Dental A - Z

AAP - American Academy of Periodontology. Dedicated to advancing the art and science of periodontics and improving the periodontal health of the public. Membership consists of specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth and in the placement and maintenance of dental implants.

AAPD - American Academy of Pediatric Dentistry. Dedicated to improving and maintaining the oral health of infants, children, adolescents, and persons with special healthcare needs.

ABCPD - Alliance for the Best Clinical Practices in Dentistry. An organization that encourages the development of evidence-based prevention and treatment protocols through the process of organizing focused seminars.

Abscess - Acute or chronic, localized inflammation associated with tissue destruction.

ADA - American Dental Association. Promotes the public's health through commitment of member dentists to provide high-quality oral healthcare and promotes accessible oral healthcare for everyone. The organization also enhances the integrity and ethics of the profession by strengthening the patient-dentist relationship and providing services through its initiatives in education, research, advocacy, and the development of standards.

AGD - Academy of General Dentistry. Serves the needs and represents the interests of general dentists. The Academy fosters their continued proficiency through quality continuing dental education in order to better serve the public.

Amalgam - An alloy used in direct dental restorations; a "silver filling."

Attrition - The normal wearing down of the surface of a tooth from chewing.

Baby bottle tooth decay - Severe decay in baby teeth due to sleeping with a bottle of milk or juice. The drink's natural sugars combine with bacteria in the mouth to produce acid that decays teeth.

Beneficiary - See enrollee.

Bitewing Radiograph - X-rays of the top and bottom molars and pre-molars to show decay between teeth or under fillings.

Bruxism - Involuntary clenching or grinding of the teeth.

Calculus - Tartar, a hard deposit of mineralized material, or calcified plaque, that adheres to teeth.

Caries - Tooth decay.

CMS - Centers for Medicare and Medicaid Services, formerly know as the Health Care Financing Administration (HCFA). A division of the Department of Health and Human Services (DHHS). The organization administers the Medicare, Medicaid, and Child Health Insurance Programs and helps pay the medical bills for more than 75 million beneficiaries. In conjunction with the Departments of Labor and Treasury, it helps millions of Americans and small companies obtain and keep health insurance coverage and helps eliminate discrimination based on health status for people buying health insurance.

Covered persons - See enrollee.

Covered services - Service for which payment is provided under the terms of the dental benefit contract.

Crown - The artificial covering of a tooth with metal, porcelain, or porcelain fused to metal; covers teeth that are weakened by decay or severely damaged or chipped.

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.

Deciduous Teeth - Baby teeth or primary teeth.

DeltaCare/DeltaCare USA Network - See Dental Health Maintenance Organization (DHMO).

DeltaCare/DeltaCare USA Product - See Dental Health Maintenance Organization (DHMO).

Delta Dental PPO Network - A group of contracted providers who agree to provide services at pre-negotiated, reduced fees.

Delta Dental PPO Product - A preferred provider option (PPO) plan that offers lower cost advantages with a choice in the selection of a provider.

Delta Dental Premier Network - A nationwide, discounted, fee-for-service group of providers that are contracted through a participating agreement that stipulates the reimbursement level and administrative policies.

Delta Dental Premier Product - A nationwide, discounted, fee-for-service dental program with out-of-network protection.

Dental Health Maintenance Organization (DHMO) - 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. See also DeltaCare/USA Network, DeltaCare/USA Provider.

DHHS/HHS - Department of Health and Human Services. Federal department that oversees the federally funded programs that provide services such as prenatal screening, immunization, child care, nutrition, exercise, long-term care regulation, and autopsies. It enables individuals, families, and communities to be healthy and secure, and to achieve social and economic well being.

DOL - Department of Labor. Federal department that oversees issues relating to workplace safety and health, pensions and benefit plans, employment, and other issues related to the American workplace.

DPO - A dental benefit plan in which participating dentists agree to accept a list of specific fees as the total fees for dental treatment provided. See also DeltaPreferred Option/USA Network, DeltaPreferred Option/USA Provider.

Eligible person - A person who is qualified to receive benefits under a dental benefit program.

Endentulous - Having no teeth.

Endodontics - A dental specialty concerned with treatment of the root and nerve of the tooth. An endodontist is a dental specialist in this field.

Enrollee - A person who receives benefits under a dental benefit contract. Also known as a beneficiary, covered person, insured, or member.

ERISA - Employee Retirement Income Security Act of 1974. Administered by the Pension and Welfare Benefits Administration (PWBA) of the Department of Labor, the Act established new standards and reporting/disclosure requirements for employer-funded pension and health benefit programs in order to address public concern that funds of private pension plans were being mismanaged and abused.

