DentalBlue Network. DentalBlue Network Basics. Participating Dentists. Non-Participating Dentist. Predetermination of Benefits

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1 With more than 2,000 dentist locations in Tennessee and its bordering counties, your DentalBlue plan has the largest dental PPO network (Preferred Provider Organization network) in Tennessee. And DentalBlue offers even more. When you are outside of the Tennessee service area, you can still choose to see a network dentist through DenteMax, our national network. DenteMax contracts with more than 76,000 dentists in all 50 states, giving you the option to use a network dentist anywhere. To locate a DenteMax provider, simply go to bcbst.com and click on Find a Doctor. Then click on Dentist and select the DenteMax network option. You can search by city, state, or zip code so it s easy to find a dentist near you. DentalBlue Network Basics Using dentists that participate in your DentalBlue plan is important, because DentalBlue network dentists have agreed to discount their services for you. So, to save money and make the most of your dental plan benefits, make sure you choose participating dentists and understand how your benefits will be paid. You can check the directory online anytime at bcbst.com for the most up-to-date listings. Participating Dentists Participating dentists agree to accept the BlueCross BlueShield of Tennessee or DenteMax dental network maximum allowable fee schedule for services they provide. Participating dentists can only collect deductibles, coinsurance, and payment for noncovered services or supplies from you. Your deductible and coinsurance amount for covered dental services is listed on your Schedule of Benefits. Non-Participating Dentist Under DentalBlue, you are free to go to the dentist of your choice. But if you visit a non-participating dentist, the benefit payment will be based on a maximum allowable fee schedule and may be made directly to you. A nonparticipating dentist may charge more than the amount of the maximum allowable fee schedule. And this difference often called balance billing would be your responsibility to pay. Predetermination of Benefits Except for emergency care, you and your dentist can determine exactly what is covered by your dental plan and the amount the plan will pay before your treatment begins. After your exam, your dentist can complete and submit a Dentist s Statement to BlueCross BlueShield of Tennessee. Then you both will be notified of the exact benefits the plan will provide for your treatment. A predetermination is recommended for any service that may exceed a $200 charge. Please keep in mind, that an authorized predetermination for dental care is valid for 90 days provided the patient has not exceeded their yearly maximum and the subscriber/member remains covered by the Dental program. Every effort will be made to provide accurate contract benefits and payment information on predeterminations. However, contract provisions and /or limitations will always be applied. 108 PPO Group Administrator Reference Manual

2 Standard DentalBlue Covered Services, Limitations & Exclusions Important Note: Your Actual Dental Benefits May Vary. Check Your Attachment C: Schedule of Benefits Exams Covered: Standard exams including comprehensive, periodic, detailed/ extensive and periodontal oral evaluations (exams). Emergency exams, including limited oral evaluations (exams). Limitations: No more than one standard exam in any 6-month period. No more than one emergency exam in any 12-month period. No more than one comprehensive, detailed/extensive, or periodontal exam in any 36-month period. Exclusions: Re-evaluations and consultations. X-rays Covered: Full mouth series, intraoral and bitewing radiographs (X-rays). Limitations: No more than one full mouth set of X-rays in any 36-month period. A full mouth set of X-rays is defined as either an intraoral complete series or panoramic X-ray. Benefits provided for either include benefits for all necessary intraoral and bitewing films taken on the same day. No more than four bitewing films in any 12-month period. Bitewing films must be taken on the same date of service. Limitations: No more than one full mouth set of X-rays in any 36-month period. A full mouth set of X-rays is defined as either an intraoral complete series or panoramic X-ray. Benefits provided for either include benefits for all necessary intraoral and bitewing films taken on the same day. No more than four bitewing films in any 12-month period. Bitewing films must be taken on the same date of service. Exclusions: Extraoral, skull and bone survey, sialography, TMJ, and tomographic survey X-ray films, cephalometric films and diagnostic photographs. Cephalometric films and diagnostic photographs may be covered as orthodontic benefits under Coverage D. Cleanings, Fluoride Treatment Covered: Adult and child prophylaxis (cleaning). Child and adult (subject to age limitations) fluoride treatments, performed with or without a prophylaxis. Limitations: No more than one of any prophylaxis or periodontal maintenance procedure in any 6-month period. Periodontal maintenance procedures are subject to additional limitations listed below under Basic Periodontics in Section VI, and may be subject to a different Coverage level under Attachment C: Schedule of Benefits. No more than one fluoride treatment in any 12-month period. Flouride is covered for Members under age 19. Fluoride must be applied separately from prophylaxis paste. 109 PPO Group Administrator Reference Manual

