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Benefits Dictionary M-R

Malocclusion: Improper alignment of biting or chewing surfaces of the upper and lower teeth.
Maximum Benefit: The limit set in a dental contract on the total dollar amount a dental plan pays for covered dental services in a specific time frame. For example: $1,000 per enrollee in a calendar year.
Maximum Plan Allowance (MPA): The highest dollar amount Delta Dental pays for a covered service. Participating dentists agree not to charge our enrollees the difference (if any) between the MPA and the dentist's fee for covered services.
Member: see Enrollee
National Provider Identifier (NPI): A unique identification number used by a health care entity in the electronic transmission of protected Personal Health Information (PHI).
Nonparticipating (Non-Par) Dentist: Any dentist who does not have a contractual agreement with Delta Dental for any or all of our programs. Also, an out-of-network dentist.
Nonparticipating Dentist Fee: The maximum reimbursement amount per procedure that Delta Dental pays for services performed by a nonparticipating dentist.
Onlay: A custom-made filling that is permanently placed in a prepared tooth and covers one or more of the tooth's cusps. Gold and porcelain are commonly used materials for onlays.
Optional Services: Procedures that are not covered benefits under the terms of the dental contract. If an enrollee elects to have an optional service, a claim should be submitted, and Delta Dental will review the procedure. If the procedure is an alternative to a covered service, Delta Dental could make payment based on the allowed amount for the covered service.
Oral Surgery: The dental specialty concerned with diagnosis and surgery of diseases, injuries and defects in the mouth, jaw and face.
Orthodontics: The dental specialty concerned with straightening or moving misaligned teeth and/or jaws with braces and/or surgery.
Osseous Surgery: The repair of the bone around and supporting teeth that has been damaged by gum disease.
Partial Denture: A device used to replace missing teeth by attaching artificial teeth to adjacent natural teeth or implants. A fixed partial denture is cemented or otherwise attached, and is also referred to as a fixed bridge. A removable partial denture can be taken in and out by the patient and is also referred to as a removable bridge.
Participating (Par) Dentist: A licensed dentist who has signed an agreement with Delta Dental. He or she agrees to submit claims and accept Delta Dental's payment, which is calculated based on the program in which the dentist participates. Delta Dental sends claim payments directly to the dentist. Also, an in-network dentist.
Panoramic Radiograph: A large X-ray that shows the teeth, jaws, and surrounding soft and hard tissue.
Pediatric Dentistry: The dental specialty concerned with the comprehensive treatment of children.
Periodontal Disease: Inflammation and loss of connective tissue of the supporting or surrounding structure of the teeth (gum disease).
Periodontics: The dental specialty concerned with diseases, conditions, and treatment of the gums, tissue and bone that supports the teeth.
Plaque: A soft, sticky film that collects on the surface of teeth. The bacteria in plaque can cause decay and gum irritation if not removed by daily brushing and flossing. If left on the teeth, plaque builds up, hardens, and becomes calculus.
Point-of-Service: A dental benefit plan that bases reimbursement on the participation status of the treating dentist.
Porcelain: A hard, glass-like material that can be tinted to duplicate individual tooth color, and is used in restorations to give the look of a natural tooth.
Pre-treatment Estimate: A treatment plan submitted to Delta Dental for review and estimation of benefits before procedures are started.
Preferred Provider Organization (PPO): A dental benefit plan in which participating dentists agree to accept a list of specific fees as the total fees for dental treatment provided.
Processing Policies: Delta Dental's policies and guidelines used for payment of claims. Processing policies may be amended from time to time. If a processing policy is applied to a billed service, the explanation is included on the statement (EOB) sent to the enrollee and participating dentist.
Prophylaxis: A professional dental cleaning to remove plaque, calculus and stains to help prevent dental disease. Also referred to as a prophy or teeth cleaning.
Prosthodontics: A dental specialty concerned with restoration and/or replacement of missing teeth and other oral structures.
Provider: A dentist or group dental practice.
Radiographs: X-rays of the teeth and areas in and around the mouth that can help dental professionals evaluate and diagnose many diseases and conditions.
Root Canal Therapy: Treatment for disease or inflammation of the pulp or root of a tooth.


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