the program
to subscribers in return for payment on a per-capita basis., Certificate Holder: The
person, usually the employee or responsible party, who represents the family unit covered
by the dental benefit program; other family members are referred to as
"dependents.", Closed Panel: A closed panel dental benefit plan exists when
patients eligible to receive benefits can receive them only if service are provided by
dentists who have signed an agreement with the benefit plan to provide treatment to
eligible patients. As a result of the dentist reimbursement methods characteristic of a
closed panel plan, only a small percentage of practicing dentists in a given geographical
area are typically contracted by the plan to provide dental services., Contract Dentist: A
practitioner who contractually agrees to provide services under special terms, conditions
and financial reimbursement arrangements., Contract Fee Schedule Plan: A dental benefit
plan in which participating dentists agree to accept a list of specific fees as the total
fees for dental treatment provided., Coverage: Benefits available to an individual covered
under a dental benefit plan., Covered Person: An individual who is eligible for benefits
under a dental benefit program., Covered Services: Services for which payment is provided
under the terms of the dental benefit contract., D, Dental Benefits Organization: Any
organization offering a dental benefit plan. Also known as dental plan organization.,
Dental Benefit Plan: Entitles covered individuals to specified dental services in return
for a fixed, periodic payment made in advance of treatment. Such plans often include the
use of deductibles. coinsurance, and/or maximums to control the cost of the program to the
purchaser., Dental Benefit Program: The specific dental benefit plan being offered to
enrollees by the sponsor., Dental Insurance: A plan that financially assists in the
expense of treatment and care of dental disease and accidents to teeth., Dental
Prepayment: A method of financing the cost of dental services prior to their receipt.,
Dependents: Generally spouse and children of covered individual, as defined by terms of
the dental benefit contract., E, Eligibility Date: The date an individual and/or
dependents become eligible for benefits under a dental benefit contract. Often referred to
as effective date., Enrollee: Individual covered by a benefit plan., Exclusions: Dental
services not covered under a dental benefit program., Expiration Date: 1) the date on
which the dental benefit contract expires. , 2) The date and individual cease to be
eligible for benefits., F, Fee-for-Service: A method of paying practitioners on a
service-by-service rather than a salaried or capitated basis., Fee Schedule: A list of the
charges established or agreed to by a dentist for specific dental services., H, Health
Maintenance Organization (HMO): A legal entity that accepts responsibility and financial
risk for providing specified services to a defined population during a defined period of
time at a fixed price. An organized system of health care delivery that provides
comprehensive care to enrollees through designated providers. Enrollees are generally
assessed a monthly payment for health care services and may be required to remain in the
program for a specified amount of time., I, Indemnity Plan: A dental plan where a
third-party payer provides payment of an amount for specific services, regardless of the
actual charges made by the provider. Payment may be made either to enrollees or, by
assignment, directly to dentists. Schedule of allowances, table of allowances, or
reasonable and customary plans are examples of indemnity plans., Insurer: An organization
that bears the financial risk for the cost of defined categories or services for a defined
group of beneficiaries., Insured: Person covered by the program., L, Liability: An
obligation for a specified amount or action., Limitations: Restrictive conditions stated
in a dental benefit contract, such as age, length of time covered, and waiting periods,
which affect an individual's or group's coverage. The contract may also exclude certain
benefits or services, or it may limit the extent or conditions under which certain
services are provided., M, Managed Care: Refers to a cost containment system that directs
the utilization of health benefits by:, a. restricting the type, level and frequency of
treatment;, b. limiting the access to care; and, c. controlling the level of reimbursement
for services., Maximum Allowance: The maximum dollar amount a dental program will pay
towards the cost of a dental service as specified in the program's contract provisions,
e.g., UCR. Table of Allowances., Maximum Benefit: The maximum dollar amount a program will
pay toward the cost of dental care incurred by an individual or family in a specific
period, usually a calendar year., Maximum Fee Schedule: A compensation arrangement in
which a participating dentist agrees to accept a prescribed sum as the total fee for one
or more covered services., Member: An individual enrolled in a dental benefit program., N,
Necessary Treatment: A necessary dental procedure or service as determined by a dentist,
to either establish or maintain a patient's oral health. Such determinations are based on
the professional diagnostic judgment of the dentist, and the standards of care that
prevail in the professional community., Noncontributory Program: A method of payment for
group coverage in which all of the monthly premium for the program is paid by the
sponsor., Nonduplication of Benefits: This may apply if a subscriber is eligible for
benefits under more than one plan. A dental benefit contract provision relieving the
third-party payer of liability for cost of services if the services are covered under
another program. Distinct from a coordination of benefits provision, because reimbursement
would be limited to the greater level allowed by the two plans, rather than a total of
100% of the charges. Also referred to as "benefit-less-benefit" or
"carve-out"., Nonparticipating Dentist: Any dentist who does not have a
contractual agreement with a dental benefit organization to render dental care to members
of dental benefit program., O, Open Enrollment: The annual period in which employees can
select from a choice of benefit programs., P, Participating Dentist: Any dentist who has a
contractual agreement with a dental benefit organization to render care to eligible
persons., Point of Service: arrangements in which patients with a managed care dental plan
have the option of seeking treatment from an "out-of-network" provider. The
reimbursement for the patient is usually based on a low table of allowances, with
significantly reduced benefits than if the patient had selected an "in-network"
provider., Preauthorization: Statement by a third-party payer indicating that proposed
treatment will be covered under the terms of the benefit contract. , Precertification:
Confirmation by a third-party payer of a patient's eligibility for coverage under a dental
benefit program., Predetermination: An administrative procedure that may require the
dentist to submit a treatment plan to the third party before treatment is begun. The third
party usually returns the treatment plan indicating one or more of the following:
patient's eligibility, guarantee of eligibility period, covered services, benefit amounts
payable, application of appropriate deductibles, co-payment and/or maximum limitation.