3 Sealants, Space Maintainers Covered: Other Preventive Services, including sealants, space maintainers. Limitations: No more than one sealant per first or second molar tooth per lifetime, for Dependents under age 16. Space maintainers for Dependents under age 14. No more than one recementation in any 12-month period. Exclusions: Nutritional and tobacco counseling, oral hygiene instructions. Basic Restorative Services Covered: Basic restorative services, including amalgam restorations (silver fillings), resin composite restorations (tooth colored fillings), stainless steel crowns. Palliative emergency) treatment for the relief of pain. Other restorative services, including repair of full and partial dentures. Limitations: No more than one amalgam or resin restoration per tooth surface in any 12-month period. Replacement of existing amalgam and resin composite restorations covered only after 12 months from the date of initial restoration. Replacement of stainless steel crowns covered only after 36 months from the date of initial restoration. No more than one repair per denture per 24 months. Exclusions: Gold foil restorations. Major Restorative Services Covered: Single tooth restorations, including crowns (resin, porcelain, ¾ cast, and full cast), inlays and onlays (metallic, resin and porcelain), and veneers. Limitations: Only for the treatment of severe carious lesions or severe fracture on permanent teeth, and only when teeth cannot be adequately restored with an amalgam or resin composite restoration (filling). For permanent teeth only. For Dependents under age 12, benefits will not be provided for cast crowns or laminate veneers. Replacement of single tooth restorations Covered only after 60 months from the date of initial placement. Exclusions: Temporary and provisional crowns. Prosthodontic Services - Fixed Bridges Covered: Fixed partial dentures (bridges), including pontics, retainers, and abutment crowns, inlays, and onlays (resin, porcelain, ¾ and full cast). Limitations: Only for treatment where a missing tooth or teeth cannot be adequately restored with a removable partial denture. For permanent teeth only, no benefits for Dependents under age 16. Replacement of fixed partial dentures covered only after 60 months from the date of initial placement. Prosthodontic Services - Removable Dentures Covered: Complete, immediate and partial dentures. Limitations: If, in the construction of a denture, the Member and the Dentist decide on a personalized 110 PPO Group Administrator Reference Manual

