Dental Insurance

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glossary terms

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D

Debridement

removal of subgingival and/or supragingival plaque and calculus which obstructs the ability to perform an evaluation; removal of contused and devitalized tissue; from a wound surface.


Decay

the lay term for carious lesions in a tooth; decomposition of tooth structure.


Deciduous

having the property of falling off or shedding; a name used for the primary teeth.


Deductible

the amount of dental expense for which the beneficiary is responsible before a third party will assume any liability for payment of benefits. Deductible may be an annual or one-time charge, and may vary in amount from program to program. (see Family Deductible.)


Dental Benefit Organization

any organization offering a dental benefit plan. Also known as dental plan organization.


Dental Benefit Plan

entitles covered individuals to specified dental services in return for a fixed, periodic payment made in advance of treatment. Such plans often include the use of deductibles, coinsurance, and/or maximums to control the cost of the program to the purchaser.


Dental Benefit Program

the specific dental benefit plan being offered to enrollees by the sponsor.


Dental Health Maintenance Organization (DHMO)

typically, the least expensive of dental plans. All dental services are provided by professional dentists who agree to provide specific treatments and services to patients at no charge (some services may require a co-payment.) DHMO plans reward participating dentists who keep patients in good health, thereby keeping plan costs low. Dentists are paid directly by the insurance company for each individual, regardless of how much or how often covered services are used.


Dental Insurance

a plan that financially assists in the expense of treatment and care of dental disease and accidents to teeth.


Dental Prepaid

Dental Prepaid plan is commonly referred to as a Dental HMO (DHMO). Dental Health Maintenance Organization (DHMO) is an organized system of dental health care that provides comprehensive and affordable care to you through a network of highly qualified dentists. There are no waiting periods, calendar year maximums or deductibles and no claim forms. With these plans, you are responsible for the copayment for each service.


Dental Prepayment

a method of financing the cost of dental services prior to their receipt.


Dental Prophylaxis

scaling and polishing procedure performed to remove coronal plaque, calculus, and stains.


Dental Service Corporation

a legally constituted, not-for-profit organization that negotiates and administers contracts for dental care. Delta Dental Plans and Blue Cross/Blue Shield Plans are such plans.


Dentin

that part of the tooth that is beneath enamel and cementum.


Dentition

the teeth in the dental arch; permanent dentition - refers to the permanent teeth in the dental arch; deciduous dentition -- refers to the deciduous or primary teeth in the dental arch.


Denture

an artificial substitute for natural teeth and adjacent tissues.


Denture Base

that part of a denture that makes contact with soft tissue and retains the artificial teeth.


Dependents

generally spouse and children of covered individual, as defined by terms of the dental benefit contract.


Detailed and Extensive

detailed and extensive oral evaluation - problem- focused, by report: A detailed and extensive problem-focused evaluation entails extensive diagnostic and cognitive modalities based on the findings of a comprehensive oral evaluation. Integration of more extensive diagnostic modalities to develop a treatment plan for a specific problem is required. The condition requiring this type of evaluation should be described and documented. Examples of conditions requiring this type of evaluation may include dentofacial anomalies, complicated perio-prosthetic conditions, complex temporomandibular dysfunction, facial pain or unknown origin, conditions requiring multi-disciplinary consultations, etc.


Diagnostic Cast

plaster or stone model of teeth and adjoining tissues; also referred to as study model.


Diastema

a space, such as one between two adjacent teeth in the same dental arch.


Direct Billing

a process whereby the dentist bills a patient directly for his/her fees.


Direct Pulp Cap

procedure in which the exposed pulp is covered with a dressing or cement with the aim of maintaining pulp vitality.


Direct Reimbursement

a self-funded program in which the individual is reimbursed based on a percentage of dollars spent for dental care provided, and which allows beneficiaries to seek treatment from the dentist of their choice.


Direct Restoration

a restoration fabricated inside the mouth.


Discectomy

excision of the intra-articular disc of a joint.


Displaced Tooth

a partial evulsion of a tooth-may be mesial, distal, facial, lingual or incisal.


Distal

toward the back of the dental arch (or away from the midline).


Downcoding

a practice of third-party payers in which the benefit code has been changed to a less complex and/or lower cost procedure than was reported.


DRGs (Diagnosis-Related Groups)

a system of classifying hospital patients on the basis of diagnosis, consisting of distinct groupings. A DRG assignment to a case is based on the patient’s 1) principal diagnosis; 2) treatment procedures performed; 3) age; 4) gender; 5) discharge status.


Dry Socket

localized inflammation of the tooth socket following extraction due to infection or loss of blood clot; osteitis.


Dual Choice Program

a benefit package from which an eligible individual can choose to enroll in either an alternative dental benefit program or a traditional dental benefit program.


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Dental Insurance

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