Glossary

A
Abutment:: A tooth or root that supports a fixed bridge or removable prosthesis.
Adjunctive General Services:: Important procedures that do not neatly fit into any of the other categories of services. Procedures within this category can include emergency palliative treatment, anesthesia, professional consultations, drugs or miscellaneous services such as bleaching.
Allowable Expense:: A monetary amount allowed according to your benefits plan.
Amalgam:: An alloy of mercury, silver and other metals, used as a restorative material.
Alternate Benefit:: A provision in a dental plan contract that allows payment of benefits based upon a less costly service when two or more dental treatments for a dental condition exist; provided that the less costly service would produce a professionally acceptable result under generally accepted dental standards; and would qualify as a covered service under the dental plan.
Anterior:: Refers to teeth located in front, cuspids or eyeteeth, and forward.
Arch:: The curved structure of the natural teeth. There are two arches in your mouth: the maxilla (maxillary) and the mandible (mandibular).
Adolescent Dentition:: Refers to the stage of permanent dentition prior to cessation of growth.
B
Benefit Paid:: The amount reimbursed to Payee as benefit for covered services.
Benefit Period:: The time defined by the dental benefit plan in regards to your benefits.
Bicuspid:: Most people have eight bicuspid teeth. They are located immediately preceding the molar teeth with two in each quadrant of the mouth.
Birthday Rule:: The Birthday Rule states that the plan of the parent whose birthday (excluding the year) is earlier in the year is primary for child. If both parents have the same date of birth (excluding the year), the plan with the earlier effective date is primary. MetLife adopted the NAIC (National Association of Insurance Commissioners) Birthday Rule approach to coordination of benefits for all cases on January 1, 1987. The Birthday Rule is gender-neutral, non-discriminatory and nationally uniform. All states have now also adopted this rule.
Bitewing:: A type of x-ray, where the patient bites on a special holder with dental film. This type of x-ray discloses cavities between the teeth and the levels of the bone.
Bleaching:: The cosmetic procedure of tooth whitening.
Bonded Teeth:: Teeth that have been restored with composite or resin fillings.
Bridge:: A replacement for one or more missing teeth that is permanently attached to the teeth adjacent to the empty space(s).
Bruxism:: A clenching or grinding of teeth with forceful jaw movements. This usually occurs during sleep.
C
Calculus:: Tartar (hardened dental plaque).
Caries:: Decomposed tooth structure also known as decay or cavities.
Cast High Noble Metal Crown:: A crown restoration that is fabricated by means of being cast using precious or semi-precious metal, usually gold.
Cavities:: Decomposed tooth structure also known as decay or dental caries.
Claim Year:: The year in which the listed dental services took place.
Co-insurance:: The percentage amount of a covered dental expense that you are responsible for after your deductible is met.
Composite:: A plastic restorative material; also called a resin.
Coordination of Benefits (COB):: This provision outlines how a plan will pay benefits when a patient is covered by more than one dental benefits plan.
Co-payment (DHMO):: Refers to the amount in the Schedule of Benefits for covered services that the participant is required to pay at the time of treatment.
Covered Expenses:: The maximum allowable amount that your plan will consider for services.
Credentialing:: This is the process used to select and retain dentists for the MetLife PPO and DHMO networks. Following the review of information on the application form that is submitted by a dentist, the state license, Drug Enforcement Agency Certificate and malpractice coverage are verified.
Crown:: The anatomical portion of the tooth above the gumline; restoration that replaces the entire tooth above the gumline, sometimes called a cap.
Crown Repair:: The repair of an existing crown which is usually the replacement of fractured porcelain.
D
Date of Service:: The date(s) service(s) or procedures took place.
Decay:: Decomposed tooth structure also known as dental caries or cavities.
Deductible Applied:: The amount you must pay before benefit payments will be made by the plan during each benefit period. Family deductibles are typically a multiple of an individual deductible. Deductibles may be waived for certain types of services (such as preventive care).
Dental Health Maintenance Organization (DHMO):: This type of plan provides in-network benefits only. Enrolled members pre-select a primary care dentist from the Find a Dentist directory and visit that dentist for all dental services. There are typically no calendar year maximums, deductibles, waiting periods, or claim forms. Patient co-payment is required for certain procedures.