4 restoration or to employ special rather than standard techniques or materials, benefits provided shall be limited to those that would otherwise be provided for the standard procedures or materials (as determined by the Plan). Benefits are not provided for Dependents under age 16. Replacement of removable dentures Covered only after 60 months from the date of initial placement. Exclusions: Interim (temporary) dentures. Other Major Restorative & Prosthodontic Services Covered: Crown and bridge services including core buildups, post and core, recementation, and repair. Denture services including adjustment, relining, rebasing and tissue conditioning. Implant supported prosthetics including local anesthetic. Limitations: The benefits provided for crown and bridge restorations include benefits for the services of crown preparation, temporary or prefabricated crowns, impressions and cementation. Benefits will not be provided for a core build-up separate from those provided for crown construction, except in those circumstances where benefits are provided for a crown because of severe carious lesions or fracture is so extensive that retention of the crown would not be possible. Post and core services are covered only when performed in conjunction with a Covered crown or bridge. Crown and bridge repair and re-cementation are covered separately only after 12 months from the date of initial placement. Denture adjustments are covered separately from the denture only after 6 months from the date of initial placement. No more than one denture reline or rebase in any 36-month period. Exclusions: Other major restorative services including sedative fillings and coping. Other prosthodontic services including overdenture, precision attachments, connector bars, stress breakers and coping metal. Basic Endodontics Covered: Pulpotomy, pulpal therapy. Limitations: For primary teeth only. Not covered when performed in conjunction with major endodontic treatment. The benefits for basic endodontic treatment include benefits for x-rays, pulp vitality tests, and sedative fillings provided in conjunction with basic endodontic treatment. Exclusions: Pulpal debridement. Major Endodontics Covered: Root canal treatment and re-treatment, apexification, apicoectomy services, root amputation, retrograde filling, hemisection, pulp cap. Limitations: No more than one root canal treatment, re-treatment or apexification per tooth in 60-month period. No more than one apicoectomy per root per lifetime. The benefits for major endodontic treatment include benefits for x-rays, pulp vitality tests, pulpotomy, pulpectomy and sedative fillings and temporary filling material provided in conjunction with major endodontic treatment. Exclusions: Implantation, canal preparation, and incomplete endodontic therapy. 111 PPO Group Administrator Reference Manual

5 Basic Periodontics Covered: Non-surgical periodontics, including periodontal scaling and root planing, full mouth debridement and periodontal maintenance procedure. Limitations: No more that one periodontal scaling and root planing per quadrant in any 24-month period. No more than one full mouth debridement per lifetime. No more than one of any prophylaxis (cleanings) or periodontal maintenance procedure in any 6-month period. Cleanings are subject to additional limitations listed under Preventive Services, and may be subject to a different Coverage level under Attachment C: Schedule of Benefits. Benefits for periodontal maintenance are provided only after active periodontal treatment (surgical or non-surgical), and no sooner than 90 days after completion of such treatment. Benefits for periodontal scaling and root planing, full mouth debridement, periodontal maintenance and prophylaxis are not provided when more than one of these procedures is performed on the same day. Exclusions: Provisional splinting, scaling in the presence of gingival inflammation, antimicrobial medication and dressing changes. Major Periodontics Covered: Surgical periodontics including gingivectomy, gingivoplasty, gingival flap procedure, crown lengthening, osseous surgery and bone and tissue grafting. Limitations: No more than one major periodontal surgical procedure in any 36-month period. Benefits provided for major periodontics include benefits for services related to 90 days of postoperative care. Exclusions: Tissue regeneration and apically positioned flap procedure. Basic Oral Surgery Covered: Non-surgical or simple extractions. Limitations: Benefits provided for basic oral surgery include benefits or suturing and postoperative care. Exclusions: Benefits for general anesthesia or intravenous sedation when performed in conjunction with basic oral surgery. Major Oral Surgery Covered: Surgical extractions (including removal of impacted teeth and wisdom teeth), and other oral surgical procedures typically not Covered under a medical plan. Benefits provided for major oral surgery include benefits for local anesthesia, suturing and postoperative care. Limitations: Benefits for general anesthesia or intravenous (IV) sedation are provided only in connection with major oral surgery procedures, and only when provided by a Dentist licensed to administer such agents. Exclusions: Oral surgery typically covered under a medical plan, including but not limited to, excision of lesions and bone tissue, treatment of fractures, suturing, wound and other repair procedures, TMJ and related procedures. Orthognathic surgery and treatment for congenital malformations. 112 PPO Group Administrator Reference Manual

