Dental Insurance plans / Vision Insurance plans Illinois
Dentists use a lot of terms to describe problems and procedures. They would be glad to explain any term you don’t know, of course, but here are a few:
ABSCESSAcute or chronic localized inflammation with a collection of pus, associated with tissue destruction and, frequently, swelling.ABRASIONTooth wear caused by forces other than chewing, such as improper brushing.ABUTMENTA tooth or implant used to support an artificial device replacing teeth.ACID ETCHINApplying an acid to the tooth-enamel surface to provide retention for bonding.ALLOPLASTIC
Synthetic material used for tissue augmentation.
The bone to which a tooth is attached.
The recontouring of bone structures, usually in preparation for a prosthesis.
A mixture of mercury, silver, tin, and copper used to fill cavities.
Loss of pain sensations without loss of consciousness.
Removal of sensation. General anesthesia: a controlled state of unconsciousness. Local anesthesia: drug-induced elimination of sensation in one part of the body.
The teeth and tissues located towards the front of the mouth.
The most a dental plan will pay toward your dental care within a specific period, usually a calendar year.
The tip or end of the root end of the tooth.
Amputation of a tooth apex (root tip).
Upper or lower jaw.
Separation of tooth from its socket due to trauma; scientific term for “having a tooth knocked out.”
A metal ring orthodontists cement to a tooth as part of the bracing process.
The practice of billing a patient for the difference between what the dentist charges and the agreed-upon charge established by Delta Dental. In-network dentists cannot balance-bill patients.
Dental treatments are grouped into levels. The percentage covered by your dental plan often varies by benefit level. Most plans include the following benefit levels:
Usually includes exams, cleanings, X-rays and fluoride treatments.
Usually includes procedures such as fillings, root canals, periodontal (gum) treatment and simple tooth extractions.
Usually includes procedures such as crowns, dentures and implants.
Dental services that are required immediately to avoid jeopardizing the patient’s health, or to relieve pain, swelling or bleeding.
Treatment and procedures used to correct misaligned or crooked teeth. May include braces, retainers and other orthodontic appliances.
The 12-month period your dental plan covers, which is not always a calendar year. For example, a benefit year could run June-May instead of January–December. This is also known as a plan year.
A tooth with two cusps, usually a premolar tooth.
Process of removing tissue for evaluation.
A side-view mouth X-ray.
A composite resin that changes the shape or color of a tooth.
A fixed partial denture replacing one or more missing teeth. Bridges can be fixed or removable.
Grinding and/or clenching of teeth.
Pertaining to or around the cheek.
CALCULUSHard mineralized plaque attached to crowns and/or roots of teeth.CANALThe space inside the root portion of a tooth containing pulp tissue; the passage which transmits vessels and nerves through the jaw.CANTILEVER EXTENSIONPart of a fixed prosthesis supported at one end only.CARIESTooth decay.CAVITY
Decay in tooth caused by caries; also referred to as carious lesion.
Material used under a filling to replace lost tooth structure.
Hard connective tissue covering the tooth root.
A full-head X-ray.
CERTIFICATE OF COVERAGE
A booklet you receive from Delta Dental that explains your benefits coverage in detail.
Information the dentist submits to the dental plan to get paid for services performed on a patient.
Congenital deformity resulting in lack of fusion of the soft and/or hard palate.
The clamping and pressing of the jaws and teeth together, frequently associated with psychological stress or physical effort.
The repositioning of a fractured bone without surgery.
A fixed percentage of a dental treatment cost that you share with your dental plan. For example, Delta Dental may pay for 80 percent of a given service, while you are responsible for 20 percent. Coinsurance kicks in after you meet your deductible.
A dental restorative material.
A broken bone exposed to external contamination.
COORDINATION OF BENEFITS
Guidelines that determine how each dental plan pays when you are covered by more than one dental plan.
A set dollar amount you are required to pay your dentist for a service. An enrollee usually has a copayment or coinsurance, but not both. (Also known as “copay.”)
A thin covering of a tooth crown applied as part of a restoration.
The crown of a tooth.
A dental treatment or procedure paid for – either partially or fully – by your dental benefits.
A process to ensure a dentist is properly trained to treat patients before being able to be a part of Delta Dental’s networks.
A restoration that covers or “caps” a tooth to restore it to its normal shape and size. Anatomical crowns: The normal enamel covering of a tooth. Abutment crown: An artificial crown that supports a dental prosthesis. Artificial crown: A restoration that covers most or all of a tooth crown. Clinical crown: The part of a tooth not covered by supporting tissues.
Scraping or cleaning the walls of a cavity or gingival pocket.
An extruded part of the chewing surface of a tooth.
