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• Abrasion: The wearing away of enamel on teeth. This may be caused by normal grinding, the friction of clasps, or incorrect brushing of teeth.

• Abutments: The 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: A metallic filling made by combining an alloy of silver, zinc, lead, and tin with mercury. It is silver in color.

• Accumulation period: The length of time an individual has to incur covered expenses which satisfy a required deductible and/or calendar year or plan year maximum.

• Alveolar bone
  The part of the jaw that surround the roots of the teeth.

• Alveolectomy: The removal of excessive bone and soft tissues, usually done to enhance the fit or appearance of an artificial denture.

• Amalgam
  An alloy used in direct dental restorations.

• Analgesia
  Loss of pain sensations without loss of consciousness.

• Anesthesia

  General Anesthesia: A controlled state of unconsciousness, accompanied by a partial or complete loss of protective reflexes, including loss of ability to independently maintain airway and respond purposefully to physical stimulation or verbal command, produced by a pharmacologic or non-pharmacologic method or combination thereof;

  Intravenous Sedation/Analgesia: A medically controlled state of depressed consciousness while maintaining the patient’s airway, protective reflexes and the ability to respond to stimulation or verbal commands. It includes intravenous administration of sedative and/or analgesic agent(s) and appropriate monitoring.

  Local Anesthesia: The loss of pain sensation over a specific area of the anatomy without loss of consciousness.

  Non-Intravenous Conscious Sedation: A medically controlled state of depressed consciousness while maintaining the patient’s airway, protective reflexes and the ability to respond to stimulation or verbal commands. It includes administration of sedative and/or analgesic agent(s) by a route other than IV; (PO, PR, Intranasal, IM) and appropriate monitoring

• Ankylosis
  A condition where two hard tissues are fused together. When this happens to a tooth and the alveolar bone, the tooth partially erupts.

• Annual maximum benefit: The maximum dollar amount paid by the dental plan in a calendar year or plan year.

• Anterior teeth: The front teeth. They include six upper front teeth and six lower front teeth.

• Apicoectomy: Cutting off the root end of a tooth.

• Arch: The arrangement of the teeth in a bow shape or arc.

• Baby teeth: The primary or deciduous teeth of young children. There are 20; 10 uppers and 10 lowers.

• Basic services: Dental procedures concerned with the repair or restoration of 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: The amount of dollars that have been paid for a covered person during the calendar year or plan year.

• Benefit plan document: The term HumanaDental may use to refer to a legal document detailing a member or group’s coverage. This document is sometimes referred to as a certificate of coverage, certificate of insurance, evidence of coverage, or summary plan description.

• Bicuspid: The permanent teeth between the cuspids (canines) and the 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: This X-ray 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 the teeth.

• Bleaching: A 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: An appliance used to replace a missing tooth or teeth and is attached to and supported by abutment teeth.

• Bruxism: The grinding of teeth during sleep. This occurs in children and adults and causes abrasion of the tooth enamel.

• Buccal surface: The surface of the back teeth next to the cheek.

• Canal: The canal is the space within the root of the tooth that contains the pulp tissue.

• Canine: Pointed tooth used to tear food. There are two upper and two lower canines. Also known as cuspids or eyeteeth.

• Capitation: A method of payment for health services in which a dentist or specialist is paid a fixed amount for each person served regardless of the actual number or nature of services provided to each person, usually associated with a prepaid/HMO.

• Caries: The decaying of teeth. Also known as cavities.

• Cavities: The decaying of teeth. Also known as caries.

• Certificate of coverage: The term HumanaDental may use to refer to a legal document detailing a member or group’s coverage. This document is sometimes referred to as a certificate of coverage, certificate of insurance, evidence of coverage, or summary plan description.

• Certificate of insurance: The term HumanaDental may use to refer to a legal document detailing a member or group’s coverage. This document is sometimes referred to as a certificate of coverage, certificate of insurance, evidence of coverage, or summary plan description.

• Cleft lip: A congenital facial deformity characterized by non-fusion or malfusion of the development processes that form the lips.

• COBRA: (Consolidated Omnibus Budget Reconciliation Act) COBRA is federal legislation relative to the continuation of health benefits for all types of employee benefit plans that are provided by the employer.

• Completed: Indicates HumanaDental has received a predetermination or claim and an explanation of remittance has been released.

• Composite: A white plastic filling material made up of resin and quartz crystals.

• Condyle: The joint of the jaw.

• Continuation: State or federal (COBRA) option for a member who no longer qualifies as an active employee 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 specific legislation and group size. Coverage and premium are the same as the group coverage.

• Contract types: Type of contract or plan selected by each case or group, such as traditional, PPO, or Prepaid/DHMO.

• Coordination of benefits: A provision in a contract that applies when a person is covered under more than one group dental program. It requires that all programs coordinate payment of benefits to eliminate overinsurance or duplications of benefits.

