The following alphabetical list of dental and benefits terms were provided with the permission of Trojan Professional Services, Inc. of Southern California. We thank them for their contribution.
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.
ANNIVERSARY YEAR Begins on the day of the month that the patients' insurance became effective.
ANTERIOR TEETH The front teeth (incisors and cupids).
ARCH The upper or lower jaw.
ASSIGNMENT OF BENEFITS A clause in the policy that allows the insured person to direct the payment by the carrier to the dentist. The insured person does this by signing the assignment box on the claim form, or by signing a signature on file form.
BACK TEETH See Posterior Teeth
BASIC Trojan classifies the silver fillings, composite fillings, perio, endo and oral surgery as basic procedures.
BENEFIT LESS BENEFIT See Limited C.O.B..
BENEFIT YEAR Usually begins on the month of the year that the employer purchased the plan.
BICUSPIDS 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).
BIRTHDAY RULE When a child is covered under both parent's plans, the plan of the parent who's birthday (month and day, not year) falls earlier in the calendar year is billed first. (In cases of divorced or separated parents there are other factors that must be considered.)
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.
CALENDAR YEAR January 1st to December 31st.
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.
CAPITATION PLAN A plan where the dentist is contracted with the administrator to provide dental services to persons covered under the program in return for payment on a per-capita basis (per head). Trojan classifies these plans as Managed Care.
CARIES Correct technical term for decay.
CARRIER The party (usually an insurance company) that pays the claims and collects the premiums.
CARRYOVER If the deductible was paid last year (usually the last quarter, Oct., Nov. or Dec.) the next year (or quarter, Jan., Feb. and March) they do not have to pay the deductible again.
CARVE OUT PLAN See Limited C.O.B..
CLEANING See prophylaxis.
CLOSED PANEL A plan where the covered patient only receives benefits if the services are provided by a dentist who is contracted with the administrator. Trojan classifies these plans as Managed Care.
C.O.B. See Coordination Of Benefits.
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.
COORDINATION OF BENEFITS (C.O.B.) This becomes involved when the patient is covered by more than one plan. The first issue to consider is which carrier should be billed first (see birthday rule and gender rule). The second issue is how the second carrier will pay the claim (see Standard C.O.B. and Limited C.O.B.).
CROWN Full coverage for a tooth. sed when the tooth cannot be restored by a filling.
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.
DECIDUOUS TEETH See Primary Teeth.
DEDUCTIBLE The amount paid by the patient before the carrier starts to pay benefits.
DENTAL MAINTENANCE ORGANIZATION (D.M.O.) A legal entity that accepts the responsibility of providing services at a fixed price. The enrollees in these plans must have dental care provided through designated doctors. Trojan classifies these plans as Managed Care.
DENTURE A removable appliance (prosthesis) that replaces all of the teeth in either the upper or lower jaw.
DEPENDENT Usually the spouse and children of the subscriber.
DIAGNOSTIC 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-ray which Trojan classifies as preventive.
D.M.O. See Dental Maintenance Organization.
EDENTULOUS All the teeth are missing in either the upper or lower arch.
ELIGIBILITY Determining if the patient is eligible for benefits. This should be done before the treatment begins.
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.
EXCLUSION Services not covered by a dental policy.
FEE SCHEDULE A set amount paid by the insurance company regardless of the doctor's fee.
FLUORIDE 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.