Dental Billing, Coding, and Reimbursement - A Dental Temp Training Manual

The NOOK Book (eBook) of the Dental Billing, Coding, and Reimbursement - A Dental Temp Training Manual by Loretta Sinclair at Barnes.
Table of contents

Definitions of these three terms are posted online at http: A lay term used for the restoring of lost tooth structure by using materials such as metal, alloy, plastic or porcelain. A prosthetic replacement of one or more missing teeth cemented or otherwise attached to the abutment teeth or implant replacements. A benefit program in which an employee has a choice of credits or dollars for distribution among various benefit options, e. See cafeteria plans ; flexible spending account.

Employee reimbursement account primarily funded with employee designated salary reductions. The breaking of a part, especially of a bony structure; breaking of a tooth. Refers to a system for marketing a dental practice, usually under a trade name, where permitted by state laws. In return for a financial investment or other consideration, participating dentists may also receive the benefits of media advertising, a national referral system, and financial and management consultation.

The concept that a patient has the right to choose any licensed dentist to deliver his or her oral health care without any type of coercion. Muscle fibers covered by a mucous membrane that attaches the cheek, lips and or tongue to associated dental mucosa. A managed care concept used by some alternative benefit plans, in which enrollees select a primary care dentist, usually a general practitioner or pediatric dentist, who is responsible for providing non-specialty care and managing referrals, as appropriate, for specialty and ancillary care. Laboratory technique used to determine if a person has a genetic condition or disease or is likely to get the disease.

Soft tissues overlying the crowns of unerupted teeth and encircling the necks of those that have erupted. Polyelectrolyte cement in which the solid powder phase is a fluoride-containing aluminosilicate glass powder to be mixed with polymeric carboxylic acid. The cement can be used to restore teeth, fill pits and fissures, lute and line cavities. It is also known as glass polyalkenoate cement, ionic polymer cement, polyelectrolyte cement.

Thin pure gold leaf that is self adhering when condensed into a cavity. One of the oldest restorative techniques, it is compacted or condensed into a retentive cavity form. A piece of tissue or alloplastic material placed in contact with tissue to repair a defect or supplement a deficiency. Donors may be cadavers, living related or living unrelated individuals. Also called allogenic graft or homograft. A surgical procedure that uses a barrier membrane placed under the gingival tissue and over the remaining bone support to enhance regeneration of new bone. A federal law that includes Administrative Simplification Provisions that require all health plans, including ERISA, as well as health care clearinghouses and any dentist who transmits health information in an electronic transaction, to use a standard format.

Procedures and Nomenclature code set. Paper transactions are not subject to this requirement. A legal entity that accepts responsibility and financial risk for providing specified services to a defined population during a defined period of time at a fixed price. An organized system of health care delivery that provides comprehensive care to enrollees through designated providers. Enrollees are generally assessed a monthly payment for health care services and may be required to remain in the program for a specified amount of time.

The code that identifies the type of health care provider involved in furnishing services to beneficiaries. A contract provision in which one party to the contract promises to be responsible for liability incurred by the other party. Hold harmless clauses frequently appear in the following contexts:. This may include a promise to pay the dental benefit organization's attorney fees and related costs; and. If the dentist takes action against the patient to recover the difference between the amount billed by the dentist and the amount paid by the organization, the dental benefit organization will take over the defense of the claim and will pay any judgments and court costs.

Pertaining to an abnormal increase in the number of cells in an organ or a tissue with consequent enlargement. Prosthesis constructed for placement immediately after removal of remaining natural teeth. An unerupted or partially erupted tooth that is positioned against another tooth, bone, or soft tissue so that complete eruption is unlikely. Device placed into the alveolar and basal bone of the mandible or maxilla and transecting only one cortical plate.

Subperiosteal implant that conforms to the superior surface of an edentulous area of alveolar bone. Device with threaded posts penetrating both the superior and inferior cortical bone plates of the mandibular symphysis and exiting through the permucosa. It may be intraoral or extraoral. Placement of an artificial or natural tooth into an alveolus. Intentionally engaging in practices which would force a dentist, who does not have a participating provider agreement, to accept discounted fees or be bound by the terms and conditions set forth in the participating provider contract.

