Individual Dental Plans in California
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Dental Insurance terminology sometimes sounds like a foreign language. The following glossary will help you better understand your oral health and dental insurance coverage.
Dental Insurance Glossary
Abutments: Attachments on the ends of a bridge, which are cemented to the natural teeth; a tooth used for support or anchorage of a fixed or removable prosthesis.
Amalgam: Metallic filling made by combining an alloy of silver, zinc, lead and tin with mercury. It is silver in color.
Accumulation period: Length of time an individual has to incur covered expenses to satisfy a required deductible and/or calendar year or plan year maximum.
Alveolectomy: Removal of excessive bone and soft tissues, usually done to enhance the fit or appearance of an artificial denture.
Annual maximum benefit: Maximum dollar amount paid by the dental plan in a calendar year or plan year.
Anterior teeth: The front teeth: six upper and six lower.
Apicoectomy: Cutting off the root end of a tooth.
Arch: Arrangement of the teeth in a bow shape or arc.
Basic services: Dental procedures to repair and restore individual teeth due to decay, trauma, impaired function, attrition, abrasion or erosion. Basic services may include oral surgery, endodontics (root canals), fillings and periodontics (tissue/bone treatment).
Benefit accumulations: Amount that has been paid for a covered person during the calendar year or plan year.
Benefit plan document: Generic term for a legal document detailing a member's or group's coverage. This document usually is referred to as a Certificate of Coverage, Certificate of Insurance or Summary Plan Description.
Bicuspid: Permanent teeth between the cuspids (canines) and first molars. They have two cusps (points) and are used for crushing and tearing food.
Billing provider: Any eligible person, physician, doctor's office, hospital, dentist or facility licensed to perform services for our members.
Bitewing X-ray: X-ray that reveals the crown and the adjacent tissue of the upper and lower jaws on the same film. It is used to detect decayed areas between teeth.
Bleaching: Technique used to restore a discolored tooth to its natural color.
Braces: Metallic bands and appliances used to move teeth for correction of the bite and tooth position.
Bridge: Appliance to replace a missing tooth or teeth, attached to and supported by abutment teeth.
Bruxism: Grinding of teeth during sleep. This occurs in children and adults, and causes abrasion of the tooth enamel.
Buccal surface: Surface of the back teeth next to the cheek.
Canine: Pointed tooth used to tear food: two upper and two lower. Also known as cuspids or eyeteeth.
Capitation: Method of payment for health services in which a dentist or specialist is paid a fixed amount for each person served regardless of the number or nature of services provided to each person, usually associated with a prepaid/HMO.
Caries: Decaying of teeth. Also known as cavities.
Cavities: Decaying of teeth. Also known as caries.
Certificate of Coverage: Legal document detailing a member or group's coverage. Description.
Certificate of Insurance: Legal document detailing a member or group's coverage.
Cleft lip: Congenital facial deformity characterized by non-fusion or malfusion of the development processes that form the lips.
COBRA: Consolidated Omnibus Budget Reconciliation Act; federal legislation regarding the continuation of health benefits for all types of employee benefit plans provided by the employer.
Completed: Indicates HumanaDental has received an estimate or claim, and released an explanation of benefits or explanation of remittance.
Composite: White plastic filling material of resin and quartz crystals.
Condyle: Joint of the jaw.
Continuation: State or federal (COBRA) option for a member who no longer qualifies as an active employee but can extend his or her insurance coverage for a specific amount of time. The member is responsible for any premium. This generally applies to medical coverage only, but can include dental depending on legislation and group size. Coverage and premium are the same as the group's.
Contract types: Type of contract or plan?such as Traditional, PPO or Prepaid/DHMO?selected.
Coordination of benefits: Provision in a contract that applies when a person is covered by more than one group dental program. It requires that all programs coordinate payment of benefits to eliminate over insurance or duplication of benefits.
Copay: Cost-sharing arrangement in which a member pays a specified charge at the time for service; for example, $15 for an office visit.
Crown: Part of the tooth above the gum line. A crown also refers to a metal, plastic or porcelain cap that covers the tooth above the gum line.
Cuspid: Pointed tooth used to tear food: two upper and two lower. Also known as canines or eyeteeth.
Dentin: Tissue that forms the main body of the tooth.
Dentures: Any dental appliance to replace missing natural teeth and the surrounding tissues.
Diastema: Space between two adjacent teeth in the same jaw.
Distal: Surface of a tooth farthest from the center line of the face.
DOB: Date of birth.
Document number: Nine-digit number assigned by our computer system to each document received.
Eligibility: Requirements that must be satisfied by people who wish to be insured to establish eligibility.
Enamel: Hard surface covering the dentin portion of the crown of the tooth.
End date: Date on which the member's coverage ends.
