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BRIDGE A fixed appliance (prosthesis) that replaces missing teeth. A bridge is a series
of crowns (abutments and pontics).
BRUXISM Clenching or grinding of the teeth.
CALENDAR YEAR January 1st to December 31st.
CALCULUS The sticky film on your teeth (plaque) that has hardened. Also known as
tartar.
CANAL The narrow chamber inside the root of the tooth that contains the nerve and
blood vessels.
CANINES See cuspids.
CAPITATION PLAN A plan where the dentist is contracted with the administrator to
provide dental services to persons covered under the program in return for payment on a
per-capita basis (per head). Trojan classifies these plans as Managed Care.
CARIES Correct technical term for decay.
CARRIER The party (usually an insurance company) that pays the claims and collects
the premiums.
CARRYOVER If the deductible was paid last year (usually the last quarter, Oct., Nov. or
Dec.) the next year (or quarter, Jan., Feb. and March) they do not have to pay the
deductible again.
CARVE OUT PLAN See Limited C.O.B..
CLEANING See prophylaxis.
CLOSED PANEL A plan where the covered patient only receives benefits if the services
are provided by a dentist who is contracted with the administrator. Trojan classifies these
plans as Managed Care.
C.O.B. See Coordination Of Benefits.
COMPLETE SERIES See Full Mouth X-rays.
COMPOSITE FILLING Tooth colored filling. Insurance companies usually only allow
them on the front teeth (anterior teeth). When composites are done on the back teeth
(posterior teeth) the insurance company usually pays them as an amalgam. Composites
are also known as resin fillings.
MANAGED CARE PLANS Plans that restrict the type, level and frequency of
treatment; limit the access to care; and control the level of reimbursement for services.
These are D.M.O.'s, Capitation plans and Closed Panel plans. Trojan does not classify
P.P.O. plans as Managed Care.
MANDIBLE The lower jaw.
MAXILLA The upper jaw.
MAXIMUM The maximum dollar amount of benefits a plan will pay toward the cost of
dental care over a specific period of time (usually one year).
MOLARS The first, second and third molars, those are the sixth, seventh and eighth
teeth from the center of the mouth to the back of the mouth. The back teeth with the large
chewing surface on top. They have 4 points (cusps).
NIGHTGUARD A removable acrylic appliance to minimize the effects of grinding the
teeth (bruxism) or joint problems (T.M.J.). Usually worn at night to prevent the grinding
of teeth or relieve joint pain. Also known as an occlusal guard.
NON DUPLICATION OF BENEFITS See Limited C.O.B..
OCCLUSAL The chewing surfaces of the back teeth.
OCCLUSAL GUARD See Nightguard.
ONLAY A laboratory processed restoration made of metal, porcelain or acrylic that
replaces one or more of the highest points of the tooth (cusps).
ORAL SURGERY (O.S.) Surgery of the mouth.
ORTHO See Orthodontics.
ORTHODONTICS (ORTHO) Straightening of the teeth.
O.S. See Oral Surgery.
P.A. Common dental language for a periapical. See Periapical.
PALATE Roof of the mouth.
PANOREX An x-ray taken outside of the mouth that shows all the teeth on one film.
PARTIAL DENTURE A removable appliance (prosthesis) that replaces some of the
teeth in either the upper or lower jaw. See illustration below.
SIGNATURE ON FILE The insured person signs a form stating that the payments made
by the carrier go to the dentist. This form expires 1 year from the date it is signed. Some
policies do not accept signature on file.
SINGLE FILM See Periapical.
SUBSCRIBER The person who carries the dental plan.
STANDARD C.O.B. When a patient is insured by two plans, the plan that is billed
second will pay up to 100% of U.C.R. between both of the carriers.
Example:
Both insurance companies were billed $250 and both insurance companies pay at 50%.
The first plan paid $125, the second plan paid $125
TARTAR See Calculus.
TEMPOROMANDIBULAR JOINT (T.M.J.) Temporo (temporal bone), mandibular
(lower jaw). This is the connecting hinge between the lower jaw and base of the skull.
Also known as T.M.J.. T.M.J. treatment is sometimes paid under medical.
THIRD MOLAR See Wisdom Tooth.
T.M.J. See Temporomandibular Joint
VIRGIN TEETH Teeth that have no decay or fillings.
WAIVER OF DEDUCTIBLE Some policies exclude certain types of procedures from
the deductible.
WISDOM TOOTH The third molar, this is the eighth tooth from the center of mouth to
the back of the mouth. Wisdom teeth are often impacted (obstructed from erupting) and
have to be extracted.