Glossary of Common Dental Terms: M-R
Malocclusion - improper alignment of biting or chewing surfaces of the upper and lower teeth.
Maximum allowable charge - see maximum benefit.
Maximum allowable reimbursement - see maximum fee schedule.
Maximum allowance - the maximum dollar amount a dental program will pay toward the cost of a dental service as specified in the program's contract provisions (e.g., UCR, table of allowances).
Maximum benefit - the maximum dollar amount a program will pay toward the cost of dental care incurred by an individual or family in a specific time period (also known as: maximum allowable charge).
Maximum fee schedule - a compensation agreement in which a participating dentist agrees to accept a prescribed sum as the total fee for one or more covered services (also known as: maximum allowable reimbursement).
Member - see enrollee.
NADP - National Association of Dental Plans - a trade association that promotes and advances the HMO/PPO sector of the dental benefits industry to improve consumer access to affordable, quality dental care.
NAIC - National Association of Insurance Commissioners - assists state insurance regulators, individually and collectively, in serving the public interest and achieving fundamental insurance regulatory goals.
National Provider File (NPF) - a data warehouse of dentists' filed fees used by local Delta Plans to facilitate the central claims administration for DeltaUSA accounts. Plans gather, submit, and maintain individual provider fees to the NPF along with Plan fee tables for DeltaPremier and DeltaPreferred Option.
Network - a collective expression for all dentists who have contractually agreed to provide treatment according to administrative guidelines for a certain program.
NIDCR - National Institute of Dental and Craniofacial Research - promotes the general health of the American people by improving their oral, dental and craniofacial health. Through research and the development of researchers, the NIDCR aims to promote health, to prevent diseases and conditions, and to develop new diagnostics and therapeutics.
NIH - National Institutes of Health - part of the U.S. Department of Health and Human Services. The organization conducts research; supports the research of non-Federal scientists in universities, medical schools, hospitals, and research institutions. It also helps in the training of research investigators and fosters communication of medical information.
Non-participating (non-par) dentist - any dentist who does not have a contractual agreement with Delta Dental to render dental care to members of a dental benefit program.
Orthodontics - a dental specialty concerned with straightening or moving misaligned teeth and/or jaws with braces and/or surgery. An orthodontist is a dental specialist in this field.
PANDA - Prevent Abuse and Neglect through Dental Awareness - educational program sponsored by a number of Delta Dental Plans across the country that seeks to educate oral health professionals about child abuse and to help them learn how to diagnose and report potential abuse situations to appropriate authorities.
Participating (par) dentist- a dentist who has entered into a DeltaPremier Participating Dentist Agreement or DeltaPreferred Option Agreement with a participating Plan or DeltaUSA and provides dental care services to members; designated by a participating Plan as a participating dentist.
Panoramic radiograph - a single large x-ray of the jaws taken by a machine that rotates around the head.
Pediatric Dentistry - a dental specialty concerned with treatment of children. A pediatric dentist is a dental specialist in this field (also known as: pedodontist).
Periodontics - a dental specialty concerned with treatment of gums, tissue and bone that supports the teeth. A periodontist is a dental specialist in this field.
Periodontitis - inflammation and loss of connective tissue of the supporting or surrounding structure of the teeth (also known as: gum disease).
Plaque - a bacteria-containing substance that collects on the surface of teeth. Plaque can cause decay and gum irritation when it is not removed by daily brushing and flossing.
Point-of-service - arrangements in which patients with a managed care dental plan have the option of seeking treatment from an "out-of-network" provider. The reimbursement for the patient is usually based on a lower table of allowances with significantly reduced benefits than if the patient had selected an "in-network" provider.
Prevailing fee - the fee most commonly charged for a dental service in a given area.
Primary Subscriber - see subscriber.
Prophylaxis - (prophy) a professional cleaning to remove plaque, calculus (mineralized plaque) and stains to help prevent dental disease.
Prosthodontics - a dental specialty concerned with restoration and/or replacement of missing teeth with artificial materials. A prosthodontist is a dental specialist in this field.
Provider - a unique individual dentist (preferred providers, general dentists, specialty providers, practicing providers).
Radiograph - x-ray.
Reasonable and Customary (R & C) Plan - a dental benefit plan that determines benefits based only on "Reasonable and Customary" fee criteria (also see Customary fee, Reasonable fee).
Reasonable fee - the fee charged by a dentist for a specific dental procedure that has been modified by the nature and severity of the condition being treated and by any medical or dental complications or unusual circumstances. Therefore, it may differ from the dentist's "usual" fee or the benefit administrator's "customary" fee (also see customary fee).
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