Endodontics (root canals): Dental specialty concerned with the treatment of diseases of the dental pulp (nerves, blood vessels, etc., within the tooth).
Erosion: Defect in the surface of a tooth, which cannot be accounted for by abrasion, in which the enamel is worn and smooth. This usually results from chemical action in the mouth.
Erupt, Eruption: When a new tooth comes in, it erupts when it breaks the surface of the gums, and you can see it.
Estimate: Details on how benefits would be covered by a member's plan when a dentist submits an estimate of services.
Explanation of benefits (EOB): The EOB is not a bill. It details how the claim was processed and indicates the portion of the claim paid to the dentist and the portion of the claim you need to pay (if applicable).
Extraction: Separation and surgical removal of a tooth from its surrounding tissues.
Eyeteeth: Pointed tooth used to tear food: two upper and two lower. Also known as cuspids or canine.
Filling: Material used to fill a cavity in a tooth. The substance may be gold, silver amalgam, copper amalgam, acrylic resins, porcelain or cement.
Fluoride: Chemical solution or gel hat you place on your teeth to help prevent decay.
Frenum: Piece of pink-colored skin that attaches your lips, cheeks and tongue to your mouth.
Frenectomy: Surgical cutting of the frenum.
Gingiva: Gum tissue surrounding the teeth and covering the bone of the upper and lower jaws.
Gingivectomy: Cutting away of loose infected and diseased gum tissue.
Gingivitis: Inflammation of the gum tissue.
Group ID: Number assigned to each case or group when we receive the application. It identifies the group in our computer system and remains with the account permanently.
Hemisection: Surgical division of a tooth to allow salvage of one part of the tooth, which is relatively free of disease.
Hygienist: A trained, licensed person who performs dental prophylaxis under the direction of a licensed dentist.
Implant: Device of metal or other foreign material that is surgically placed into or on the upper or lower bone, to support a crown, bridge, or partial or full denture.
Impacted tooth: Tooth that has not erupted and is embedded in the jaw.
Incisal: The cutting edge of the front teeth.
Incisor: A cutting tooth in the front of the mouth: four on the upper jaw and four on the lower jaw.
Inlay: A porcelain or metal restoration to be inserted into a previously prepared cavity in a tooth and retained with cement.
Interproximal surface: Surface of a tooth that faces its adjoining tooth as they stand in the line in the dental arch.
Individual deductible: Amount of eligible expense a covered person must pay each year before the dental plan will pay for eligible benefits.
Jaw: The term to indicate either the maxilla (upper) or mandible (lower).
Late applicant: Member and/or member's eligible dependent who enrolls or is enrolled for coverage more than 31 days after his/her eligibility date. Late applicants may be subject to a waiting period.
Lifetime orthodontic services: Maximum amount payable (for each covered person) for eligible charges related to treatment. No further benefits are payable after the maximum is reached.
Lingual surface: Surface of the tooth toward the tongue.
Malocclusion: Abnormal position of the teeth or jaws.
Mandible: Horseshoe-shaped bone that forms the lower jaw.
Maxilla: Bones that form the upper jaw.
Member ID: Unique identifying number for a member under the dental plan.
Mesial: Surface of the tooth toward the center of the mouth.
Molars: The last three teeth in the upper and lower left and right sides of the mouth in an adult. These 12 teeth are for grinding food. The baby set of teeth has eight molars.
Myofacial pain dysfunction (MPD): Hyperactivity of the jaw, usually affecting the facial muscles and chewing muscles.
Mbr Resp Amt: Member responsible amount.
Nonparticipating provider: Dentist who has not contracted with the carrier to be a participating dentist for a plan.
Nonprecious metals: Materials developed for all types of restorative procedures that are less costly than gold and other precious metals.
Occlusal guard (night guard): Removable appliance, usually constructed of plastic, that covers one or both dental arches; designed to minimize the damaging effects of teeth grinding.
Onlay: Restoration that is extended to cover the entire incisal or occlusal surface of the tooth; often used to restore lost tooth structure and increase the height of the tooth.
Oral surgery: Dental specialty concerned with the surgical procedures in and about the mouth and jaw.
Orthodontic services: Dental specialty concerned with the correction of improper alignment of the upper and lower teeth.
Osseous: Pertaining to bone.
Out-of-network: Dental services from a dentist who is not affiliated with or contracted with the dental network.
Overbite: Misalignment of the upper and lower teeth or jaws in which the upper teeth overlap the lower teeth when the mouth is closed.
Over denture: A complete denture that fits over one or more natural teeth.
Panorex: Out-of-mouth film that provides a continuous view of the teeth and associated structures. It is used for orthodontics and the detection of fractures, TMJ cysts and tumors.
Partial denture: Prosthesis replacing one or more, but less than all, of the natural teeth; may be removable or fixed.