Dental Preferred Provider Organization (DPPO):: The dental benefits program featuring the MetLife Preferred Dentist Program. Dentists participating in the program agree to accept negotiated fees as payment in full for covered services rendered to plan participants. MetLife's negotiated fees with participating dentists may extend to services not covered under the plan and services received after the plan maximum has been met, where permitted by applicable state law.
Dentition:: The teeth in the dental arch.
Deciduous (Primary) Dentition:: Refers to the deciduous or primary teeth in the dental arch.
Denture:: A removable prosthesis replacing missing teeth.
Dependent:: A spouse and/or child covered under your dental benefits plan. Dependent eligibility and coverage vary by plan.
Diagnostic:: Procedures necessary to recognize and identify any condition (and its causes) that may be a departure from normal. Diagnostic procedures provide your dentist with the information needed to determine the appropriate care for you, and may include exams, x-rays, tests or photographs.
E
Effective Coverage Period:: The time period your dental benefits coverage is in force.
Effective Date:: The date your dental benefits coverage begins.
Elevation:: The loosening of teeth as part of an extraction.
Endodontics:: Procedures that deal with the diagnosis and treatment of diseases associated with the tooth pulp or nerve within your tooth and the area around the root tip. The most common endodontic procedure is Root Canal Therapy. In many cases, by having Root Canal Therapy you will be able to save a tooth that otherwise might be lost.
Endosteal:: To place a structure within the bone. This generally refers to the placement of dental implants.
Erupted Tooth:: A tooth that has broken through the gum tissue.
Exposed Root:: Area of the root of a tooth that is naturally below the gumline but has been uncovered.
Extraction:: Removing a tooth from the mouth.
F
Fee:: The amount charged by the dentist for each procedure.
File Reference Number:: The number assigned to identify each specific claim.
Fissures:: A groove or defect in the surface of a tooth.
Fixed Bridge:: The replacement of a missing tooth or teeth with a combination of abutments and pontics. Abutments go on existing teeth on either side of the missing tooth. Pontics replace the missing teeth. These are permanently cemented in the mouth and are removable only by a dentist.
Flap Entry and Closure:: A step within surgical procedures to open the gums and close, usually with sutures.
Fluoride:: Is used to prevent dental cavities. Fluoride may be in a liquid, paste, foam or tablet form. Fluoride treatment is more commonly provided to children because their enamel is more porous than adults and more susceptible to absorbing the fluoride. Fluoride aids in hardening the enamel and building up immunity to cavities. Fluoride may, in certain areas, be provided through community drinking water.
Forceps:: Special tools or instruments used in oral surgery procedures or extractions.
Full-Mouth X-ray/ Panorex X-ray:: X-rays of a patient's full mouth, as either individual x-rays (full mouth series) or one film (panoramic or Panorex).
G
General Anesthesia:: Renders a patient unconscious while the doctor supports their respiratory and other life-sustaining functions during and after treatment.
H
Health Insurance Portability and Accountability Act (HIPAA):: HIPAA is a federal law that was passed in 1996. The privacy rules and security rules of HIPAA set national standards for protection, security, and privacy of personal health information. Learn more about MetLife's privacy policies.
High Noble Metal:: The metals used in fabrication of restorations that are comprised of precious or semi-precious metals, usually gold.
I
Impacted Tooth:: A tooth that is below the gum tissue, bone or both.
Implant Services:: Completed to replace missing teeth with artificial components that function as natural teeth. Implants require at minimum two phases, surgical and restorative. Your regular dentist may place the implants or he/she may refer you to a specialist (Periodontist or Oral Surgeon).
Incisal:: Refers to the cutting edge of anterior teeth.
Inlay:: A cast restoration made to fit a prepared cavity and then cemented in place.
In-network:: Refers to oral health providers and facilities who participate in a MetLife network and the services that network provides.
Intraoral:: Within the oral cavity or mouth.
L
Lifetime:: The time defined by the life of your dental plan. It usually ends upon termination, changing of plan, or death.
Limitations:: The conditions stated in a dental benefit contract, such as age, frequency limitation, length of time covered, and waiting periods, that 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.
M
Managed Dental Plan:: This type of benefits plan provides in-network benefits only. Enrolled members pre-select a primary care dentist from the ‘Find a Dentist’ directory and visit that dentist for all dental services. There are typically no annual maximums, deductibles, waiting periods or claim forms. Patient co-payment is required for certain procedures.