Some examples of inappropriate fee discounting practices include: A dental benefit program that pays an increasing share of the treatment cost, provided that the covered individual utilizes the benefits of the program during each incentive period usually a year and receives the treatment prescribed. Most frequently, there is a corresponding percentage reduction in the programs copayment level if the covered individual fails to visit the dentist in a given year but never below the initial copayment level.

One of the angles formed by the junction of the incisal and the mesial or distal surfaces of an anterior tooth; called the mesioincisal and distoincisal angle respectfully. The procedure of incising a fluctuant mucosal lesion to allow for the release of fluid from the lesion. A tooth for cutting or gnawing; located in the front of the mouth in both jaws. Those individuals whose income falls below the poverty line as defined by the federal Office of Management and Budget OMB.

See table of allowances. A non-network dental plan that reimburses the member or dentist at a certain percentage of charges for services rendered, often after a deductible has been satisfied. Indemnity plans typically place no restrictions on which dentist a member may visit.

Indemnity plans are also referred to as fee-for-service plans. Procedure in which the nearly exposed pulp is covered with a protective dressing to protect the pulp from additional injury and to promote healing and repair via formation of secondary dentin. A legal entity organized and governed by individual participating dentists for the primary purpose of collectively entering into contracts to provide dental services to enrolled populations.

An intracoronal dental restoration, made outside the oral cavity to conform to the prepared cavity, which restores some of the occlusal surface of a tooth, but does not restore any cusp tips.


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It is retained by luting cement. The party in an insurance contract that promises to pay a benefit if a specified loss occurs. Usually an insurance company. Person covered by the program. The intentional removal, radicular repair and replacement of a tooth into its alveolus.

Diagnostic codes designed for the classification of morbidity and mortality information for statistical purposes; for the indexing of hospital records by disease and operations; and for data storage and retrieval. Between the adjoining surfaces of adjacent teeth in the same arch. A protein present in all cuticular structures of the body, such as hair, epidermis and horns. The oral surface of the gingiva extending from the mucogingival junction to the gingival margin.

In gingival health, the coronal portion of the sulcular epithelium may also be keratinized. Pertaining to or around the lip. A thin covering of the facial surface of a tooth usually constructed of tooth colored material used to restore discolored, damaged, misshapen or misaligned teeth. A type of cost containment measure used by many third-party payers.

Under a LEAT clause, when there are multiple treatment options for a specific condition, the plan will only pay for the least expensive treatment. An obligation to pay an amount in money, goods, or services to another party. Restrictive conditions stated in a dental benefit contract, such as age, length of time covered, and waiting periods, which affect an individual's or group's coverage. The contract may also exclude certain benefits or services, or it may limit the extent or conditions under which certain services are provided. An angle formed by the junction of two planes; used to designate the junction of two surfaces of a tooth, or of two walls of a tooth cavity preparation.

Pertaining to or around the tongue; surface of the tooth directed toward the tongue; opposite of facial. Therapy for preserving the state of health of the periodontium. Pertaining to the cheek bone; see zygomatic bone. Improper alignment of biting or chewing surfaces of upper and lower teeth. The term "managed care" refers to a cost containment system that directs the utilization of health benefits by: Fixed partial denture featuring conservative retainers which are resin bonded to abutments.

A federal assistance program established as Title XIX under the Social Security Act of which provides payment for medical care for certain low income individuals and families. The program is funded jointly by the state and federal governments and administered by states. The reasonable and appropriate diagnosis, treatment, and follow-up care including supplies, appliances and devices as determined and prescribed by qualified, appropriate health care providers in treating any condition, illness, disease, injury, or birth developmental malformations.

Care is medically necessary for the purpose of: Substance or combination of substances intended to be pharmacologically active, specially prepared to be prescribed, dispensed or administered by authorized personnel to prevent or treat diseases in humans or animals. Pharmacological substance especially prepared to be applied on tissues of the oral cavity. A federal insurance program enacted in as Title XVIII of the Social Security Act that provides certain inpatient hospital services and physician services for all persons age 65 and older and eligible disabled individuals.

