Dental benefits terms
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There are many special words and phrases to describe parts of the mouth, problems and procedures, and just as many special terms in dental benefit plans. Use this guide to learn some of the most common terms.
Dental benefits terms
Use this guide to understand the terms you may find in your dental plan and make the most of your benefits.
Annual Maximum Benefit: The total dollar amount Delta Dental will pay for covered dental care for a member during a coverage year.
Assignment of Benefits: When a member authorizes Delta Dental to send payment for a covered procedure directly to the member’s dentist.
Balance Billing: The practice of billing a patient for the difference between what the dentist charges and the agreed-upon charge established by Delta Dental. Participating dentists cannot balance-bill patients. Balance billing does not include co-insurance or deductibles.
Benefit Year: See 'Coverage Year'
Claim/Claims Form: Information a dentist submits to Delta Dental to get paid for services performed for a member.
Coinsurance: A fixed percentage of a dental treatment that you share with your dental plan. For example, Delta Dental may pay 80% of a given service, while you are responsible for 20%. Coinsurance applies after you meet your deductible.
Contracted Fee: The fee for each single procedure that a dentist has agreed to accept as payment in full for covered services provided to a member.
Coordination of Benefits (COB): When a member has more than one dental plan, this is the process the plans use to determine the amount each plan will pay.
Copayment: A set dollar amount a member is required to pay to the dentist for a service.
Coverage Year: The 12-month period a member's dental plan covers, during which deductibles, annual maximums and other provisions apply. The benefit year may not always be a calendar year.
Covered Service: A dental treatment for which payment is provided under the terms of a member’s dental plan.
Deductible: A dollar amount that each member must pay toward covered services before Delta Dental’s benefits are paid. A family deductible is reached from deductible amounts paid on behalf of any combination of covered family members.
Dependents: Anyone other than the primary subscriber that is covered by Delta Dental, for example, a child or spouse.
Dual Coverage: When a member has coverage under two different dental plans. See also ‘Coordination of Benefits’
Effective Date: The date the coverage under a dental plan begins.
Enrollee: See ‘Member’
Exclusions: Dental services that are not covered by a dental plan.
Explanation of Benefits (EOB): A document Delta Dental provides after a procedure. It contains a summary of the treatment the member received, including the treatment cost, the portion covered by your dental plan, and the portion you may owe. An EOB is not a bill.
Group: A company or organization that provides dental benefits to its employees. The group works with Delta Dental to select the plan type, maximums, benefit levels, and member eligibility.
Fee Schedule: A list of charges for specific dental treatments used to reimburse dentists.
HIPAA: the “Health Insurance Portability and Accountability Act of 1996,” a Federal law intended to improve access to health coverage, limit fraud and abuse, protect personal health information, and control administrative costs.
In-Network Dentist: A dentist who has agreed to be a part of Delta Dental’s network. In-network dentists agree to accept pre-established fees for services.
Limitations: Services that are limited or excluded from a dental benefit plan. A member is typically responsible for charges associated with plan limitations. These services are often referred to as optional services.
Lifetime Maximum: The maximum amount a plan will pay over the course of a lifetime. It may apply to an individual or a family and typically applies to specific treatments such as orthodontic treatment.
Maximum Plan Allowance (MPA): the amount that Delta Dental of South Dakota will pay for a service, supply, or dental procedure. The maximum plan allowance is developed from various sources, such as agreements with dentists, input from dental consultants, the simplicity or complexity of the procedure, and the charges for procedures by dentists in South Dakota. For services billed by dentists outside of South Dakota, the maximum plan allowance is based on information from the Delta Dental of that state.
Member: A person covered under a dental plan.
Network: Consists of participating dentists who have signed up with Delta Dental to provide dental treatment at agreed-upon fees.
Non-Participating Dentist: See Out-of-Network Dentist
Open Enrollment: The period of the year during which employees or qualified individuals can enroll in or make changes to their benefits plan.
Out-of-Network Dentist: A dentist who has not signed up to participate in a Delta Dental network.
Participating Dentist: See In-Network Dentist.
Plan Year: See 'Coverage Year'
Protected Health Information (PHI): Personal information about a patient, such as Social Security number and medical/dental history, which is required to be stored securely by health care entities such as a doctor, dentist, health clinic or health insurer.
Premium: The amount the member pays for dental benefits, generally paid monthly, quarterly, or annually.