Mandibular:: Refers to the lower jaw.
Maxillary:: Refers to the upper jaw.
Member:: An individual enrolled in the dental plan.
Metallic:: Relating to, or having characteristics of, a metal; containing metal.
Met-to-Date:: The monetary amount of your deductible that has been paid to date defined by your coverage period.
Mucosa:: Refers to the soft tissues of the mouth.
N
Negotiated/ Network Fee:: The negotiated fee that participating dentists in your area have agreed to accept as payment-in-full for covered services. Your out-of-pocket costs should never be more than the difference between this amount and the plan benefit for all covered services. If you receive services from a participating dentist that are not covered under your plan or that occur after the maximum has been met, in states where permitted by law, you may only be responsible for the negotiated fee.
Non-participating Provider:: A dentist who does not participate in the MetLife Preferred Dentist Program and/or the Dental HMO/ Managed Care network.
O
Occlusal:: The term used to indicate the biting surface of posterior teeth.
Onlay:: A cast restoration that covers the incisal or occlusal surface of a tooth made to fit a prepared cavity and then cemented in place.
Oral and Maxillofacial Surgery:: Deals with the diagnosis and surgical management of oral diseases, injuries, and defects of the jaws and associated structures. The most common oral surgery procedure is the extraction or removal of a tooth. Your regular dentist may perform oral surgery or refer you to a specialist (Oral Surgeon). Some surgical procedures may need to be completed in a hospital environment.
Oral Evaluation:: Is also known as an examination (exam) of the mouth, both hard and soft tissues.
Oral Surgery:: Is surgery involving the mouth; can include tooth extractions, removal of cysts and tumors, etc.
Orthodontic Lifetime Maximum:: The maximum monetary amount defined by your plan for orthodontic benefits.
Orthodontics:: Deals with the study and supervision of the growth and development of teeth. Orthodontic services include the preventive and corrective treatment for irregularities in the alignment of teeth and supporting structures. Orthodontic treatments may include braces or retainers. Treatment can be performed on baby teeth, permanent teeth or a combination (mixed dentition).
Osseous tissue:: Bone tissue.
Out-of-network:: Refers to oral health providers and facilities who participate in a MetLife network and the services that network provides.
P
Palliative:: A procedure that relieves pain but does not cure; sometimes referred to as emergency treatment.
Participating Provider:: A dentist who participates in the MetLife Preferred Dentist Program and/or Dental HMO/ Managed Care networks.
Pathology:: The branch of medical science that deals with diseases, with special emphasis on the functional and material changes that disease causes.
Payee:: Indicates the payment recipient. If payment is made to the patient, they are considered the payee.
Payment date:: The date the applicable dental claim payment was processed.
Periodontal:: Refers to the area of the gums and other structures surrounding the teeth.
Periodontal Charting:: The recording or charting of the depth between the level of the bone and the margin of the gum tissue.
Periodontal Cleaning:: The periodic evaluation of a person who has received periodontal treatment. It includes an exam, pocket charting, scaling and tooth polishing.
Periodontal Scaling and Root Planing:: The non-surgical treatment of active periodontal disease; a deep cleaning focused on the surface of the root of the tooth below the gumline.
Periodontal Surgery:: Involves surgical correction of periodontal disease. This surgery may involve the gums and/or the bone that supports the teeth.
Periodontics:: Deal with prevention, diagnosis and treatment of the diseases of the surrounding and supporting structures of your teeth, usually your gums. Both surgical and non-surgical procedures may be recommended.
Plan Benefit:: The percentage and calculated dollar amount at which the covered expense is payable.
Plan Deductible:: The monetary amount you are responsible for before benefit payments are considered; a set amount defined by your plan to be paid before any benefit reimbursements are realized.
Plan Maximum:: The total monetary amount available to you set by your benefit plan within a given coverage period.
Pocket Charting:: The recording or charting of the depth between the level of the bone and the margin of the gum tissue.
Pontics:: The false teeth that are connected to the abutments; the part of a fixed bridge that replaces the missing tooth or teeth.
Porcelain:: A tooth colored material that has the appearance of enamel.
Posterior:: Refers to all teeth located behind the cuspids or eyeteeth; any tooth with an occlusal surface.