An individual enrolled in a dental benefit program. Nearer the middle line of the body or the surface of a tooth nearer the center of the dental arch. The noble metal classification system has been adopted as a more precise method of reporting various alloys used in dentistry. The alloys are defined on the basis of the percentage of metal content and listed in order of biocompatibility.

Mechanical removal of a small amount of tooth structure to eliminate superficial enamel discoloration defects. A minute living organism, such as a bacterium, fungus, yeast, virus or rickettsia. Teeth posterior to the premolars bicuspids on either side of the jaw; grinding teeth, having large crowns and broad chewing surfaces. A positive reproduction of a body part formed on a cast from a negative impression. Individually molded device designed primarily to be worn for the purpose of helping prevent injury to the teeth and their surrounding tissues. Sometimes called a mouth protector.

Lining of the oral cavity as well as other canals and cavities of the body; also called "mucosa.


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    • Professional or trade association for state departments of insurance http: This is an identifier assigned by the federal government to all providers considered to be HIPAA covered entities. An NPI is unique to an individual dentist or dental entity, and has no intrinsic meaning. There are two types of NPI available to dentists and dental practices:. Type 1 Individual Provider —A health care practitioner who is a single human being. Type 2 Organization Provider —A health care provider that is an organization, such as a group practice or corporation.

    Individual dentists who are incorporated may enumerate as Type 2 providers, in addition to being enumerated as a Type 1. All incorporated dental practices and group practices are eligible for enumeration as Type 2 providers. On paper, there is no way to distinguish a Type 1 from a Type 2 in the absence of any associated data; they are identical in format.

    A necessary dental procedure or service as determined by a dentist, to either establish or maintain a patient's oral health. Such determinations are based on the professional diagnostic judgment of the dentist, and the standards of care that prevail in the professional community. A graft from donor other than patient. A method of payment for group coverage in which the sponsor pays the entire monthly premium for the program. Term used to describe one of the ways the secondary carrier may calculate its portion of the payment if a patient is covered by two benefit plans.

    The secondary carrier calculates what it would have paid if it were the primary plan and subtracts what the other plan paid. For example, if the primary carrier paid 80 percent, and the secondary carrier normally covers 80 percent as well, the secondary carrier would not make any additional payment. If the primary carrier paid 50 percent, however, the secondary carrier would pay up to 30 percent. Any dentist who does not have a contractual agreement with a dental benefit organization to render dental care to members of a dental benefit program.

    See National Provider Identifier. With reference to endodontics, refers to the sealing of the canal s of tooth roots during root canal therapy procedure with an appropriately prescribed material such as gutta percha in combination with a suitable luting agent. A disc or plate which closes an opening; a prosthesis that closes an opening in the palate.

    Pertaining to the biting surfaces of the premolar and molar teeth or contacting surfaces of opposing teeth or opposing occlusion rims. An intraoral radiograph made with the film, phosphorous plate, emulsion or digital sensor being held between the occluded teeth. A surface of a posterior tooth or occlusion rim that is intended to make contact with an opposing occlusal surface. Any contact between biting or chewing surfaces of maxillary upper and mandibular lower teeth. A dental restoration made outside the oral cavity that covers one or more cusp tips and adjoining occlusal surfaces, but not the entire external surface.

    The annual period in which employees can select from a choice of benefit programs. This type of dental benefits plan allows covered patients to receive care from any dentist and allows any dentist to participate. Any dentist may accept or refuse to treat patients enrolled in the plan.

    Open panel plans often are described as freedom of choice plans. Re-approximation of fractured bony segments accomplished through cutting the adjacent soft tissues and bone to allow direct access. A dental specialist whose practice is concerned with recognition, diagnosis, investigation and management of diseases of the oral cavity, jaws, and adjacent structures. Oral pathology is the specialty of dentistry and discipline of pathology that deals with the nature, identification, and management of diseases affecting the oral and maxillofacial regions.

    It is a science that investigates the causes, processes, and effects of these diseases. The practice of oral pathology includes research and diagnosis of diseases using clinical, radiographic, microscopic, biochemical, or other examinations. A dental specialist whose practice is concerned with the production and interpretation of images and data produced by all modalities of radiant energy used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region.