6 Orthodontics Services Covered: Exams, photographic images, diagnostic casts, cephalometric x-rays, installation and adjustment of orthodontic appliances and treatment to reduce or eliminate an existing malocclusion. Limitations: The need for orthodontic services must be diagnosed, identifying a handicapping malocclusion that is both abnormal and correctable, and a Treatment Plan must be submitted to and approved by the Plan. The Plan reserves the right to review the Member s dental records, including necessary x-rays, photographs, and models to determine whether orthodontic treatment is Covered. Orthodontic services may be limited to Dependents under a specified age limit, as defined on Attachment C: Schedule of Benefits: Orthodontic services may be limited by a Maximum Allowable Charge, Calendar Year Deductible and lifetime maximum as defined on Attachment C: Schedule of Benefits. Multiple occurrences of orthodontic treatment may be allowed subject to the lifetime maximum. All orthodontic services shall be deemed to be concluded on the last date treatment performed during Member s Coverage, even if a prior approved Treatment Plan has not been completed. Exclusions: Replacement or repair of any lost, stolen and damaged appliance furnished under the Treatment Plan. Surgical procedures to aid in orthodontic treatment. Other Exclusions From Coverage 1. This EOC does not provide benefits for the following services supplies or charges: 2. Dental services received from a dental or medical department maintained by or on behalf of an Employer, mutual benefit association, labor union, trustee or similar person or group. 3. Charges for services performed by You or Your spouse, or Your or Your spouse s parent, sister, brother or child. 4. Services rendered by a Dentist beyond the scope of his or her license. 5. Dental services which are free, or for which You are not required or legally obligated to pay or for which no charge would be made if You had no dental Coverage. 6. Dental services to the extent that charges for such services exceed the charge that would have been made and collected if no Coverage existed hereunder. 7. Dental services covered by any medical insurance coverage, or by any other non-dental contract or certificate issued by BlueCross BlueShield of Tennessee or any other insurance company, carrier, or plan. For example, removal of impacted teeth, tumors of lip and gum, accidental injuries to the teeth, etc. 8. Any court-ordered treatment of a Member unless benefits are otherwise payable. 9. Courses of treatment undertaken before You become Covered under this program. 10. Any services performed after You cease to be eligible for Coverage. 11. Dental care or treatment not specifically listed in Attachment C: Schedule of Benefits. 12. Any treatment or service that the Plan determines is not Necessary Dental Care, that does not offer a favorable prognosis that does not meet generally accepted standards of professional dental care, or that is experimental in nature. 113 PPO Group Administrator Reference Manual

7 13. Services or supplies for the treatment of work related illness or injury, regardless of the presence or absence of workers compensation coverage. This exclusion does not apply to injuries or illnesses of an employee who is (1) a sole-proprietor of the Group; (2) a partner of the Group; or (3) a corporate officer of the Group, provided the officer filed an election not to accept Workers Compensation with the appropriate government department. 14. Charges for any hospital or other surgical or treatment facility and any additional fees charged by a Dentist for treatment in any such facility. 15. Dental services with respect to congenital malformations or primarily for cosmetic or aesthetic purposes. This does not exclude those services provided under Orthodontic benefits (if applicable.) 16. Replacement of tooth structure lost from wear or attrition. 17. Dental services resulting from loss or theft of a denture, crown, bridge or removable orthodontic appliance. 18. Charges for the initial placement of partials and bridges to replace one or more lost, extracted or congenitally missing teeth before Your Coverage becomes effective under the Plan unless it also replaces one or more natural teeth extracted or lost after Your Coverage became effective. 19. Diagnosis for, or fabrication of, appliances or restorations necessary to correct bite problems or restore the occlusion or correct temporomandibular joint dysfunction (TMJ) or associated muscles. 20. Diagnostic dental services such as diagnostic tests and oral pathology services. 21. Adjunctive dental services including all local and general anesthesia, sedation, and analgesia (except as provided under major oral surgery). 22. Charges for the treatment of desensitizing medicaments, drugs, occlusal guards and adjustments, mouth guards, micro abrasion, behavior management, and bleaching. 23. Charges for the treatment of professional visits outside the dental office. 114 PPO Group Administrator Reference Manual

