Dental Benefits
Assignment of benefits: Authorization from the patient to the insurance carrier to forward payment directly to the endodontist for covered procedures.
Claim: Statement sent to an insurance carrier that lists the treatment performed, the date of that treatment and an itemization of associated costs. It serves as the basis for payment of benefits.
Contract: An agreement between your employer and your insurance carrier that typically describes the benefits of your dental plan.
Copayment: The part of the fee you owe the endodontist after your insurance carrier has paid its portion.
Coverage: The benefits available to you under your plan.
Customary fee: The fees your insurance carrier will pay for the specific procedure performed as opposed to the actual fees submitted for a specific endodontic procedure to establish the maximum benefit payable for that specific procedure.
Deductible: The amount you are responsible to pay before the insurance carrier will allow your benefit plan to pay the endodontist.
EOB: Identifies the benefits (the amount your insurance carrier is willing to pay) and charges covered and not covered by your plan.
Participating provider: An endodontist who signs a contractual agreement with the dental insurance carrier to provide care to eligible members.
Patient portion: The dollar amount that you will be responsible for paying if your insurance payment does not cover the entire fee.
Preauthorization: A statement from your insurance company indicating whether the required endodontic treatment will be covered under the terms of your plan.
Predetermination: An administrative procedure that requires your endodontist to submit a treatment plan to your insurance carrier for approval before treatment begins.
UCR: A term used by insurance companies to describe the amount they are willing to pay for a particular endodontic procedure.
Endodontics
Endodontics: The branch of dentistry concerned with the morphology, physiology, and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including the biology of the normal pulp and the etiology, diagnosis, prevention, and treatment of diseases and injuries of the pulp and associated periradicular conditions.
The scope of endodontics includes, but is not limited to, the differential diagnosis and treatment of oral pains of pulpal and/or periapical origin; vital pulp therapy such as pulp capping and pulpotomy; nonsurgical treatment of root canal systems with or without periradicular pathosis of pulpal origin, and the obturation of these root canal systems; selective surgical removal of pathological tissues resulting from pulpal pathosis; intentional replantation and replantation of avulsed teeth; surgical removal of tooth structure such as in root-end resection, bicuspidization, hemisection and root resection; root-end filling endodontic implants; bleaching of discolored dentin and enamel (teeth); retreatment of teeth previously treated endodontically; and treatment procedures related to coronal restorations by means of post and/or cores involving the root canal space.
Endodontist: A dentist with two or more years of advanced training in the scope of endodontics who has received a certificate in endodontics from an advanced education program accredited by the ADA Commission on Dental Accreditation and who limits his or her practice to endodontics. (Dentists who limited their practice to endodontics prior to recognition of the specialty in 1963 are also recognized as endodontists.) The endodontic specialist is responsible for the advancement of endodontic knowledge through research, the transmission of information concerning the most recent advances in biologically acceptable procedures and materials, and the education of the public as to the importance of endodontics in keeping the dentition in a physiologically functional state for the maintenance of oral and systemic health.
Board-certified endodontist: As defined by the American Board of Endodontics, an endodontist who has passed the certifying examination administered by the American Board of Endodontics.
Board-eligible endodontist: As defined by the American Board of Endodontics, an endodontist whose application for examination for certification is current and who has been accepted for examination by the American Board of Endodontics.
Educationally qualified endodontist—As defined by the American Board of Endodontics, an endodontist who successfully completed an advanced educational program accredited by the ADA and is eligible to apply for examination by the American Board of Endodontics.
Tooth Composition
Apical dental foramen: The main apical opening of the root canal. A natural opening or passage, especially into or through a bone; also describes openings in the root structure that communicates with the dental pulp and generally contain neural, vascular and connective elements.
Cementum: A mineralized tissue covering the roots of teeth that provides a medium for the attachment of the periodontal fibers that connect the tooth to the alveolar bone and gingival tissues; composed of approximately 45–50% inorganic substances and 50–55% organic material and water; softer than dentin; histologically differentiated as cellular and acellular.
Crown: The part of a tooth that is covered with enamel or an artificial substitute for that part.
Dental pulp: A richly vascularized and innervated specialized connective tissue of ectomesenchymal origin; contained in the central space of a tooth, surrounded by the dentin, with inductive, formative, nutritive, sensory and protective functions.
Dentin: A mineralized tissue that forms the bulk of the crown and root of the tooth, giving the root its characteristic form; surrounds coronal and radicular pulp, forming the walls of the pulp chamber and root canals; composed of approximately 67% inorganic, 20% organic and 13% water.
Enamel: A mineralized tissue that forms a protective covering of variable thickness over the entire surface of the crown of the tooth. The hardest tissue in the human body, enamel provides a resistant covering suitable for mastication. Its composition is approximately 96% inorganic and 4% organic substance and water.
Gingiva: The dense fibrous tissue and overlying mucous membrane, which envelop the alveolar processes of the upper and lower jaws and surrounds the necks of the teeth.
Neck: The slightly constricted part of a tooth between the crown and the root.
Root: The part of the tooth below the neck covered by cementum rather than enamel and attached by the periodontal ligament to the alveolar bone.