    Oral and maxillofacial radiology is the specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities of radiant energy that are used for the diagnosis and management of diseases, disorders and conditions of the oral and maxillofacial region. A dental specialist whose practice is limited to the diagnosis, surgical and adjunctive treatment of diseases, injuries, deformities, defects and esthetic aspects of the oral and maxillofacial regions.

    Oral and maxillofacial surgery is the specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. The determination by a dentist of the oral health condition of an individual patient achieved through the evaluation of data gathered by means of history taking, direct examination, patient conference, and such clinical aids and tests as may be necessary in the judgment of the dentist.

    The degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions. A dental specialist whose practice is limited to the interception and treatment of malocclusion and other neuromuscular and skeletal abnormalities of the teeth and their surrounding structures.

    Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures. Apparatus used to support, align, prevent or correct deformities, or to improve the function of movable parts of the body. Abbreviation for Occupational Safety and Health Administration. Federal agency in the US responsible for making and enforcing employee safety regulations. The misrepresentation of a fee as higher than actual charges; for example, when a patient is charged one fee and an insurance company is billed a higher fee to benefit the patient's co-payment, or to increase a fee to a patient solely because the patient is covered under a dental benefits plan.

    A removable prosthetic device that overlies and may be supported by retained tooth roots or implants. The hard and soft tissues forming the roof of the mouth that separates the oral and nasal cavities. An extraoral projection whereby the entire mandible, maxilla, teeth and other nearby structures are portrayed on a single image, as if the jaws were flattened out. A behavior management technique utilizing immobilization to control the actions of a patient who is receiving dental treatment. Other than normal function or use. Usually refers to a prosthetic device that replaces missing teeth.

    See fixed partial denture or removable partial denture. An individual who has established a professional relationship with a dentist for the delivery of dental health care. For matters relating to communication of information and consent this term includes the patient's parent, caretaker, guardian, or other individual as appropriate under state law and the circumstances of the case. A self-insured employer, insurance company, governmental agency or other party responsible for payment of health care claims of covered persons.

    A dental specialist whose practice is limited to treatment of children from birth through adolescence, providing primary and comprehensive preventive and therapeutic oral health care; formerly known as a pedodontist. Pediatric Dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

    An evaluation of the quality and conduct of an individual's work by the individual's professional equals peers in order to resolve questions or disputes regarding the quality, or conduct of the work. Peer review, when applied to dentistry, is a process, consistently structured and implemented by organized dentistry, in which a dentist's professional equals peers resolve questions or disputes regarding the quality or appropriateness of care provided by the dentist or the fairness of the fee the dentist charged in an individual case by retrospectively evaluating the quality or appropriateness of care in relation to professional norms or criteria or evaluating the fee charged in relation to the dentist's fee for the given complexity and level of care provided.

    In addition to their review and monitoring functions, these entities can invoke sanctions, penalties, or other corrective actions for noncompliance in organization standards.

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    The number in a frequency distribution below which a certain percentage of fees will fall. A radiograph made by the intraoral placement of film, phosphorous plate, emulsion or digital sensor, for disclosing the apices of the teeth. Pathologically deepened gingival sulcus; a feature of periodontal disease. Periodontics is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

    A dental specialist whose practice is limited to the treatment of diseases of the supporting and surrounding tissues of the teeth. Inflammation and loss of the connective tissue of the supporting or surrounding structure of teeth with loss of attachment. A small metal rod, cemented or driven into dentin to aid in retention of a restoration. A soft sticky substance that accumulates on teeth composed largely of bacteria and bacterial derivatives. A health plan allowing the member to choose to receive a service from a participating or non-participating provider, usually with different benefits levels associated with the use of participating providers.

    The term used for an artificial tooth on a fixed partial denture bridge. Refers to pressed, fired, polished or milled materials containing predominantly inorganic refractory compounds including porcelains, glasses, ceramics and glass-ceramics. Rod-like component designed to be inserted into a prepared root canal space so as to provide structural support. This device can either be in the form of an alloy, carbon fiber or fiberglass, and posts are usually secured with appropriate luting agents. Refers to teeth and tissues towards the back of the mouth distal to the canines ; maxillary and mandibular premolars and molars.