8 Claims and Payment When you receive Covered Services, either you or the Dentist must submit a claim form to us. We will review the claim, and let you, or the Dentist, know if we need more information, before we pay or deny the claim. You should not be billed or charged for Covered Services rendered by Network Dentists, except for required Member payments. The Network Dentist will submit the claim directly to us. You may be charged or billed by an Out-of-Network Dentist for Covered Services rendered by that Dentist. If you use an Out-of-Network Dentist, you are responsible for the difference between Billed Charges and the Maximum Allowable Charge for a Covered Service. If you are charged, or receive a bill, you must submit a claim to us. To be reimbursed, you must submit the claim within 1 year and 90 days from the date a Covered Service was received. If you do not submit a claim, within the 1 year and 90 day time period, it will not be paid. If it is not reasonably possible to submit the claim within the 1 year and 90 day time period, the claim will not be invalidated or reduced. You may request a claim form from our customer service department or by visiting our Web site at bcbst.com. 115 PPO Group Administrator Reference Manual

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10 Dental Claim Form Completion Instructions Data Element Specific Instructions Form completion instructions are provided for each data item, which is indicated by a number. Please note that data items are in groups of related information. These instructions explain the reasons for such groupings, and the relationships (if any) between groups. IMPORTANT INFORMATION When it is necessary for you to file the claim, you will need to complete item numbers 1-23 and You will need to attach a signed super bill or statement from your dentist that reflects the treatment you received. Mail completed form to: BlueCross BlueShield of Tennessee Dental Department P. O. Box Chattanooga, TN Header Information The header provides information about the type of submission being made. This information applies to the entire transaction. 1. Type of Transaction: There are three boxes that may apply to this submission. If services have been performed, check the Statement of Actual Services box. If there are no dates of service, check the box marked Request for Predetermination/Preauthorization. If the claim is through the Early and Periodic Screening, Diagnosis and Treatment Program, check the box marked EPSDT/Title XIX. 2. Predetermination/Preauthorization Number: If you are submitting a claim for a procedure that has been pre-authorized by a third party payer, enter the preauthorization or predetermination number provided by the insurance company. Primary Payer Information 117 PPO Group Administrator Reference Manual

11 3. Name, Address, city, State, Zip Code: This item is always completed. Enter the information for the insurance company or third-party payer. If the patient is covered by more than one plan, enter the primary insurance company information here. Other Coverage The other coverage area of the claim form provides information on the existence of additional dental or medical insurance policies. This is necessary to determine if multiple coverages are in effect, and the possibility of coordination of benefits. 4. Other Dental or Medical Coverage?: If there is no other coverage, check the box marked No and skip to Item #12. If there will be a claim made to a second insurance company, check the box marked Yes and complete Items Other Insured s Name (Last, First, Middle, Suffix): Enter the name of the individual who is insured through another dental or medical plan. If the patient has secondary coverage through a spouse, domestic partner or, if a child, through both parents, the name of the person who has the secondary coverage should be reported here. 6. Date of Birth (MM/DD/CCYY): Enter the date of birth of the person listed in Item #5. The date must be entered with two digits each for the month and day and four digits for the year of birth. 7. Gender: Enter the gender of the person who is listed in Item #5. Check M for Male or F for Female, as applicable. 8. Subscriber Identification Number: Enter the subscriber identification number of the person who is listed in Item #5. The identifier number is a number assigned by the payer/insurance company to this individual. 9. Plan/Group Number: Enter the group plan or policy number of the person identified in Item # Patient s Relationship to Other Insured (Check applicable box): Enter the patient s relationship to the other (secondary) insured named in Item # Other Carrier Name, Address, City, State, Zip Code: Enter the complete information of the additional payer, benefit plan or entity for the insured named in Item # PPO Group Administrator Reference Manual

