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Dental Insurance Dictionary

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Basic dental services

An umbrella term for dental services that generally include exams, x-rays, polishing, scaling, root planing, endodontic services and tooth removal.

Bitewing x-rays

A type of x-ray that you bite down on, that is usually taken every six to nine months with your recall visits. You bite on the film and the dental professional takes an image. The image shows tooth decay, cavities, and bite alignment.

Bridges

When there is a gap in your mouth due to a missing tooth, a prosthetic is placed in your mouth. A false tooth fills the gap and is fastened to the surrounding teeth. This differs from a partial denture in that a bridge is permanently fixed while a denture can be removed. Bridges are considered a major dental service and a pre-treatment plan should be sent in beforehand.

Co-Payments

The remaining amount after your insurance has paid a portion. If your plan pays 80%, your co-payment is the remaining 20%.

Crowns

A cap that covers the remains of your damaged tooth, restoring its function. Crowns are considered a major dental service and a pre-treatment estimate should be sent in advance.

Dentures

The replacement of one tooth, several, or all teeth using a prosthetic device. Partial dentures are meant to replace one or several teeth, while a full denture replaces all of the teeth. Dentures are a major dental service and a pre-treatment plan should be sent in prior to service.

Endodontic Services

The treatment of dental pulp, includes root canals and other services that involve the inside of the tooth.

Extractions

The removal of teeth. Your dentist will numb the area and depending on your situation, may use anesthesia. Extractions are considered under the basic dental service umbrella, unless your wisdom teeth are being removed, in which case a specialist comes into play.

Fee Guide

A list of suggested fees for every single dental service that is released annually. Most dentists abide by this guide or at least keep their fees as low as possible. Your plan may indicate a specific year edition of the guide that your claims will be paid against.

Fluoride

A mineral that helps your teeth resist decay. This treatment is usually covered only for dependent children under the age of 18.

Implants

A several-phase procedure where a screw-in prosthetic tooth is placed in a gap in the mouth. A metal post is implanted into the gums for the tooth to screw into. Implants are a major dental service that is not covered by most if not all individual dental insurance plans. An estimate is required before treatment.

Major Dental Services

Any service that replaces a missing tooth or requires extensive or complex oral surgery. This includes crowns, bridges, dentures, implants and others, depending on your insurance plan. Major dental services are usually payable at 50%-60%. An estimate must always be sent before any major service is performed.

Orthodontics

Also known as braces, orthodontia is the branch of dentistry in which crooked teeth are straightened with wires and brackets, as well as invisalign mouth guards. This method is also used to correct your bite. Orthodontic services are covered separately from your regular dental plan. Not all individual dental plans include this, and most will have a lifetime maximum paid at a percentage. A pre-treatment plan must be submitted before you have anything done.

Panoramic X-Ray

An x-ray image showing all of your teeth. This is the most effective x-ray in determining most major dental treatment, such as crowns, dentures and bridges. This x-ray is eligible under your basic dental services every 3-5 years.

Pit and Fissure Sealants

These are like pre-fillings, used to seal the teeth, preventing further damage. This treatment is used solely on children, and is more common in children who lack tooth enamel. It is considered a basic dental service under your dental insurance plan.

Polishing

After your hygienist gives you scaling treatment, they will polish your teeth with a buffing instrument and toothpaste. One unit of time is fifteen minutes. Most dental plans allow one unit every 6-9 months.

Premiums

The amount of money that you pay every month to keep your insurance policy active. This payment must be made on time every month or your plan will terminate.

Pulpotomy

Your teeth contain pulp, keeping your teeth vital and in good health. When the pulp becomes damaged it sometimes needs to be removed. A pulpotomy is the removal of some of the pulp with the aim to save the remaining amount. This is a comprehensive basic service, which is covered under the comprehensive basic dental service provision.

Restorations

Also known as fillings. When your teeth have cavities they must be filled with either a metal or tooth-coloured composite resin. Many plans cover tooth-coloured restorations on molars.

Root Canal

When your tooth is badly decayed or infected, a root canal is used to save the tooth. The nerve and pulp of the tooth are removed and the area is sealed. A root canal is usually a precursor to getting a crown. Root canals are a comprehensive basic dental service.

Root Planing

Very similar to scaling, root planing is the removal of plaque from the teeth using a sharp instrument, but it delves deeper than regular scaling. The hygienist focuses on the area around the gums. This is a comprehensive basic dental service. Your plan will have a maximum on the number of units you may have per year. A unit of time is fifteen minutes.

Scaling

A periodontal treatment where your hygienist scrapes tartar off your teeth with a sharp instrument. A unit of time is fifteen minutes. Your insurance plan will cover 6-8 units of time per year.

Tooth Bleaching

The professional whitening of teeth. This is almost always considered a cosmetic service and is not eligible for reimbursement. However, if the bleaching needs to be performed as the result of endodontic treatment, it may be considered.

Veneers

Very thin covers placed on your teeth, fixing cracks, cavities and decay. These are also used to protect the tooth from further damage. Veneers are mostly considered cosmetic and an estimate must be submitted first. They generally are not covered by most insurance plans.

2 Responses

    1. Yes, any time your dental procedures are anticipated to be over $300, the insurance companies ‎all want a pre-estimate. This is also good practice so you know exactly how much the insurance company will pay for the services and no surprises arise when the final bill comes.

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