    Statement by a third-party payer indicating that proposed treatment will be covered under the terms of the benefit contract. See also precertification , predetermination. Confirmation by a third-party payer of a patient's eligibility for coverage under a dental benefit program. See preauthorization , predetermination. Interlocking device, having a male component integrated into a removable prosthesis that fits precisely into a female component embedded in the body of abutment teeth or implant abutments, to stabilize or retain the prosthesis when it is seated in the mouth.

    A process where a dentist submits a treatment plan to the payer before treatment begins. The payer reviews the treatment plan and notifies the dentist and patient of one or more of the following: A formal agreement between a purchaser of a dental benefit program and a defined group of dentists for the delivery of dental services to a specific patient population, as an adjunct to a traditional plan, using discounted fees for cost savings. The submission of a participating dentist's full fees for the purpose of establishing, in advance, that dentist's full fees and the fees in a geographic area to determine benefits under a dental benefit program.

    The amount charged by a dental benefit organization for coverage of a level of benefits for a specified time. A method of financing the cost of dental care for a defined population, in advance of receipt of services. The first set of teeth; see deciduous. The third party payer determined to have initial responsibility in a benefit determination.

    Also known as fair claims practice regulations. Enacted state by state, prompt payment laws set standards for the prompt, fair and equitable settlements of insurance claims by requiring that a set amount of interest be paid on "clean claims" that are paid beyond the established timeframe. These laws need to be analyzed on a case by case basis to determine whether a lawsuit has to be filed by the state department of insurance.

    Documentary evidence required by a payer to prove a valid claim exists. It usually consists of a claim form completed by the patient's treating dentist. Removal of plaque, calculus and stains from the tooth structures. It is intended to control local irritational factors. See preauthorization, precertification, predetermination, second-opinion program. Formed or preformed for temporary purposes or used over a limited period; a temporary or interim solution; usually refers to a prosthesis or individual tooth restoration.

    A dentist whose practice is limited to the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. Dental public health is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts.

    It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. Connective tissue that contains blood vessels and nerve tissue which occupies the pulp cavity of a tooth. See direct pulp cap ; indirect pulp cap. Complete removal of vital and non-vital pulp tissue from the root canal space.

    Removal of a portion of the pulp, including the diseased aspect, with the intent of maintaining the vitality of the remaining pulpal tissue by means of a therapeutic dressing. Organization or entity, often employer or union, that contracts with the dental benefit organization to provide dental benefits to an enrolled population. One of the four equal sections into which the dental arches can be divided; begins at the midline of the arch and extends distally to the last tooth.

    An appliance, designed to relate osteotomy or fixture position to existing anatomic structures. An image or picture produced on a radiation sensitive film, phosphorous plate, emulsion or digital sensor by exposure to ionizing radiation. Procedure used to encourage biologic root repair of external and internal resorption defects.

    Payment made by a third party to a beneficiary or to a dentist on behalf of the beneficiary, to offset expenses incurred for a service covered by the dental benefit plan. Insurance for third-party payers to spread their risk for losses claims paid over a specified dollar amount. Coded listing of professional services with unit values to indicate relative complexity as measured by time, skill, and overhead costs.

    Third-party payers typically assign a dollar value per unit to calculate provider reimbursement. Process of resurfacing the tissue side of a removable prosthesis with new base material. A removable partial denture is a prosthetic replacement of one or more missing teeth that can be removed by the patient. Resinous material of the various esters of acrylic acid, used as a denture base material, for trays or for other restorations.

    Application of a resin material engineered to penetrate and fill the sub-surface pore system of an incipient caries lesion to strengthen, stabilize, and limit the lesion's progression, as well as mask visible white spots. Refers to dental services offered within a retail, department or drug store operation. Typically, space is leased from the store by a separate administrative group that, in turn, subleases to a dentist or dental group providing the actual dental services.

