Glossary of Terms
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 the 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.
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 communicate 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 the 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 membrance, which envelop the alveolar processes of the upper and lower jaws and surrounds the necks of the teeth.
Neck: The slightly constricted part of the 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.