12 Primary Insured Infromation This section documents information about the insured person who may or may not be the patient. 12. Name (Last, First, Middle Initial, Suffix), Address, City, State, Zip Code: Enter the complete name, address and zip code of the primary insured/employee. 13. Date of Birth (MM/DD/CCYY): A total of eight digits are required in this field; two for the month, two for the day of the month, and four for the year. 14. Gender: This applies to the primary insured, who may or may not be the patient. Check M for male or F for female. 15. Subscriber Identification Number: Enter the subscriber identification number of the primary insured that has been assigned to the primary insured by the payer or insurance company. 16. Plan/Group Number: Enter the primary insured s group plan/policy number. 17. Employer Name: If applicable, enter the name of the insured s employer. Patient Information The information in this section of the claim form pertains to the patient. 18. Relationship to Primary Insured (Check applicable box): Enter the relationship of the patient to the person identified in Item #12 who has the primary insurance coverage. The relationship between the insured and the patient may affect the patient s eligibility or benefits available. If the patient is also the primary insured, mark the box titled Self and skip to Item # PPO Group Administrator Reference Manual

13 19. Student Status: Check FTS if patient is a dependent and a full-time student. Check PTS if the patient is a dependent and a part-time student. If neither applies, skip to Item # Name (Last, First, Middle Initial, Suffix), Address, City, State, Zip Code: Enter the complete name, address and zip code of the patient. 21. Date of Birth (MM/DD/CCYY): A total of eight digits are required in this field; two for the month, two for the day of the month, and four for the year of birth of the patient. 22. Gender: This applies to the patient. Check M for male or F for female. 23. Patient ID/Account# (Assigned by Dentist): Enter if the dentist s office has assigned a number to identify the patient. This is not required to process claim. Attach a signed super bill/statement from your dentist that reflect the treatment that you received and skip to Item # 36. Authorizations This section provides consent for treatment as well as permission for the payer to send any patient benefit available for precedures performed directly to the dentist or the dental business entity. 36. Patient Consent: The patient is defined as an individual who has established a professional relationship with the dentist for the delivery of dental health care. For matters relating to communication of information and consent, the term includes the patient s parent, caretaker, guardian, or other individual as appropriate under state law and the circumstances of the case. By signing (or signature on file notice) in this location of the claim form, the patient or patient s representative has agreed that he/she has been informed of the treatment plan, the costs of treatment and the release of any information necessary to carry out payment activities related to the claim. 37. Insured s Signature: The signature and date (or signature on file notice) are required when the insured wishes to have benefits paid directly to the dentist/provider. This is an authorization of payment. It does not create a contractual relationship between the dentist or dental entity and the insurance company. 120 PPO Group Administrator Reference Manual

14 Definition of Common Dental Terms ABUTMENT - A tooth or root that retains or supports a fixed bridge or a removable prosthesis. ACID ETCH - The etching of a tooth with a mild acid to aid in the retention of composite filling material. ACRYLIC - Plastic materials used in the fabrication of dentures and crowns and occasionally as a restorative filling material. AMALGAM - A metal alloy usually consisting of silver, tin, zinc and copper combined with liquid pure mercury and used as restorative material in operative dentistry. ANESTHESIA Local - The condition produced by the administration of specific agents to achieve the loss of pain sensation in a specific location or area of the body. General The condition produced by the administration of specific agents to render the patient completely unconscious and without pain sensation. APPLIANCE - A device used to provide function, therapeutic (healing) effect, space maintenance, or as an application of force to teeth to provide movement or growth changes as in Orthodontics. Fixed - One that is attached to the teeth by cement or by adhesive materials and cannot be removed by the patient. Removable - One that can be taken in and out of the mouth by the patient. Prosthetic - Used to provide replacement for a missing tooth. BITEWING - A type of dental x-ray film that has a central tab or wing upon which the teeth close to hold the film in position. They are commonly called decay detecting x-rays because they show decay better than other x-rays. BRIDGEWORK OR PROSTHETIC APPLIANCE - Pontics or replacement teeth retained with crowns or inlays cemented to the natural teeth, which are used as abutments. Fixed- removable - One which the dentist can remove but the patient cannot. Removable - A partial denture retained by attachments that permit removal of the denture. Normally held by clasps. CARIES - A disease of progressive destruction of the teeth from bacterially produced acids on tooth surfaces. COMPOSITE - Tooth colored filling material primarily used in the anterior teeth. CROWN - A natural crown is the portion of a tooth covered by enamel. An artificial crown (cap) restores the anatomy, function and esthetics of the natural crown. DENTAL HYGIENIST - A person who has been trained to clean teeth, and provide additional services and information on the prevention of oral disease. 121 PPO Group Administrator Reference Manual

