1. Amalgam - Silver filling used to restore posterior (back) teeth.

2. Anesthesia (General) - The condition, resulting from administration of anesthetics, in which the patient is rendered completely unconscious and completely without conscious pain.

3. Anesthetic - A drug that produces a loss of feeling or sensation such as novocaine.

4. Appliance - An artificial device that provides healing effects, or is used to assist in performing an intended function.

• Fixed - An appliance that is cemented to the teeth or attached by adhesive materials.
• Removable - An appliance that is not cemented to the teeth and can be removed from the mouth and replaced at will.

5. Bitewing - Dental X-ray picture showing a part of either the right or left upper and lower jaw.

6. Bridgework - A replacement for one or more missing or extracted natural teeth.

• Fixed Ð Supported and held in place with crowns cemented to the natural teeth that are used as abutments and cannot be removed.
• Removable - A partial denture retained by attachments that can be removed from the mouth and replaced at will.

7. Clasp - The most common attachment for a removable partial denture. It is constructed of metal and used as a stabilizing and retaining device to keep the denture in place.

8. Completion Date - Defined as follows: for dentures and partial dentures, the delivery date; for crowns and bridgework, the cementation date; for root canals and periodontal treatment, the date of the final procedure that completes treatment.

9. Contracting Dentist - A licensed Michigan dentist who filed with Delta Dental, and had accepted by Delta Dental, a list of his or her usual fees and, in addition, signed a Delta Dental Service Agreement. The Plan's payment and the patient's payment, if any, are to be accepted by the contracting dentist as payment in full under the State of Michigan Standard plan. The Plan’s payment is sent directly to the contracting dentist.

10. Copayment - The amount the subscriber is required to pay in addition to the Plan’s payment.

11. Covered Services - Only those benefits selected under your State of Michigan Dental plan.

12. Crown - The portion of a tooth covered by enamel and visible above the gum. Some common types of artificial crowns include: full cast crowns used for the teeth that chew the food, porcelain crowns (resembling the color of the natural tooth) generally used on front teeth, stainless steel crowns generally used in restoring children’s primary teeth.

13. Delta Dental - Delta Dental Plan of Michigan, Inc., a nonprofit dental health care corporation providing dental service benefits. Delta Dental is not a commercial insurance company.

14. Delta Dental’s Non-Contracting Dentist Fee - The maximum amount per procedure that Delta Dental will allow for services rendered by a non-contracting dentist.

15. Dental Hygienist - A person who has been trained to remove tartar and stains from the surface of the teeth and who may provide additional services and information on the prevention of oral disease.

16. Dental Services - Care and procedures employed by dentists for diagnosis or treatment of dental disease, injury or abnormal conditions based on valid dental need according to accepted standards of dental practice.

17. Dentist - A person licensed to practice dentistry in the state or country in which dental services are rendered.

18. Denture -A removable prosthetic appliance replacing missing natural teeth.

19. Fee Charged - The amount a dentist accepts as full payment for a given service provided to the person for whom the claim is filed. Any amount billed that person over and above the benefit paid by Delta Dental on behalf of the Plan will not be considered a fee actually charged unless the dentist intends to collect the amount billed and makes a reasonable effort to do so.

20. Fluoride - A chemical solution that is applied to the teeth for the purpose of preventing dental decay.

21. Gingivectomy - A surgical procedure involving cutting away diseased gums.

22. Malposed Teeth - The abnormal positioning and relation of the upper and lower teeth when they come together.

23. Maximum Payment - The maximum dollar amount the Plan will pay in any benefit period for covered dental services. The maximum dollar amount that the Plan pays during each Plan year (October - September) for each covered person is $1,000. For orthodontic care, the Plan pays a lifetime maximum of $1,500 for each eligible person.

24. Non-contracting Dentist - A licensed dentist who has not filed any fees with Delta Dental and has not signed a Delta Dental Service Agreement. Because the Plan's payment is sent to the subscriber, it is the responsibility of the subscriber to make full payment to the non-contracting dentist.

25. Onlay - A preformed restoration that covers the entire chewing surface of a tooth and does not extend down to the gum.

26. Optional Treatment- A service or treatment other than that customarily provided or for which there is no valid dental need.

27. Orthodontics - That branch of dentistry concerned primarily with the detection, prevention and correction of abnormalities in the positioning of teeth in relationship to the jaws. Commonly, straightening teeth.