• Copay: A cost-sharing arrangement in which a member pays a specified charge for a specific service - for example, $10 for an office visit. The member is responsible for payment at the time of service.

• Crown: The part of the tooth above the gum line. A crown may also refer to a metal, plastic or porcelain cap that covers that part of the tooth above the gum line.

• Cuspid: Pointed tooth used to tear food. There are two upper and two lower cuspids. Also known as canines or eyeteeth.

• Decay: Decomposed tooth structure (cavity formation).

• Dentin: The tissue which forms the main body of the tooth.

• Dentures: Any dental appliance used to replace missing natural teeth and the surrounding tissues.

• Diastema: A space between two adjacent teeth in the same jaw.

• Distal: The surface of a tooth farthest from the centerline of the face.

• DOB: Date of birth.

• Document number: A 9-digit number assigned by our computer system to each document that has been received.

• Effective date: The date on which the member’s coverage begins.

• Eligibility: Requirements must be satisfied by people who wish to be insured. When these requirements have been satisfied, eligibility is established.

• Enamel: The hard surface covering the dentin portion of the crown of the tooth.

• End date: The 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: A defect in the surface of a tooth (which cannot be accounted for by abrasion) where the enamel is worn and smooth. This is usually the result of chemical action in the mouth.

• Erupt, Eruption: When a new tooth comes in, it has erupted when it breaks the surface of the gums and you can see it.

• Explanation of benefits (EOB): Even though the EOB looks official, it is not a bill. The EOB details how the claim was processed and indicates the portion of the claim already paid to the dentist and the portion of the claim you need to pay (if applicable).

• Extraction: The separation and surgical removal of a tooth from its surrounding tissues.

• Eyeteeth: Pointed tooth used to tear food. There are two upper and two lower cuspids. Also known as cuspids or canine.

• Family deductible: A type of deductible, which may be satisfied by the combined expense of all covered family members.

• Filling: The material used to fill a cavity in a tooth. The filling substance may be gold, silver amalgam, copper amalgam, acrylic resins, porcelain or cement.

• Fluoride: A chemical solution or gel which you place on your teeth. The fluoride helps prevent decay.

• Frenum: Piece of pink colored skin that attaches your lips, cheeks, and tongue to your mouth.

• Frenectomy: The surgical cutting of the frenum.

• General anesthetic: A drug that causes loss of feeling either generally or renders the patient unconscious.

• Gingiva: The gum tissue surrounding the teeth and covering the bone of the upper and lower jaws.

• Gingivectomy: The cutting away of loose infected and diseased gum tissue.

• Gingivitis: An inflammation of the gum tissue.

• Group ID: The number assigned to each case or group when we receive the application. We use the group number to identify the group in our computer system. The group ID remains with the account permanently.

• Hard palate: The approximate two-thirds of the front section of the palate, composed of relatively hard and unyielding tissue.

• Hemisection: The surgical division of a tooth for a purpose of allowing salvage of one part of the tooth, which is relatively free of disease.

• Hygienist: A trained and licensed person that performs dental prophylaxis under the direction of a licensed dentist.

• Immediate denture: A denture constructed for insertion immediately following removal of natural teeth.

• Implants: A device made of metal or other foreign material which is surgically placed into or on the upper or lower bone to provide support for a crown, bridge, partial or full denture.

• Impacted tooth: A tooth that has not erupted and is embedded in the jaw.

• Incisal: The cutting edge of the front teeth.

• Incisor: A cutting tooth. There are eight incisors in the front of the mouth, four on the upper jaw, 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: The surface of a tooth, which faces its adjoining tooth, as they stand in the line in the dental arch.

• Individual deductible: The amount of eligible expense a covered person must pay each year before the dental plan will make payment for eligible benefits.

• Jacket: A full crown constructed entirely of porcelain or plastic.

• Jaw: The term used to indicate either the maxilla (upper) or the mandible (lower).

• Labial surface: The surface of the front teeth, which faces the lip.

• 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: The maximum amount payable (for each covered person) for eligible charges related to treatment. No further benefits are payable once the maximum is reached.

• Lingual surface: The surface of the tooth toward the tongue.

• Major services: Dental procedures concerned with the restoration of teeth by cast restorations such as inlays, onlays, crowns, or veneers. Major services may also include endodontics (root canals) or periodontics (tissue/bone treatment).

• Malocclusion: An abnormal position of the teeth or jaws.

• Mandible: The horseshoe shaped bone that forms the lower jaw.

• Maxilla: The bones that form the upper jaw.

• Max: Maximum.

• Member ID: The unique identifying number for a member under the dental plan.

• Mesial: The surface of the tooth toward the centerline 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 used for grinding food. There are eight molars in the baby set of teeth.

• Myofacial pain dysfunction (MPD): The hyperactivity of the jaw usually affecting the facial muscles and chewing muscles.

• Mbr Resp Amt: Member responsible amount.

• Network deal: A financial agreement applied to a specific dentist or dental network.