    The dental operation generally maintains the same hours of operation as the store and appointments often are not necessary. Considered to be a type of practice, not a dental benefit plan model. A method of sealing the root canal by preparing and filling it from the root apex. A post-treatment assessment of services on a case-by-case or aggregate basis after the services have been performed.

    The act of revising; second or more surgical procedure for correction of a condition. A portion of provider fees or capitation payments withheld as financial reserves to cover unanticipated utilization of services in an alternative benefit plan. The anatomic portion of the tooth that is covered by cementum and is located in the alveolus socket where it is attached by the periodontal apparatus; radicular portion of tooth. The portion of the pulp cavity inside the root of a tooth; the chamber within the root of the tooth that contains the pulp. The treatment of disease and injuries of the pulp and associated periradicular conditions.

    A barrier technique used to prevent the passage of saliva or moisture, or to provide an isolated operative field. Exocrine glands that produce saliva and empty it into the mouth; these include the parotid glands, the submandibular glands and the sublingual glands. A listing of dental services and the maximum benefit amounts an insurer will pay for a given service. Specificity will vary by benefit plan. A resinous material designed to be applied to the occlusal surfaces of posterior teeth to prevent occlusal caries. An opinion about the appropriateness of a proposed treatment provided by a practitioner other than the one making the original recommendation; some benefit plans require such opinions for selected services.

    A benefit plan in which the plan sponsor bears the entire risk of utilization. Some plans may be partially self-funded, if the sponsor employs indemnified stop-loss insurance to protect against the risk of unanticipated higher utilization. Third party administrators may provide claims processing and other administrative services, without bearing any of the risk of utilization of the plan. Setting aside of funds by an individual or organization to meet anticipated dental care expenses or its dental care claims, and accumulation of a fund to absorb fluctuations in the amount of expenses or claims.

    The funds set aside or accumulated are used to provide dental benefits directly instead of purchasing coverage from an insurance carrier. Dental benefit organizations established under not-for-profit state statutes for the purpose of providing health care coverage, e. One of the six relatively equal sections into which a dental arch can be divided, for example: Sometimes used for recording periodontal charting. Inspection of the salivary ducts and glands by radiograph after the injection of a radiopaque medium. Surgical procedure by which a stone within a salivary gland or its duct is removed, either intraorally or extraorally.

    A term used to describe a single area, position, or locus. A passive appliance, usually cemented in place, that holds teeth in position. Supernumerary teeth are not yet identified using this standard. A device used to support, protect, or immobilize oral structures that have been loosened, replanted, fractured or traumatized.

    Also refers to devices used in the treatment of temporomandibular joint disorders. A system that examines the distribution of treatment procedures based on claims information. In order to be reasonably reliable, the application of such claims analyses of specific dentists should include data on type of practice, dentist's experience, socioeconomic characteristics, and geographic location. A general term referring to that category of coverage that provides insurance protection reinsurance to an employer for a self-funded plan.

    Plaster or stone model of teeth and adjoining tissues; also referred to as diagnostic cast. A permanent tooth that replaces a primary deciduous tooth. See benefit plan summary. Extra erupted or unerupted teeth that resemble teeth of normal shape. A list of covered services with an assigned dollar amount that represents the total obligation of the plan with respect to payment for such service, but does not necessarily represent the dentist's full fee for that service. Legislation Public Law affecting health maintenance organizations and the Medicare and Medicaid programs.

    Provides regulations for the development of HMO risk contracting with the Medicare program and, through amendment, established new provisions for the foundation and operation of peer review organizations. An interim prosthesis designed for use over limited period of time. The connecting hinge mechanism between the base of the skull temporal bone and the lower jaw mandible. Abnormal functioning of temporomandibular joint; also refers to symptoms arising in other areas secondary to the dysfunction.

    Of or pertaining to therapy or treatment; beneficial. Therapy has as its goal the elimination or control of a disease or other abnormal state. Also known as administrative agent, carrier, insurer or underwriter. Claims payer who assumes responsibility for administering health benefit plans without assuming any financial risk. An organization other than the patient first party or health care provider second party involved in the financing of personal health services.

