Acrylic
A type of plastic used for dentures and some kinds of crowns.
Amalgam
One of the most common filling materials; usually soft silver that hardens
after it is packed into the cavity.
Bitewing
X-ray
An X-ray showing exposed portions of the back teeth. Primarily used for
early detection of hidden decay between teeth.
Cavity
Portion of a tooth destroyed by decay. Requires filling or sometimes more
extensive treatment.
Certificate
This document is the certificate of coverage. Delta Dental
will provide benefits as described in this certificate. Any changes in
this certificate will be based on changes to the plan.
Completion
Dates
Some procedures may require more than one appointment. Treatment is complete:
* For dentures and partial dentures,
on the delivery dates.
* For crowns and bridgework, on the cementation dates.
* For root canals and periodontal treatment, on the date of the final procedure
that completes treatment.
Control
Plan (Delta Dental)
The Delta Dental Plan that contracts with your group.
The Control Plan will provide all claims processing, service and administration
for a multi-state group. Your Control Plan is Delta Dental
Plan of Ohio and is referred to as Delta Dental in this Web site.
Copayment
The percentage of covered services that you will have
to pay toward treatment.
Covered
Services
The unique benefits selected in your plan. The Summary
of Dental Plan Benefits lists your covered services.
Crown
A dental restoration usually covering the whole exposed
portion of a tooth. Most often made of porcelain, gold or acrylic.
Frequently used in bridgework or to restore a badly-broken tooth.
Deductible
The amount an individual and/or a family must pay toward covered
services before Delta Dental begins paying for services. The Summary
of Dental Plan Benefits lists the deductible that applies to you,
if any.
Delta
Dental Plan
An individual state dental benefit plan that is a member of the Delta
Dental Plans Association, a nationwide system of dental health plans offering
employers, large and small, custom programs and reporting systems.
Delta
Dental's Nonparticipating Dentist Fee
The maximum amount allowed per procedure for services rendered by a nonparticipating
dentist.
Delta Dental PPO Point-of-Service (DPO)
A preferred provider organization program that can reduce your out-of-pocket
expenses if you receive care from one of Delta Dental's DPO
Dentists. This program has back-up coverage through Delta Dental Premier when treatment is received from a non-DPO dentist.
Delta Dental PPO
Option Participating Dentist (DPO Dentist)
A dentist who has entered into a Prudent Purchaser
agreement with the Delta Dental Plan in his or her
state. The DPO dentist accepts Delta Dental's payment and the patient's
payment, if any, as payment in full.
Delta Dental Premier
A national fee-for-service dental benefits program that covers you when
you go to a non-DPO dentist.
Delta Dental Premier
Participating Dentist
A dentist who has signed an agreement with the Delta Dental Plan in his or her state to participate
in DeltaPremier. The DeltaPremier participating dentist accepts Delta
Dental's payment and the patient's payment, if any, as payment in full.
Delta Dental Premier
Non-Participating Dentist
A dentist who has not signed an agreement with
Delta Dental to participate in DeltaPremier. It is the subscriber's
responsibility to make full payment to the DeltaPremier nonparticipating
dentist.
DeltaUSA
A national program with a nationwide network of participating dentists
for groups with enrollees in two or more states.
Dentist
A person licensed to practice dentistry in the state or country in which
dental services are rendered.
Denture
A removable replacement for a natural tooth or teeth.
Endodontics
Treatments of diseases within the tooth, primarily root
canal therapy.
Extraction
The removal of a natural tooth or teeth.
Filling
Material used to fill a cavity that is inserted
in a tooth as opposed to one which covers it (crown).
Fixed
Bridge
A non-removable replacement for natural tooth or teeth. It is cemented
to natural teeth on either side which are used as abutments.
Fluoride
A topically-applied chemical used to prevent tooth decay.
Gingiva
Soft tissue adjacent to your teeth; your gums.
Impaction
A tooth partly- or wholly-buried under the gum by bone or tissue.
Non-Participating
DeltaPreferred Option Dentist (Non-DPO Dentist)
A dentist who has not signed a Prudent Purchaser
agreement with Delta Dental. It is the responsibility of the subscriber to make full payment to the non-DPO dentist, unless the non-DPO dentist
is participating with the DeltaPremier program.
Maximum
Payment
The maximum dollar amount Delta Dental will pay in any benefit year or
lifetime for covered dental services (see the Summary of
Dental Plan Benefits).
Occlusion
The contact position of the teeth when the upper and lower jaws are closed,
sometimes called "bite."
Oral
Surgery
Surgery of the oral mouth cavity, including teeth,
tongue and gums. May be dental or non-dental in nature.
Orthodontics
Teeth straightening or repositioning.
Periodontics
Treatment of the gum and tissue around the teeth.
Pontic
An artificial replacement of a missing tooth; part of a fixed
bridge.
Predetermination
An estimate of covered services. Dentists may submit
their treatment plans and X-rays to Delta Dental before procedures are
started. Delta Dental reviews the treatment plan and advises the patient
and dentist of what services are covered by your
plan and what Delta Dental's payment may be. Delta Dental's payment for
predetermined services depends on continued eligibility and the annual
or lifetime maximum payment available.
Prophylaxis
Professional cleaning and polishing of the teeth.
Processing
Policies
Delta Dental's policies and guidelines used for predetermination and payment of claims. The Processing Policies may be amended from time
to time.
Prosthodontics
Artificial replacement of natural teeth (bridges and dentures).
Removable
Bridge
A partial denture normally held by clasps to the natural teeth, permitting
removal if desired.
Restoration
A filling or crown that restores
a natural tooth.
Root
Canal Therapy
Treatment of the pulp of the tooth.
Sodium
Fluoride Application
A mild decay prevention dental treatment applied to the outer surface of the teeth.
Submitted
Amount
The fee the dentist bills to Delta Dental for a
specific treatment.
Subscriber
You, when the State of Ohio notifies Delta Dental that you are eligible
to receive dental benefits.
Summary
of Dental Plan Benefits
A list of the specific provisions of your group dental plan and is a part
of the Dental Care Certificate.
Surface
A term which refers to one of the four sides of your tooth or a chewing
area of the tooth. A one-surface filling is inserted
in only one surface of a tooth; a two-surface filling includes two adjoining surfaces of the same tooth in a single filling.
Usual,
Customary, and Reasonable Fees
Usual: The usual fee is the lowest fee regularly charged, offered or
received by an individual dentist for a dental
service. There may be some exceptions for fees charged under preferred
provider plans or charitable programs.
Customary:
A fee is customary when it is within the range of usual fees charged by
dentists of similar training and experience within a specific and limited
geographic area.
Reasonable:
A fee is reasonable when it meets the above two criteria or it is justifiable
considering special circumstances.
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