• Non-participating provider: Dentist who has not contracted with the carrier to be a participating dentist for a particular plan.

• Non-precious metals: Materials developed for use in all types of restorative procedures that are less costly than gold and other precious metals.

• Occlusal: The biting or grinding surfaces of molars and bicuspids.

• Occlusal guard (night guard): A 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 to 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 obtained from an unaffiliated or noncontracted dentist.

• Overbite: Misalignment of the upper and lower teeth or jaws in which the upper teeth overlap the lower teeth when the mouth is closed.

• Overdenture: A complete denture that fits over one or more natural teeth.

• Palate: The roof of the mouth.

• Panorex: An 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: A 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 HumanaDental has received a predetermination or a claim although the process has not been completed.

• 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, 32 in number.

• Pit: A small depression in the enamel of the tooth.

• Plan certificate: The document that spells out all of the ins and outs of your dental benefits.

• Planing (root): A scaling of the root surface to smooth the surface.

• Plaque: A sticky substance composed of secretions containing bacteria, dead tissue cells, and debris. When this toxic substance accumulates on the teeth, it is considered to be an initiating factor in gingival inflammation.

• Pontic: The portion of a fixed bridge between the abutments. This serves as an artificial substitute for a missing tooth.

• Porcelain: A restorative material made of various types of fused (molten) glasses. Used to make teeth, facings, jackets, and dentures.

• Post and core: A 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.

• Predetermination: A breakdown of how benefits would be covered by a member’s plan certificate when a dentist submits an estimate of services.

• Premolars: The bicuspid teeth immediately preceding 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 on the basis of proportion.

• Prosthodontic services: Dental specialty concerned with the restoration of missing teeth by artificial means.

• Proximal: The surface nearest the adjacent tooth.

• Pulp: The soft inner structure of a tooth, consisting of blood vessels and nerves.

• Pulpectomy: The complete removal of either vital or inflamed pulp from the chamber and root canals.

• Quadrant: One half of each dental arch: one fourth of the two dental arches.

• Reline: To resurface the tissue-borne areas of a denture with new material.

• Recession: The gradual drawing away of tissue from its normal position, for example the recession of the gum away from the tooth.

• Reference number: A 9-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: An appliance to prevent collapse of the dental arch.

• Root canal therapy (endodontic therapy): Treatment of a tooth having damaged pulp usually performed by completely removing the pulp chamber and root canals, and filling these spaces with inert sealing material.

• Root planing: The smoothing of roughened root surfaces by the use of scalers and dental instruments.

• Scale: To remove tartar and stains from the teeth with special dental instruments.

• Sealant: A material applied to the chewing surface of a tooth to prevent decay.

• Seat date: The date the appliance is cemented/put into place. For orthodontics, it is the date the bands were placed on the teeth.

• Semi-precious metals: Materials developed for dental restorations that have a lesser amount of precious metals.

• Silicate: Synthetic fillings other than silver, gold or ordinary cement used to set crowns, bridges, etc. 

• Socket: The cone-shaped cavities in the upper and lower arch, in which the teeth are embedded.

• Splint: An appliance used to prevent motion of teeth.

• Status: Informs the member if policy is active, termed, or COBRA.

• Stayplate (flipper): An acrylic partial, with or without wire clasps, that replaces one or more teeth usually temporary in nature.

• Stomatitis: The 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: The unique identifying number for a member.

• Surgical extraction: The removal of a tooth by means of surgical methods.

• Tartar: A hard deposit that forms when plaque hardens.

• Temporomandibular joint (TMJ): The joint between the skull and the mandible.

• TMJ syndrome: The symptoms associated with malfunction of the temporomandibular joint.

• Torus: A projection or overgrowth of bone.

• Unerupted: Not having come through the gums.

• Unilateral: Involves only one side.

• Usual and customary: establishment of a maximum amount to pay for a specific procedure based on prevailing fees in a geographical area.

• Veneer crown: A full crown, which has one or more surfaces, covered by tooth-colored plastic or porcelain.

• Vitality test: A test using thermal, electrical, or mechanical stimuli to determine the vitality of the dental pulp.

• Voluntary plans: Employers can offer comprehensive dental plans at no cost to their business. Employees like the simplicity and convenience of having their dental premiums deducted directly from their paycheck.

• Waiting period: The period between employment or enrollment in a dental plan and the date when a covered person becomes eligible for benefits. Services subject to a waiting period could be crowns, bridges, or orthodontics.

• Waiting period days remaining: The amount of time remaining before the waiting period expires.

• Xerostomia
  Decreased salivary secretion that produces a dry and sometimes burning sensation of the oral mucosa and/or cervical caries.

• X-ray: A form of radiation that produces a shadowy negative, which provides a means of diagnostic evaluation. The following terms are examples of dental X-rays taken:
  • 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, which provides a continuous view of the teeth, and associated structures.
  • Periapical: An intraoral film showing the entire tooth.