Fee-for-service - A method of paying practitioners on a service-by-service rather than a "salaried basis." See also DeltaPremier/USA Network, DeltaPremier/USA Provider.

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.

Halitosis - Bad breath

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 healthcare delivery that provides comprehensive care to enrollees through designated providers. Enrollees are generally assessed a monthly payment for healthcare services and may be required to remain in the program for a specified amount of time.

HIAA - Health Insurance Association of America. An advocate on behalf of the industry in the states and in the nation's capital. The organization tracks health-related regulatory activity in key federal agencies; participates in rulemaking; provides information on recently enacted legislation; provides guidance on implementation of federal health initiatives; and works closely with member companies to provide information and feedback to federal officials.

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.

HRSA - Health Resources Services Administration. A division of DHHS. The organization directs national health programs that improve the nation's health by assuring equitable access to comprehensive, quality healthcare for all.

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).

Indemnity schedule - See table of allowances.

Insured - See enrollee.

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 allowance - The maximum dollar amount a dental program will pay toward 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 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.

Member - See enrollee.

NADP - National Association of Dental Plans. A trade association that promotes and advances the HMO/PPO sector of the dental benefits industry to improve consumer access to affordable, quality dental care.

NAIC - National Association of Insurance Commissioners. Assists state insurance regulators, individually and collectively, in serving the public interest and achieving fundamental insurance regulatory goals.

National Provider File (NPF) - A data warehouse of dentists' filed fees used by local Delta Plans to facilitate the central claims administration for DeltaUSA accounts. Plans gather, submit, and maintain individual provider fees to the NPF along with plan fee tables for DeltaPremier and DeltaPreferred Option.

Network - A collective expression for all dentists who have contractually agreed to provide treatment according to administrative guidelines for a certain program.

NIDCR - National Institute of Dental and Craniofacial Research. Promotes the general health of the American people by improving their oral, dental, and craniofacial health. Through research and the development of researchers, the NIDCR aims to promote health, to prevent diseases and conditions, and to develop new diagnostics and therapeutics.

NIH - National Institutes of Health. Part of the U.S. Department of Health and Human Services. The organization conducts research; supports the research of non-federal scientists in universities, medical schools, hospitals, and research institutions. It also helps in the training of research investigators and fosters communication of medical information.

Non-participating 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.

PANDA - Prevent Abuse and Neglect through Dental Awareness. Educational program sponsored by a number of Delta Dental plans across the country that seeks to educate oral health professionals about child abuse and to help them learn how to diagnose and report potential abuse situations to appropriate authorities.

Participating dentist - A dentist who has entered into a DeltaPremier Participating Dentist Agreement or DeltaPreferred Option Agreement with a participating plan or DeltaUSA and provides dental care services to members; designated by a participating plan as a participating dentist.

Panoramic radiograph - A single large x-ray of the jaws taken by a machine that rotates around the head.

Pediatric Dentistry - A dental specialty concerned with treatment of children. A pediatric dentist is a dental specialist in this field, also known as a pedodontist.

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.

Plaque - A bacteria-containing substance that collects on the surface of teeth. Plaque can cause decay and gum irritation when it is not removed by daily brushing and flossing.

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 lower table of allowances with significantly reduced benefits than if the patient had selected an in-network provider.

Prevailing fee - The fee most commonly charged for a dental service in a given area.

Primary Subscriber - See subscriber.

Prophylaxis - 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 Plan - A dental benefit plan that determines benefits based only on reasonable and customary fee criteria. See also 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. See also customary fee.

Scaling - Removal of plaque, calculus, and stain from teeth.

Schedule of allowances - See table of allowances.

SCHIP - State Children's Health Insurance Program. Created from The Balanced Budget Act of 1997, this program expands healthcare coverage for children who are not covered by Medicaid.

Sealant - A thin plastic material used to cover the biting surface of a child's tooth to prevent tooth decay.

Subscriber - The person, usually the employee, who represents the family unit in relation to the dental benefit program. Also known as primary subscriber, enrollee, insured, covered person, or beneficiary.

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. Also known as schedule of allowances or indemnity schedule.

UCR (Usual, Customary and Reasonable) Plan - A dental benefit plan that determines benefits based on "Usual, Customary, and Reasonable" fee criteria. See usual fee, reasonable fee.

Usual fee - The fee that an individual dentist most frequently charges for a given dental service. See customary fee, reasonable fee.