Under some programs. predetermination by the third party is required when covered charges
are expected to exceed a certain amount, such as $200., Pre-existing Conditions: Oral
health condition of an enrollee which existed before his/her enrollment in a dental
program., Preferred Provider Organization (PPO): A formal agreement between a purchaser of
a dental benefit program and a defined group of dentists for the delivery of dental
services to a specific patient population, as an adjunct to a traditional plan, using
discount fees for cost savings., Premium: The amount charged by a dental benefit
organization for coverage of a level of benefits for a specified time., Prepaid Dental
Plan: A method of financing the cost of dental care for a defined population, in advance
of receipt of services., Prevailing Fee: Term used by some dental benefit organizations to
refer to the fee most commonly charged for a dental service in a given area., Preventive
Dentistry: Refers to the procedures in dental practice and health programs which prevent
the occurrence of oral diseases., Purchaser: Program sponsor, often employer or union,
that contracts with the dental benefit organization to provide dental benefits to an
enrolled population., Q, Quality Assessment: The measure of the quality of care provided
in a particular setting., Quality Assurance: The assessment or measurement of the quality
of care and the implementation of any necessary changes to either maintain or improve the
quality of care rendered., R, Reasonable and Customary (R&C) Plan: A dental benefit
plan that determines benefits based only on "Reasonable and Customary" fee
criteria., Reasonable Fees: The fee charged by a dentist for a specific dental procedure
that has been modified by the nature and severity of the condition being treated and by
any medical or dental complications or unusual circumstances, and therefore may differ
from the dentist's "usual" fee or the benefit administrator's
"customary" fee., Reimbursement: Payment made by a third party to a beneficiary
or to a dentist on behalf of the beneficiary, toward repayment of expenses incurred for a
service covered by the contractual arrangement., S, Schedule of Allowances: A list of
covered services with an assigned dollar amount that represents the total obligation of
the plan with respect to payment for such services, but does not necessarily represent the
dentist's full fee for that service., Schedule of Benefits: A listing of the services for
which payment will be made by a third-party payer, without specification of the amount to
be paid., Subscriber: The person, usually the employee, who represents the family unit in
relation to the dental benefit program. This term is most commonly used by service
corporation plans., Surcharge: A stated dollar amount paid to the dentist by the
beneficiary, in addition to other reimbursement received by third-party payer(s)., T,
Table of Allowances: A list of covered services with an assigned dollar amount that
represents the total obligation of the plan with respect to payment for such services, but
does not necessarily represent the dentist's full fee for that service., Termination Date:
1) the date on which the dental benefit contract expires. , 2) The date and individual
cease to be eligible for benefits., Third Party: The party to a dental benefit contract
that may collect premiums, assume financial risk, pay claims, and/or provide other
administrative services, Third-Party Administrator (TPA): Claims payer who assumes
responsibility for administering health benefits plans without assuming any financial
risk. Some commercial insurance carriers and Blue Cross/ Blue Shield plans also have TPA
operations to accommodate self-funded employers seeking administrative services only (ASO)
contracts., Third-Party Payer: An organization other than the patient (first party) or
health care provider (second party) involved in the financing of personal health
services., U, Usual, Customary and Reasonable (UCR) Plan: A dental benefit plan that
determines benefits based on "Usual, Customary, and Reasonable: fee criteria., Usual
Fee: The fee that an individual dentist most frequently charges for a given dental
service., Utilization: 1) The extent to which the members of a covered group use a program
over a stated period of time; specifically measured as a percentage determined by dividing
the number of covered individuals who submitted one or more claims by the total number of
covered individuals. 2) An expression of the number and types of services used by the
members of a covered group over a specified period of time., W, Waiting Period: The period
between employment or enrollment in a dental program and the date when a covered person
becomes eligible for benefits., Uni-Care Inc The Cure for Health Care., Dentemax Your
Preferred Provider Dental Network., Dominion Dental Services Dental Benefit Plans for
Groups, Individuals, and Associations., Protective Doing the Right Thing is Smart
Business., Qualident A Quality Dental Network. Providing Savings to Groups and Individuals
Since 1994., Atlantic Dental Inc. The Healthiest Way to Save Money., Resource1 Dental
Implant Program., Liberty Dental Plan Dental Plan of California., National Discount
Services Premier Providers of Discount Health Services., First Dental Health Shop from
home and find great deals and products online., Scrip Solutions Change is Inevitable. ,
