Delta Dental of New Mexico

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Benefits Dictionary E-L

Edentulous: Having no teeth; toothless.

Effective Date: (1) The date a company's or organization's dental contract goes into effect; (2) The date that an individual/family becomes eligible for dental benefit coverage.

Enamel: Hard, calcified outer covering of the crown of a tooth.

Endodontics: The dental specialty concerned with the treatment of the nerve of the tooth.

Enrollee: A person covered under a dental benefit contract.

Exclusion: A dental service or procedure not covered by a benefit contract.

Explanation of Benefits (EOB): A detailed statement of a processed claim sent to the enrollee and participating dentist. It shows procedures, date(s) of service, processing policies, Delta Dental's payment and the amount (if any) that the enrollee owes to the dental provider.

Fee-For-Service: A dental plan under which a dentist is paid for each covered service rendered to an eligible enrollee.

Fee Schedule: A list of the charges established by a benefit provider and agreed to by a dentist for specific dental services.

Fluoride: A chemical compound that strengthens tooth enamel and makes it more resistant to decay.

Gingivitis: Redness and swelling of the gums surrounding the teeth. It is the earliest stage of periodontal disease, usually caused by a buildup of plaque.

Group: The company or organization that contracts with Delta Dental to administer its dental benefit plan. The group determines plan type, benefit levels, maximums, and member eligibility.

Group Member: see Subscriber

Gum Disease: see Periodontal Disease

Halitosis: Bad breath.

HIPAA: The Health Insurance Portability and Accountability Act of 1996. This federal law is intended to improve access to health insurance, limit fraud and abuse, and control administrative costs.

Impacted Tooth: An un-erupted or partially erupted tooth that is blocked from fully erupting by another tooth, bone, or soft tissue.

Implant: A device inserted into the jawbone to provide an anchor for replacing missing tooth/teeth.

Inlay: A custom-made filling that is permanently placed in a prepared tooth. Gold and porcelain are commonly used materials for inlays.

Insured: see Enrollee

Limitations: Conditions, such as age and period of time covered, that restrict a dental program's coverage for certain services. (For example, in most programs, a prophylaxis is a covered benefit twice in a 12-month period.)


More Definitions

A-D (Abscess—Dependents)
M-R (Malocclusion—Root Canal Therapy)
S-Z (Scaling—Waiting Period)