    Material intended to be placed in contact with tissues, for a limited period, with the aim of assisting the return to a healthy condition. Portion of the Social Security Act that provides for federal grants to the states for medical assistance programs, commonly known as Medicaid. An X-ray technique that produces an image representing a detailed cross section of tissue structures at a predetermined depth.


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      • A space created by one or more missing teeth that has a tooth on each side. A bony elevation or protuberance of bone. A surgical procedure to create an opening in the trachea windpipe to aid in breathing. Relating to a passage or change from one position, state, phase or concept to another. Refers to a mixed dentition; begins with the appearance of the permanent first molars and ends with the exfoliation of the deciduous teeth. Surgical placement of biological material from one site to another.

      Transfer of a tooth from one socket to another, either in the same or a different person. Restricted ability to open the mouth, usually due to inflammation or fibrosis of the muscles of mastication. The separating of a dental procedure into component parts with each part having a charge so that the cumulative charge of the components is greater than the total charge to patients who are not beneficiaries of a dental benefit plan for the same procedure. A system that assigns a unique number from to permanent teeth, and a unique letter A-T for primary teeth.

      Also known as overcoding. Usual, Customary and Reasonable Fees: The extent to which the members of a covered group use a program over a stated period of time; specifically measured as a percentage determined by dividing the number of covered individuals who submitted one or more claims by the total number of covered individuals. Also, an expression of the number and types of services used by the members of a covered group over a specified period of time. A set of techniques used by or on behalf of purchasers of health care benefits to manage the cost of health care prior to its provision by influencing patient care decision-making through case-by-case assessments of the appropriateness of care based on accepted dental practices.

      A system that examines the distribution of treatment procedures based on claims information and in order to be reasonably reliable, the application of such claims analyses of specific dentists should include data on type of practice, dentist's experience, socioeconomic characteristics, and geographic location. A dental image with a central projection on which the teeth can close, holding it in a vertical position for the radiographic examination of several upper and lower teeth simultaneously.

      The vertical height of the face with the teeth in occlusion or acting as stops. Any of a series of surgical procedures designed to increase relative alveolar ridge height. A collection of specimen for the purpose of incubating a virus for identification. The period between employment or enrollment in a dental program and the date when a covered person becomes eligible for a given benefit.

      Glossary of Dental Clinical and Administrative Terms

      A wax form that is the positive likeness of an object to be fabricated. A benefit paid to an employee who suffers a work-related injury or illness. A general term for a fungus occurring as a. Some yeasts may reproduce by fission, many producing mycelia or pseudomycelia. Quadrangular bone on either side of face that forms the cheek prominence.

      A base font size A medium font size A larger font size. Glossary of Dental Clinical and Administrative Terms There are many terms used daily by dentists and their staff in the course of delivering care to patients, maintaining patient records and preparing claims. A tooth or implant fixture used as a support for a prosthesis. A secondary treatment in addition to the primary therapy. Referring to the bone to which a tooth is attached. Methods of Anxiety and Pain Control analgesia —the diminution or elimination of pain.

      Routes of Administration enteral —any technique of administration in which the agent is absorbed through the gastrointestinal GI tract or oral mucosa i. The diminution or elimination of anxiety. The tip or end of the root end of the tooth. Amputation of the apex of a tooth. B bad faith insurance practices: Occurring on, or pertaining to, both right and left sides. Process of removing tissue for histologic evaluation. A relatively narrow tubular passage or channel.

      Commonly used term for tooth decay. Material used under a filling to replace lost tooth structure. With over 25 years of experience in this fast paced and challenging field, Lori shares her experience and lets you in on the secrets of working in a medical office. Find out if this field is for you, and prepare yourself for a new career as a Medical Office Temp. Read more Read less. Kindle Cloud Reader Read instantly in your browser.

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      Glossary of Dental Clinical and Administrative Terms

      For someone currently performing medical billing with many years experience it does not encompass the information I require. It could be used for new hires possibly. One person found this helpful 2 people found this helpful. Vague and shallow Not detailed enough and it seems to be widowed. There should be references suggested for readers that wants to expand or go deeper into the subject matter.

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