15 DENTURE - A device replacing missing teeth. The term usually refers to full or partial dentures but it actually means any substitute for missing natural teeth. ENDODONTIC THERAPY - Treatment of diseases of the dental pulp and their sequelae. FLUORIDE - A solution of fluorine that is applied topically to the teeth for the purpose of preventing dental decay. IMPLANT - A device surgically inserted into or onto the jawbone. It may support a crown or crowns, partial denture, complete denture or may be used as an abutment for a fixed bridge. IMPRESSION - A negative reproduction of a given area. It is made in order to produce a positive form or cast of the recorded teeth and/or soft tissues of the mouth. INLAY- A restoration usually of cast metal made to fit a prepared tooth cavity and then cemented into place. MALOCCLUSION - An abnormal contact and/or position of the opposing teeth when brought together. OCCLUSION - The contact relationship of the upper and lower teeth when they are brought together. OCCLUSAL GUARDS/BITE GUARDS - Appliances to relieve clenching and grinding of teeth. ONLAY - A case restoration that Covers the entire chewing surface of the tooth. ORTHODONTICS - The branch of dentistry primarily concerned with the detection, prevention and correction of abnormalities in the positioning of the teeth in their relationship to the jaws. PALLIATIVE - An alleviating measure. To relieve, but not cure. PARTIAL DENTURE - A prosthesis replacing one or more, but less than all, of the natural teeth and associated structures; may be removable or fixed, one side or two sides. PEDODONTICS - The specialty of children s dentistry. PERIODONTICS - The science of examination, diagnosis, and treatment of diseases affecting the supporting structures of the teeth. PONTIC - The part of a fixed bridge which is suspended between the abutments and which replaces a missing tooth or teeth. PROPHYLAXIS - The removal of tartar and stains from the teeth. The cleaning of the teeth by a dentist or dental hygienist. REBASE - A process of refitting a denture by the replacement of the entire denture-base material without changing the occlusal relations of the teeth. RELINE - To resurface the tissue-borne areas of a denture with new material. RESTORATION - A broad term applied to any inlay, crown, bridge, partial dentures, or complete denture that restores or replaces loss of tooth structure, teeth or oral tissue. The term applies to the end result of repairing and restoring or reforming the shape, form and function of part or all of a tooth or teeth. 122 PPO Group Administrator Reference Manual

16 ROOT CANAL THERAPY - The complete removal of the pulp tissues of a tooth, sterilization of the pulp chamber and root canals, and filling these spaces with a sealing material. SCALING - The removal of calculus (tartar) and stains from teeth with special instruments. SEALANT - A resinous agent applied to the grooves and pits of teeth to reduce decay. SILICATE - A relatively hard and translucent restorative material that is used primarily in the anterior teeth. SPLINTING - Stabilizing or immobilizing teeth to gain strength and/or facilitate healing. TMJ, TMD, CMD AND RELATED - Non-surgical care connected with the detection or correction of jaw joint problems, including temporomandibular joint and craniomandibular disorders, or other conditions of the joints linking the jawbone and skull, including the complex of muscles, nerves, and other tissues related to that joint. TOPICAL - Painting the surface of teeth as in fluoride treatment, or application of an anesthetic formula to the surface of the gum. VERTICAL DIMENSION - The degree of jaw separation when the teeth are in contact. 123 PPO Group Administrator Reference Manual

17 Dental Tooth Chart Note: When you look at the tooth chart, you are looking into a person s mouth with the jaws open. You re facing the person, so their upper right jaw will be on the left of this image. 124 PPO Group Administrator Reference Manual