Predetermination of Benefits: See Pre-Treatment Estimate
Pre-Treatment Estimate: A treatment plan usually submitted by a dentist for Delta Dental to review and provide an estimate of benefits before treatment starts. This can help a member budget for dental procedures and decide how to proceed with treatment.
Provider: Dental professionals who provide dental treatment services.
Summary of Benefits: A summary of the benefits and limitations for dental services provided under the terms of the dental plan.
Termination Date: The date a member’s dental coverage ends or when a member is no longer eligible for benefits. Also “Term” or “Termed” for short.
Waiting Period: A period of time before a member is eligible to receive benefits for all or certain treatments.
Use this guide to understand the different types of dental health professionals that provide you care.
CDA: Certified Dental Assistant
Dental Assistant: A dental professional who supports dentists and dental hygienists in providing dental care to patients.
Dental Hygienist: A dental professional who performs diagnostic, preventive and therapeutic care under the supervision of a dentist.
Dental Specialist: A dentist who has received postgraduate trainings in one of the recognized dental specialties: endodontics, orthodontics, oral surgery, pediatric dentistry, periodontics, and prosthodontics.
DDS: Doctor of Dental Surgery.
DMD: Doctor of Dental Medicine.
Endodontist: A dental specialist who treats diseases of the pulp and nerve of the tooth.
General Dentist: A primary dental care provider that performs preventive care as well as restorative procedures such as fillings, crowns, implants, and more.
Oral and Maxillofacial Surgeon: A dental specialist who is most commonly known to remove teeth but also treats diseases, injuries, defects, and deformities of the oral and maxillofacial regions.
Orthodontist: A dental specialist who straightens of moves misaligned teeth and/or jaw.
Pediatric Dentist: A dentist who specializes in the diagnosis, treatment, and management of the oral health needs of children.
Periodontist: A dentist who specializes in diagnosing, managing, and treating the tissue, gums, and bone that support the teeth.
RDA: Registered Dental Assistant
RDH: Registered Dental Hygienist
Procedure and treatment terms
Use this guide to understand common dental procedures and treatments.
Abutment: A natural tooth or implanted tooth substitute used to support a removable partial denture or bridge work.
Acid Etching: A process that prepares tooth surface for bonding to fillings or sealants by toughening enamel with a weak acid solution.
Alveoloplasty: A surgical procedure that reshapes the jawbone.
Anesthesia: Medication administered to an individual prior to a procedure with the purpose of dulling pain or sedating the individual. Dentists most commonly use local anesthesia to numb the area where pain is likely to occur without changing the awareness of the individual undergoing the procedure.
Apicoectomy: A minor surgical procedure that removes the apex, or top, of the root of a tooth.
Band: A metal ring cemented around a tooth as part of orthodontic treatment. Bands can hold various attachments used to assist with tooth movement and alignment.
Biopsy: The process of removing tissue for histologic evaluation, an important tool in the accurate diagnosis of cancer and other diseases.
Bleaching: A cosmetic procedure that whitens teeth with a bleaching solution.
Bonding: A procedure in which a tooth-colored plastic material is applied with a special light, and ultimately “bonds” the material to the tooth to improve a person’s smile.
Bridge: An appliance that replaces missing teeth by securely attaching an artificial tooth to the natural teeth. This is also known as a fixed partial denture.
Composite: A filling material used to repair teeth. The most common type of filling.
Crown: A cover that is put over a tooth to help restore the tooth's normal shape, size, and function. These are typically applied when individuals have a cavity too large for filling, a cracked or weakened tooth, or want to conceal a discolored or poorly shaped tooth.
Crown Lengthening: A surgical procedure that recontours gum tissue, and sometimes bone, to expose more of the tooth for a crown.
Dental Prophylaxis: A scaling and polishing procedure used to remove plaque and stains. Also commonly called a routine cleaning.
Dental Prosthesis: An artificial device that replaces missing teeth.
Full Mouth Debridement: the preliminary removal of plaque and calculus that interferes with the ability of the dentist to perform a comprehensive oral evaluation.
Excision: The surgical removal of bone or tissue.
Extraction: The act of removing a tooth or portions of a tooth.
Fluoride Varnish: A liquid containing fluoride that is painted onto the teeth and hardens. It is used to prevent or reduce the risk of cavities.
Full-Mouth X-Ray: The combination of 14 or more periapical and bitewing films of the back teeth that reveals all of the teeth including the crowns, roots, and alveolar bone.
Gingivectomy: A surgical procedure for removing gingiva (gum tissue) in order to restore gum health.