A cavity containing fluid or soft matter.
DEBRIDEMENTRemoval of plaque, calculus and/or tissue.DECAYCarious lesions in a tooth resulting in decomposition of tooth structure.DECIDUOUSUsed to describe primary (baby) teeth.DEDUCTIBLEA set dollar amount you are responsible for before your dental plan begins to pay for covered services.DENTAL PROPHYLAXIS
Scaling and polishing procedure that removes plaque, calculus, and stains.
The part of the tooth beneath enamel and cementum.
The teeth in the dental arch. Permanent dentition refers to permanent teeth; deciduous dentition refers to deciduous (baby) teeth.
An artificial substitute for natural teeth and adjacent tissues.
The part of a denture that contacts soft tissue and holds the artificial teeth.
Anyone covered under a dental plan other than the primary subscriber. For example, a spouse or children.
DHMO (DENTAL HEALTH MAINTENANCE ORGANIZATION)
Also referred to as pre-paid plans, DHMOs require you to choose one dentist or dental facility for all of your oral health needs. These plans don’t have deductibles or maximums. An enrollee pays a fixed dollar amount (copayment) to the dentist at visits. Delta Dental’s DHMO plan is called DeltaCare® USA.
Plaster or stone model of teeth and adjoining tissues; also referred to as study model.
A space, often used to refer to a space between adjacent teeth.
DIRECT PULP CAP
Covering exposed tooth pulp with a dressing or cement.
An option for individuals and families that do not have dental benefits. Enrollees have access to dentists who have agreed to charge discounted fees for certain services. Patients pay the agreed-upon fee directly to the dentist. A discount card/plan is not insurance.
Partial loss of a tooth due to trauma.
Toward the back of the dental arch.
Inflammation of the tooth socket following a tooth extraction.
Coverage under two separate dental plans — for instance, if a child is covered by dental plans from both parents. Also see “Coordination of Benefits.”
EDENTULOUSWithout teeth.EFFECTIVE DATE
The date you can start using your dental benefits plan.ENAMELHard calcified tissue covering dentin of the crown of tooth.ENDODONTISTA dental specialist who treats disease and injuries of the tooth pulp. A patient who needs a root canal may be treated by an endodontist.ENROLLEEA person covered under a dental plan.
Reshaping the biting surfaces of teeth to create proper adjustment and alignment.
Periodic oral evaluation: a regular dental checkup. Limited oral evaluation — problem-focused: an exam limited to a specific oral-health problem. Comprehensive oral evaluation: a thorough evaluation of hard and soft tissues. Detailed and extensive oral evaluation — problem-focused, by report: a detailed and extensive problem-focused evaluation.
Complete separation of the tooth from its socket due to trauma (avulsion). A knocked-out tooth.
Surgical removal of bone or tissue.
Dental services or procedures not covered by your dental plan.
EXPLANATION OF BENEFITS (EOB)
A document Delta Dental provides after a procedure. It contains a summary of the treatments you received, including the treatment cost, the portion covered by your dental plan, and the portion you may owe. An EOB is not a bill.
A byproduct of inflammation or necrosis (death of tissue) containing fluid, cells, and/or other debris.
The surface of a tooth directed toward the face.
A list of charges for specific dental treatments agreed to by both the dental plan and the dentist.
The restoring of lost tooth structure using materials like metal, alloy, plastic, or cement.
In dentistry, the breaking of a tooth.
Muscle fibers covered by a mucous membrane that attach the cheek, lips and/or tongue to associated structures.
The area of a multirooted tooth where the roots diverge.
A primary dental care provider with a broad range of general oral health expertise. General dentists perform preventive care as well as many restorative procedures such as fillings, crowns, implants and more.
The soft tissues overlying the crowns of unerupted teeth and encircling the necks of erupted teeth.
The removal of gingiva.
A company or organization that provides dental benefits to its employees or members. The group works with Delta Dental to select the plan type, benefit levels, maximums and member eligibility.
Surgical separation of a multirooted tooth so that one root and/or the overlaying portion of the crown can be surgically removed.
Made up of tissue not normal to the part.
Stands for the “Health Insurance Portability and Accountability Act of 1996,” a federal law intended to improve access to health coverage, limit fraud and abuse, protect personal health information (PHI), and control administrative costs.
A licensed dental professional who assists or performs procedures such as screenings, X-rays and cleanings. The range of services hygienists can perform varies from state to state.
Includes, but is not limited to, CAT scans, MRIs, photographs, and X-rays.
Prosthesis that is placed immediately after removing natural teeth.
An unerupted or partially erupted tooth that is blocked from surfacing by another tooth, bone, or soft tissue.
