Dental Insurance & Billing Terminology

Flashcards covering key vocabulary, codes, concepts, and administrative practices in dental insurance, billing, and practice management.

CDAnet

A system that allows dental offices to submit insurance claims electronically directly to insurance carriers, making processing faster and eliminating paper claim forms.

ITRANS Claim Service

A service that securely sends dental claims electronically to insurance companies for faster processing and payment.

Explanation of Benefits (EOB)

A statement or receipt provided after claim processing that details how much the insurance pays, where the payment is sent, and patient coverage information.

Subscriber

The individual who holds the group dental insurance plan in their name.

Dependent

A family member covered under the subscriber's dental plan, such as a spouse or child.

Carrier

The insurance company responsible for processing and paying dental claims.

Provider Identification Number

A unique number used on claim forms to identify the treating dentist.

Deductible

The specific dollar amount a patient must pay out-of-pocket for dental services before insurance coverage begins.

Assignment of Benefits

An arrangement where insurance payments are directed to be paid straight to the dentist rather than to the patient.

Non-Assignment Plan

A dental plan structure where the insurance company sends payments directly to the patient rather than to the dental office.

Birthday Rule

A coordination of benefits rule for dependent children with dual coverage, stating that the primary insurance belongs to the parent whose birthday occurs earlier in the calendar year (month and day).

Edentulous

A clinical term describing a patient who has no remaining natural teeth.

Immediate Denture

A denture fabricated while the patient still has teeth and inserted immediately following the extraction of remaining natural teeth.

Cast Post

A restoration post custom-made from metal in a dental laboratory using an impression of the patient's mouth, which is cemented into place before completing the final restoration.

Pontic

The artificial tooth component of a fixed bridge that replaces a missing tooth.

Abutments

The existing teeth or roots (retainers) that support and anchor a fixed bridge.

Predetermination

An estimate submitted to an insurance company prior to treatment to confirm if a recommended procedure is covered and to what extent.

Accepted Window

The specified number of days after the date of service during which a claim can still be submitted electronically.

Patient Ledger

The record within dental management software that tracks all patient billing charges, payments, insurance claims, and running balances.

Restorative Code Series

Dental procedure codes representing restorative services (fillings), which always begin with the digit $2$ (code series $20000$).