Gingivoplasty: A surgical procedure for reshaping gingiva (gum tissue).
Graft: A piece of tissue or alloplastic material placed in contact with tissue in order to repair a deficiency.
Immediate Denture: A prosthesis constructed and placed immediately after the removal of natural teeth.
Implant: A device placed within or on the bone of the jaw or skull to support either a crown, bridge, denture, facial prosthesis, or to act as an orthodontic anchor.
Mouthguard: A removable plastic device worn over teeth and gums to protect from damage during sports.
Nightguard: A removable device worn over teeth at night to protect from damage due to clenching or bruxism.
Operculectomy: A procedure that removes the flap of tissue over an unerupted or partially erupted tooth.
Overdenture: A removable prosthetic device that covers and rests on one or more natural teeth, the roots of natural teeth, and/or dental implants.
Partial Denture: A prosthetic device used to replace missing teeth.
Periodontal Maintenance: Therapeutic removal of bacterial plaque and calculus used to treat periodontal diseased tissue after scaling and root planing treatment.
Preventative Dentistry: Procedures and services administered to prevent oral diseases.
Prophylaxis (cleaning): A routine dental cleaning that consists of the removal of plaque, stains, and calculus by scaling and polishing.
Pulpectomy: A procedure that removes diseased pulp tissue.
Radiograph: An image produced by projecting radiation. Also called an X-ray.
Reline: A procedure used to resurface the side of a denture that is not in contact with the soft tissue of the mouth to ensure a secure fit.
Removable Partial Denture (Removable Bridge): A prosthetic replacement used to replace missing teeth. This device can be removed by the individual.
Retainer: A removable device worn in the mouth to prevent teeth from shifting. These devices can be fixed or removable.
Root Planing: A procedure performed on tooth roots to remove dentin, bacteria, calculus, and diseased surfaces.
Scaling: The removal of plaque, calculus, and staining from teeth.
Sealants: Thin coating placed on the biting surfaces of molars to prevent bacteria from attacking the enamel.
Suture: A stitch used to repair an incision or wound.
Temporary Removable Denture: An interim prosthesis designed to be used for a limited period of time.
Veneer: Thin coverings placed over the front part of teeth made to look like natural teeth.
Dental condition terms
Use this guide to help you understand common diagnosed dental conditions and discuss them with your dental care team.
Abfraction: The loss of tooth structure due to clenching or grinding that occurs at the gum line.
Abscess: Localized buildup of pus in an area of infection, usually around the tooth or in the gums that can ultimately destroy oral tissue.
Abrasion: Tooth wear caused by forces other than chewing such as improper brushing or holding objects between the teeth.
Avulsion: When a tooth is knocked out of its socket due to trauma.
Bone Loss: A decrease in the amount of bone that supports a tooth or implant.
Bruxism: An unconscious habit of grinding or clenching the teeth.
Calculus: A hard deposit of mineralized material sticking to the crowns and/or roots of teeth. This substance cannot be brushed off and is removed during a professional cleaning.
Caries: Tooth decay. Tooth surfaces are slowly destroyed by acid-producing bacteria.
Cavity: An area of the tooth that is damaged by caries, abrasion, or erosion.
Cleft Palate: A birth defect that occurs when the tissues that make up the roof of the mouth do not join together completely.
Decay: The decomposition of the tooth structure.
Dry Mouth: A condition caused by lack of saliva and moisture in the mouth. If untreated, it can lead to increased levels of tooth decay and infections.
Dry Socket: Severe pain inside and around the tooth socket which can occur one to three days after a tooth extraction. This issue usually requires post-operative care.
Erosion: The wearing down of tooth structure, caused by chemicals and acid.
Fracture: The breaking of a tooth.
Gingivitis: Inflammation of gingival tissue.
Impacted Tooth: A partially erupted tooth positioned against another tooth, bone, or soft tissue, making complete eruption unlikely.
Lesion: An area of diseased tissue.
Malocclusion: Improper alignment of the upper and lower teeth.
Peri-implantitis: An infection that develops around an implant which can lead to bone loss.
Periodontal Abscess: An infection of the gum pocket that can destroy soft and hard tissues.
Periodontitis: The inflammation and loss of the connective tissue of the supporting structure of teeth.
Plaque: A soft and sticky substance that builds up on teeth due to bacteria buildup.
Pulpitis: Inflammation of the dental pulp.
Recession: When the gums pull away from the teeth, often exposing the root.