A device placed surgically in bone as support for a prosthesis.
Placement of an artificial or natural tooth into a socket.
INDIRECT PULP CAP
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.
INDIVIDUAL AND/OR FAMILY PLAN
Dental plans that individuals and their families can purchase directly from Delta Dental rather than through an employer.
A dental restoration made outside of the mouth and then applied to a tooth.
A dentist who has agreed to be part of a Delta Dental network. In-network dentists agree to accept pre-established fees for services.
The intentional removal, repair and replacement of a tooth into its socket.
Between the adjoining surfaces of adjacent teeth.
Within the crown of a tooth.
Inside the mouth.
A common name for either the maxilla or the mandible.
LABIALPertaining to or around the lip.LESIONAn injury or wound; area of diseased tissue.LIFETIME MAXIMUMThe maximum amount a plan will pay over the course of a lifetime. The lifetime maximum may apply to an individual or a family and usually applies to specific treatments such as orthodontia.LIMITATIONSConditions, such as age and period of time covered, that restrict a dental plan’s coverage for certain services.LINE ANGLE
Used to designate the junction of two tooth surfaces or two walls of a tooth-cavity preparation.
Pertaining to or around the tongue.
Therapy for preserving the health of the periodontium.
Pertaining to the cheek bone.
Improper alignment of biting or chewing surfaces.
A type of dental plan where participating dentists agree to fee schedules that can provide discounts for dental care. Delta Dental’s managed fee-for-service option is called Delta Dental Premier®.
The upper jaw.
See “Annual Maximum.”
MAXIMUM PLAN ALLOWANCE (MPA)
The amount set by Delta Dental that a Delta Dental Premier® dentist has agreed to charge for a service.
Toward the midline of the dental arch.
Teeth back of the premolars (bicuspids) on either side of the jaw; grinding teeth, having large crowns and broad chewing surfaces.
A wax or plaster cast-mold reproduction of the face.
NATIONAL PROVIDER IDENTIFIER (NPI)
A unique identification number used to identify a health care professional as an alternative to their dental license number.
Dentists who have signed up with Delta Dental to provide dental care at agreed-upon fees.
A graft from a donor other than the patient.
See “Out-of-Network Dentist.”
A prosthesis that closes an opening in the palate.
An X-ray where the film is held between the teeth.
Any contact between biting or chewing surfaces of maxillary (upper) and mandibular (lower) teeth.
A restoration made outside the mouth that replaces a tooth cusp or cusps.
The period of time in which employees or qualified individuals can enroll in or make changes to benefit plans.
Procedures not covered under the terms of a dental benefits contract. Delta Dental will review claims for optional services to determine what, if any, amount will be paid for the service.
Pertaining to the mouth.
ORAL MAXILLOFACIAL RADIOLOGIST
A dental specialist who performs and reads diagnostic imagery (such as X-rays, CT scans and ultrasounds) used to examine bones in the skull and face, as well as dental structures.
A dental specialist trained to diagnose dental diseases.
A dental specialist trained to perform dental surgeries such as wisdom teeth removal, dental implants and more.
A dental specialist who treats the misalignment of the teeth and their surrounding structures, using appliances such as braces and retainers.
Surgical procedure that modifies the bones in the jaws.
Surgical cutting of bone.
A dentist who has not signed up to participate with Delta Dental.
Prosthetic device supported by retained teeth roots or implants.
The hard and soft tissues forming the roof of the mouth.
Action that relieves pain.
An X-ray that shows the entire upper and lower mouth and jaw on a single film.
A prosthetic device that replaces missing teeth, designed to be removed by the patient.
See “In-Network Dentist.”
An individual who has established a professional relationship with a dentist for the delivery of dental care.
A dental specialist who treats children; formerly known as a pedodontist.
The area surrounding the end of the tooth root.
An X-ray made by placing film inside the mouth.
Around the crown of a tooth.
Pertaining to the supporting and surrounding tissues of the teeth.
Inflammation of the gingival tissues and/or periodontal membrane.
A deepened gingival fissure; a feature of periodontal disease.
A dental specialist who treats diseases of the supporting and surrounding tissues of the teeth. Patients with periodontal (gum) disease are treated by a periodontist.
Inflammation and loss of the connective tissue of the surrounding structure of teeth.
Surrounding a portion of the root of the tooth.
See “Benefit Year.”
A soft sticky substance, composed largely of bacteria, that accumulates on teeth.
The artificial tooth on a fixed partial denture (bridge).
A metallic projection cemented within a prepared root canal to strengthen and retain restorative material.
Teeth and tissues towards the back of the mouth – i.e., premolars and molars.
