Amalgam - an alloy used in direct dental restorations; a "silver filling."
Bitewing Radiograph - x-rays of the top and bottom molars and pre-molars to show decay between teeth or under fillings.
Covered services - service for which payment is provided under the terms of the dental benefit contract.
Customary fee - the fee level determined by the administrator of a dental benefit plan from actual submitted fees for a specific dental procedure to establish the maximum benefit payable under a given plan for that specific procedure.
Dental Health Maintenance Organization (DMO) - a benefit program in which enrollees receive all or most treatment through the dental office where they are enrolled. The dentist receives a single monthly payment from the benefits carrier for each enrolled patient, no matter how many services that patient receives.
Endodontics - a dental specialty concerned with treatment of the root and nerve of the tooth. An endodontist is a dental specialist in this field.
Fee-for-service - a method of paying practitioners on a service-by-service rather than a "salaried basis".
Fee schedule - a list of the charges established or agreed to by a dentist for specific dental services.
Fluoride - a chemical compound that prevents cavities; makes the tooth surface stronger so that teeth can resist decay.
Gingivitis - an inflammation of the gums surrounding the teeth caused by a buildup of plaque or food particles.
Gum disease - see periodontitis.
HIPAA - Health Insurance Portability and Accountability Act of 1996 - the law's primary intent is to provide better access to health insurance, limit fraud and abuse, and reduce administrative costs through simplification.
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 (e.g., schedule of allowances, table of allowances, or reasonable and customary plans).
Malocclusion - improper alignment of biting or chewing surfaces of the upper and lower teeth.
Maximum allowable charge - see maximum benefit.
Maximum allowable reimbursement - see maximum fee schedule.
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 time period (also known as: maximum allowable charge).
Maximum fee schedule - a compensation agreement in which a participating dentist agrees to accept a prescribed sum as the total fee for one or more covered services (also known as: maximum allowable reimbursement).
Network - a collective expression for all dentists who have contractually agreed to provide treatment according to administrative guidelines for a certain program.
Non-participating (non-par) dentist - any dentist who does not have a contractual agreement with Delta Dental to render dental care to members of a dental benefit program.
Orthodontics - a dental specialty concerned with straightening or moving misaligned teeth and/or jaws with braces and/or surgery. An orthodontist is a dental specialist in this field.
Participating (par) dentist- a dentist who has entered into a Participating Dentist Agreement or Agreement with a participating Plan and provides dental care services to members; designated by a participating Plan as a participating dentist.
Periodontics - a dental specialty concerned with treatment of gums, tissue and bone that supports the teeth. A periodontist is a dental specialist in this field.
Periodontitis - inflammation and loss of connective tissue of the supporting or surrounding structure of the teeth (also known as: gum disease).
Point-of-service(POS) - 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 lower table of allowances with significantly reduced benefits than if the patient had selected an "in-network" provider.
Prophylaxis - (prophy) a professional cleaning to remove plaque, calculus (mineralized plaque) and stains to help prevent dental disease.
Prosthodontics - a dental specialty concerned with restoration and/or replacement of missing teeth with artificial materials. A prosthodontist is a dental specialist in this field.
Provider - a unique individual dentist (preferred providers, general dentists, specialty providers, practicing providers).
Radiograph - x-ray.
Reasonable and Customary (R & C) Plan - a dental benefit plan that determines benefits based only on "Reasonable and Customary" fee criteria (also see Customary fee, Reasonable fee).
Reasonable fee - 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. Therefore, it may differ from the dentist's "usual" fee or the benefit administrator's "customary" fee (also see customary fee).
Scaling - removal of plaque, calculus, and stain from teeth.
Sealant - a thin plastic material used to cover the biting surface of a child's tooth to prevent tooth decay.
UCR (Usual, Customary and Reasonable) Plan - A dental benefit plan that determines benefits based on "Usual, Customary, and Reasonable" fee criteria (see Usual fee, Customary fee and Reasonable fee).
Usual fee - The fee that an individual dentist most frequently charges for a given dental service (see Customary fee and Reasonable fee).