Delta Dental of New Mexico

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Benefits Dictionary A-D

Abscess: An inflamed lesion caused by tissue destruction. Dental abscesses often occur when a tooth's nerve dies due to decay or trauma.

ADA: American Dental Association—A professional association for dentists that promotes the integrity and ethics of the profession and provides services through its initiatives in education, research, advocacy, and the development of standards.

Amalgam: An alloy of silver, tin, copper, and mercury; often called silver filling. Dental amalgam is one of the most commonly used materials to fill cavities in back teeth.

Attending Dentist's Statement: see Claim form

Attrition: Wearing down of the surface of a tooth from chewing, grinding, or clenching.

Baby Bottle Tooth Decay: Severe decay in baby teeth caused when young children sleep with a bottle of milk, juice, or other sugary drink. The drink's natural sugars combine with bacteria in the mouth to produce acids that decay teeth.

Balance Billing: Charges a provider makes to an enrollee for the difference between Delta Dental's maximum plan allowance (MPA) and the dentist's fee. Participating dentists agree to accept Delta Dental's MPA as the full fee for covered services and charge the enrollee for copayments and deductibles only.

Beneficiary: see Enrollee

Benefit Year: The 12-month period of the dental contract (not always a calendar year). Most group contracts include a maximum benefit available for their enrollees' covered dental services that renews at the beginning of each benefit year (excluding orthodontics, which has a lifetime maximum).

Bitewing Radiograph: An X-ray taken of the back teeth that shows decay between teeth or under fillings.

Bridge: A device used to replace missing teeth. See: Partial Denture

Bruxism: Involuntary clenching or grinding of the teeth.

Calculus: Hard deposits of mineralized material and calcified plaque that builds up on teeth. Also referred to as tartar, it generally requires removal by a dental professional.

Caries: Tooth decay caused by acid-producing bacteria in the mouth that weaken and break down the hard enamel shell.

Certificate of Coverage: A standard booklet provided by Delta Dental to subscribers explaining their benefit coverage.

Claim Form: A statement listing dental services, the dates of services, an itemization of fees, and the treating dentist's information. The completed form is used to request payment from Delta Dental and other companies. Download a printable claim form.

Composite Resin: A tooth-colored material used for fillings and to repair defects in the teeth.

Coordination of Benefits (COB): The order of billing and payments for dental services when an enrollee is covered by more than one dental plan. The total payments cannot exceed 100% of the charged fee(s).

Copayment: The amount or percentage of the total approved amount that the subscriber is obligated to pay.

Covered Person: see Enrollee

Covered Service: A dental service that is payable under the terms of the benefit contract.

Crown: 1) The part of the tooth covered by enamel and visible above the gum line; 2) A dental restoration used to restore form and function to a damaged tooth, also called a cap.

Deciduous Teeth: The 20 primary teeth of a child. Also called baby teeth, the deciduous teeth hold the space for the permanent, or secondary, teeth. As the permanent teeth form and begin to move into place in the jaw, the deciduous teeth gradually loosen and fall out.

Deductible: The portion of covered dental expenses the enrollee must pay before the plan's benefits begin.

Denture: A removable appliance used to replace missing teeth. A complete denture replaces all of the upper teeth and/or all the lower teeth, and a partial denture replaces one or more lost teeth.

Dependents: Anyone covered under a dental benefit contract other than the primary subscriber.


More Definitions

E-L (Edentulous—Limitations)
M-R (Malocclusion—Root Canal Therapy)
S-Z (Scaling—Waiting Period)