PPO (PREFERRED PROVIDER ORGANIZATION)
A dental plan in which participating dentists agree to fee schedules that provide deeper discounts and lower out-of-pocket expenses. Delta Dental’s PPO options are called Delta Dental PPOSM and Delta Dental PPO plus Premier.
See “Pre-Treatment Estimate.”
The amount set by Delta Dental that an in-network dentist has agreed to charge for a service.
The use of medications prior to dental procedures.
A treatment plan usually submitted by a dentist for Delta Dental to review and provide an estimate of benefits before treatment starts. Pre-treatment estimates can help you budget for dental procedures. They can also help you and your dentist decide how to proceed with a treatment. This is sometimes referred to as Pre-Authorization.
The amount the enrollee pays for dental benefits, usually paid monthly, quarterly or annually.
The first set of teeth.
Clinical guidelines to validate that a dental treatment or procedure meets the criteria set by your dental plan. Processing policies may change occasionally. If a processing policy is applied to a billed service, it will be explained on the Explanation of Benefits (EOB).
A scaling and polishing procedure that removes plaque, calculus and stains.
Artificial replacement of any part of the body. Dental prosthesis: any device or appliance replacing one or more missing teeth and/or associated structures. Types of prostheses include: definitive prosthesis — a prosthesis to be used over an extended period of time; fixed prosthesis — non-removable tooth-borne dental prosthesis; interim prosthesis — a provisional prosthesis designed for use over a limited period of time; removable prosthesis — dental prosthesis designed to be removed and reinserted by the patient.
A dental specialist who restores natural teeth and replaces missing teeth with artificial substitutes, like implants or dentures.
PROTECTED HEALTH INFORMATION (PHI)
Personal information about a patient, such as a Social Security number and medical history, which is required to be stored securely by health care entities such as a doctor, dentist, health clinic or health insurer.
See “Dental Professionals.”
A temporary prosthesis or individual tooth restoration.
The connective tissue containing blood vessels and nerves that occupies the pulp cavity of a tooth.
The space within a tooth containing the pulp.
Complete removal of pulp tissue from the root-canal space.
Inflammation of the pulp.
Surgical removal of a portion of the pulp with the aim of saving the remaining pulp.
One of four equal sections into which the dental arches are divided.
Pertaining to the root.
Refitting a denture by replacing the base material.
The return of a tooth to its socket.
The process of resurfacing the tissue side of a denture with new material.
A device used to stabilize teeth.
The portion of the tooth that is covered by cementum and located in the alveolus (socket).
The chamber within the root of the tooth that contains the pulp.
The treatment of disease and injuries of the pulp and associated conditions.
A procedure designed to remove microbial flora, bacterial toxins, calculus, and diseased cementum or dentin on the root surfaces and in the pocket.
Removal of plaque, calculus, and stains from teeth.
Surgical procedure to repair and/or restore a portion of a salivary-gland duct.
X-rays of the salivary ducts and glands.
Surgical procedure to remove a stone within a salivary gland or its duct.
A dentist who concentrates on one discipline, such as pediatric dentistry, orthodontia or prosthodontics.
A device used to support, protect, or immobilize oral structures that have been loosened, replanted, fractured, or traumatized.
Inflammation of the mouth membranes.
Part of a tooth-borne and/or tissue-borne prosthesis designed to relieve the abutment teeth and their supporting tissues from stress.
Plaster or stone model of teeth and adjoining tissues; also referred to as diagnostic cast.
A person who has signed up for dental coverage from Delta Dental. If family coverage is offered, additional people covered will be listed as the subscriber’s spouse or dependents.
A stitch used to repair an incision or wound.
TEMPORARY REMOVABLE PARTIAL DENTURE
An interim prosthesis.
TEMPOROMANDIBULAR JOINT (TMJ)
The hinge between the mandible (lower jaw) and base of the skull (temporal bone).
TEMPOROMANDIBULAR JOINT DYSFUNCTION
Abnormal functioning of the TMJ.
The date your dental benefits coverage ends or you are no longer eligible for benefits.
Material placed in contact with tissues for a limited time to help the tissues heal.
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.
Tooth/teeth that have not penetrated into the oral cavity.
VENEERA layer of tooth-colored material attached to the tooth surface. Veneers may be made of porcelain, ceramic, composite, or acrylic resin.
A dental benefits plan offered through an employer where employee participation is optional. Employers usually don’t help cover the cost of the plan but still allow employees to enjoy pre-tax savings on premiums through payroll deduction.
A period of time before you are eligible to receive benefits for all or certain dental treatments.
Decreased salivary secretion that produces a dry and sometimes burning sensation and/or tooth decay.
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