28. Periapical - Pertaining to the area of the tooth around the apex (tip) of the root.

29. Periodontal Disease - Disease which weakens and destroys the gums, bones and membranes surrounding the teeth.

30. Plan Year - The time period in which the Plan’s payments for covered services accumulate toward the maximum payment. The State Dental Plan’s plan year is October to September (except the Scientific and Engineering bargaining units represented by MPES)

31. Plaque - A sticky substance made up of bacteria, dead tissue cells and debris that accumulates on the teeth.

32. Predetermination - A procedure in which dentists submit their treatment plans and X-rays to Delta Dental before rendering dental services that are expected to exceed $200. Delta Dental reviews the treatment plan and advises the patient and dentist of what services are covered by the State Dental Plan and the amount of benefits payable. The Plan’s payment for predetermined services is contingent on continued eligibility and the annual or lifetime maximum available. See Loss of Eligibility During Treatment on page 6 for an explanation of the policy that is applied when eligibility is terminated.

33. Preferred Provider Non-member (Non-PPO) Dentist - A licensed dentist who has not signed a Prudent Purchaser agreement with Delta Dental. The Plan’s payment is sent to the subscriber and it is the responsibility of the subscriber to make full payment to the non-PPO member dentist. However, if the non-member dentist is contracting with Delta Dental under the State of Michigan Standard plan, then payment is sent to the contracting dentist.

34. Preferred Provider (PPO) Member Dentist - A licensed Michigan dentist who has entered into a Prudent Purchaser agreement with Delta Dental. The Plan’s payment and the patient's payment, if any, are to be accepted by the PPO member dentist as payment in full. The Plan’s payment is sent directly to the member dentist.

35. Preferred Provider (PPO) Member Dentist Schedule - A list of fees established by Delta Dental that determines the maximum amount per procedure that a PPO member dentist may charge a person who is covered under the State of Michigan PPO dental plan.

36. Prophylaxis - Removal of tartar and stains from the teeth.

37. Prosthesis - An artificial replacement of one or more natural teeth and/or associated structures.

38. Pulpectomy - The complete surgical removal of the pulp (nerve) of a tooth. A step in root canal treatment.

39. Pulpotomy - The partial removal of the pulp (nerve) of a tooth, usually performed on children as a treatment after dental caries (cavities) or a fracture has penetrated to the pulp.

40. Restoration - A broad term applied to any amalgam filling, resin filling, jacket or crown that restores or replaces loss of tooth structure. The term applies to the end result of repairing, restoring, or reforming the shape, form and function of part or all of one or more teeth.

41. Root Canal Treatment - The removal of the diseased pulp (nerve) tissue to the ends of the root. It is usually performed by completely removing the pulp, sterilizing the pulp chamber and the canals of the root, and filling the canals with a plastic sealing material.

42. Root Planing - The smoothing of roughened root surfaces with instruments that remove deposits and plane the root surfaces.

43. Space Maintainers - A fixed or removable appliance to prevent the movement of teeth, usually in children.

44. State of Michigan Dental Plan - (State Dental Plan or Plan) is the self-insured fee-for-service/cost management program that provides dental benefits to enrolled members. The State Dental PPO plan covers you when you have services that are rendered by a PPO member dentist. The State Dental Standard plan covers you when you have services that are rendered by a non-PPO dentist.

45. Subscriber - An eligible employee enrolled in the State of Michigan Dental Plan. A subscriber may enroll his or her eligible dependents.

46. Usual, Customary and Reasonable Fees - The State Dental Plan payment is based on the following:

a) Usual: The usual fee is lowest fee charged, offered or received by an individual dentist for a given dental service, regardless of whether or not the patient is covered under a dental expense benefits program. Exceptions may be made by Delta Dental for the fees charged under bona fide arms length Prudent Purchaser agreements as defined by Michigan law, to indigents and patients covered by programs funded by public or charitable funds primarily intended to assist the poor or disadvantaged, to family members, to clergy, to senior citizens (who are 65 or older, retired and not covered by any dental expense benefits program) and for professional courtesy.

b) Customary: A fee is customary when it is within the range of usual billed fees by dentists of similar training and experience for the same service within the same specific and limited geographic area.

c) Reasonable: A fee is reasonable when it meets the above two criteria or it is justifiable considering the special circumstances of the particular case in question.