Pre-authorization:: The approval required by the dental plan before visiting a participating provider or specialist.
Pretreatment Estimate:: An estimate of dental benefits detailing what services may be covered and at what payment level. A pretreatment estimate takes place upon request prior to receiving treatment.
Preventive:: The procedures that help you avoid, intercept, or minimize diseases of the mouth. These procedures may include cleanings, fluoride treatments, instruction and counseling, sealants, and space maintainers.
Primary Teeth:: The first set of teeth (also known as baby teeth).
Processed claim:: Means the claim has been processed.
Processed Date:: The date your claim was processed.
Prophylaxis:: The cleaning of your teeth by scaling and polishing.
Prosthesis:: An artificial replacement for one or more natural teeth and/or associated structures.
Prosthodontics (Fixed):: May include bridges (a series of connected crowns to replace any missing natural teeth). Fixed bridges contain two different types of parts: pontics and abutments.
Prosthodontics (Removable):: May include dentures (both full and partial) to replace any missing natural teeth. Removable prosthodontic devices may also include those that replace tissues of the face and head, for example an artificial nose or ear. These devices are called Maxillofacial Prosthetics.
Prosthodontics:: The restoration of natural and/or the replacement of missing teeth with artificial substitutes.
Permanent Dentition (adult dentition):: Refers to the permanent teeth in the dental arch.
Q
Quadrant:: Refers to one of the four equal sections into which your mouth can be divided.
R
Reasonable and Customary (R&C) Charge:: The R&C Charge contains three components determined by the lesser of (1) the dentist's actual charge, (2) the dentist's usual charge for the same or similar services, or (3) the usual charge of most dentists in the same geographic area for the same or similar services as determined by MetLife.
Re-cement:: Cementing any cast restoration more than one time; re-adhering a restoration that was removed or lost.
Referral:: The generated statement of approval or denial for recommended treatment to be performed by a specialist.
Resin:: A plastic restorative material; also called a composite.
Restorative:: The procedures performed to restore or return your tooth to natural form, function and/or appearance. Restorative procedures may need to be performed due to decay (dental caries), trauma, or impaired function. Restorative procedures may include fillings, inlays, onlays or crowns.
Root Canal Therapy:: The treatment of a tooth by removing the pulp or nerve of tooth in a sterile environment, and sealing with a material that is specific for this type of therapy.
Root Planing:: The smoothing of roughened root surfaces by use of special instruments (such as scalers).
Roster for DHMO/ Managed Care plans:: The list that participating providers are provided with on a monthly basis. It confirms the members/subscribers assigned to a dental office who are eligible for care.
S
Scaling:: The removal of tartar.
Sealant:: A preventive service that involves the use of resin materials to seal the grooves of teeth (similar to applying polyurethane to a wood floor) so that plaque and bacteria can't get in to cause decay.
Service Description Code:: A brief description of the service provided and the American Dental Association Current Dental Terminology (CDT) code that describes the procedure of the service.
Space Maintainer:: A passive appliance placed to prevent the shifting of teeth when a baby tooth is prematurely lost and the permanent teeth in that area haven't erupted yet. It maintains the space for the emerging permanent tooth.
Study Model:: A plaster or stone model of teeth and adjoining tissues. It’s also referred to as a diagnostic cast.
Subscriber:: The person who is covered under the plan and represents his/her dependent(s) covered under the plan. Also known as the certificate holder, enrollee or participant.
Sutures:: Stitches.
T
Tartar:: A hard deposit on the teeth, consisting of secretions and food particles. This can also be called calculus.
TMJ (Temporomandibular Joint):: The joint between the skull and the mandible.
Tooth pulp:: The nerve, blood and tissues within the crown of the tooth.
Topical:: An application to the surface of tooth, skin or mucosa.
Transitional Dentition:: Is a combination of both primary (baby) and permanent (adult) teeth in the mouth at the same time. This can also be called mixed dentition.
Transitional Dentition:: Refers to a mixed dentition; begins with the appearance of the permanent first molars and ends with the exfoliation of the deciduous teeth.
U
Unilateral:: Involving or affecting only one side.
Used-to-date:: The monetary amount of your benefits, as defined by your coverage period that has been disbursed to date.
W
Waiting Period:: The period between employment or enrollment in a dental program; and the date when a covered person becomes eligible for a given benefit.