Pedodontics: Dental specialty concerned with the prevention and treatment of dental disorders in children.
Pended: Indicates a predetermination or a claim that has been received but processing is not complete.
Periodontics: Dental specialty concerned with diseases of the gums and other supportive structures of the teeth.
Periodontal pocket: The deep crevice produced by detachment of a part of the soft tissue from the root of the tooth.
Permanent teeth: The "second" or adult teeth: 2 in number.
Pit: Small depression in the enamel of the tooth.
Plan certificate: The document that details your dental benefits.
Planing (root): Scaling of the root surface to smooth the surface.
Plaque: Sticky substance composed of secretions containing bacteria, dead tissue cells and debris. When this toxic substance accumulates on teeth, it is considered to be an initiating factor in gingival inflammation.
Pontic: Portion of a fixed bridge between the abutments. This serves as an artificial substitute for a missing tooth.
Porcelain: Restorative material of various types of fused (molten) glasses. Used to make teeth, facings, jackets and dentures.
Post and core: Single cast unit that provides strength and restores lost structure. It is placed into the tooth, followed by the permanent exterior restoration, usually a crown.
Posterior: The back teeth: molars and bicuspids.
Premolars: The bicuspid teeth immediately before the molars.
Preparation (prep) date: The date the tooth is prepared for an appliance, and an impression is taken of the tooth.
Preventive services: Dental procedures concerned with the prevention of dental diseases by protective and educational measures. May include examination, cleanings, X-rays and fluoride.
PCP name: Primary care physician name. In dental insurance for a DHMO, we use PCD, for primary care dentist.
Prophylaxis: Teeth cleaning.
Prorate: To divide, distribute or assess based on proportion.
Prosthodontic services: Dental specialty concerned with the restoration of missing teeth by artificial means.
Proximal: Surface nearest the adjacent tooth.
Pulp: Soft inner structure of a tooth consisting of blood vessels and nerves.
Pulpectomy: Removal of either vital or inflamed pulp from the chamber and root canals.
Recession: Gradual drawing away of tissue from its normal position; for example, the recession of the gum away from the tooth.
Reference number: N ine-digit number assigned by our computer system that serves as a confirmation number of receiving the document.
Resin: Organic materials, usually named according to chemical composition, physical structure or means of curing, frequently referred to as "plastic.”
Retainer: Appliance to prevent collapse of the dental arch.
Root canal therapy (endodontic therapy): Treatment of a tooth having damaged pulp, usually performed by removing the pulp chamber and root canals, and filling these spaces with inert sealing material.
Root planing: Smoothing of roughened root surfaces with scalers and dental instruments.
Sealant: Material applied to the chewing surface of a tooth to prevent decay.
Seat date: Date the appliance is cemented/put in place. For orthodontics, it is the date the bands are placed on the teeth.
Semiprecious metals: Materials developed for dental restorations that have a lesser amount of precious metals.
Silicate: Synthetic fillings other than silver, gold or ordinary cement to set crowns, bridges, etc.
Sockets: C one-shaped cavities in the upper and lower arch, in which the teeth are embedded.
Splint: Appliance to prevent motion of teeth.
Status: Informs the member if the policy is active, termed or COBRA.
Stayplate (flipper): An acrylic partial, with or without wire clasps, that replaces one or more teeth; usually temporary.
Stomatitis: Inflammation of the tissues of the mouth.
Study models: Plaster models of the teeth made from an impression showing all the teeth in the upper and lower jaws, and the relationship between the teeth.
Subscriber number: Unique identifying number for a dental insurance plan member.
Summary Plan Description: A legal document detailing a member's or group's coverage.
Surgical extraction: Removal of a tooth by surgical methods.
Temporomandibular joint (TMJ): Joint between the skull and the mandible.
TMJ syndrome: Symptoms associated with malfunction of the temporomandibular joint.
Torus: A projection or overgrowth of bone.
Unilateral: Involves only one side.
Usual and customary: Establishing a maximum amount to pay for a specific procedure.
Vitality test: Test using thermal, electrical or mechanical stimuli to determine the vitality of the dental pulp.
Voluntary plans: A comprehensive dental insurance plan that employers can offer at no cost to their business. Employees like the simplicity and convenience of having their dental premiums deducted directly from their paychecks.
Waiting period days remaining: Time remaining before the waiting period expires.
Bitewing: Both upper and lower teeth are shown on one intraoral film.
Extraoral: Film is held outside the mouth and records larger areas.
Full mouth: Usually consists of 14 periapical films plus bitewings.
Occlusal: An intraoral film showing the lingual surfaces of the teeth and a portion of the hard palate.
Panorex: An external film that provides a continuous view of the teeth and associated structures.
Periapical: An intraoral film showing the entire tooth.
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