Glossary
A controlled mixture of nitrogen and oxygen gases (N2O) that is inhaled by the patient in order to decrease sensitivity to pain. Also referred to as laughing gas.
A generic name for the many kinds of anesthetics used in the dental injection, such as Xylocaine, Lidocaine, or Novocaine. See local anesthetic.
An intraoral x-ray taken with the film held between the teeth in biting position.
The chewing surface of the back teeth.
Any contact between biting or chewing surfaces of upper and lower teeth.
Treatment to restore a physically disabled person's ability to perform activities such as walking, eating, drinking, dressing, toileting, and bathing.
A cast gold or porcelain filling that covers one or all of the tooth's cusps.
A period when eligible persons can enroll in a health benefits plan.
The removal of teeth and the repair and treatment of other oral problems, such as tumors and fractures.
A specialized branch of dentistry that corrects malocclusion and restores the teeth to proper alignment and function. There are several different types of appliances used in orthodontics, one of which is commonly referred to as braces.
Any health care service provided to a patient who is not admitted to a facility. Outpatient care may be provided in a doctor's office, clinic, the patient's home or hospital outpatient department.
A condition in which the upper teeth excessively overlap the lower teeth when the jaw is closed. This condition can be corrected with orthodontics.
The exact amount issued on a bank draft to the provider of service.
The hard and soft tissues forming the roof of the mouth.
Treatment that relieves pain but is NOT curative.
An extraoral full-mouth X-ray that records the teeth and the upper and lower jaws on one film.
A removable appliance used to replace one or more lost teeth.
A person who is eligible to receive health benefits under a health benefits plan. This term may refer to the employee, spouse or other dependents.
The unique identifier associated with a participant.
A physician, hospital, pharmacy, laboratory or other appropriately licensed facility or provider of health care services or supplies that has entered into an agreement with a managed care entity to provide services or supplies to a patient enrolled in a health benefit plan.
The specialized branch of dentistry that deals solely with treating children's dental disease. Also referred to as pedodontics.
Claims that require additional information prior to completing the adjudication process due to a specific reason code.
The area that surrounds the root tip of a tooth.
An inflammation of the gum tissue around the crown of a tooth, usually the third molar.
Relating to the tissue and bone that supports the tooth (from peri, meaning "around," and odont, "tooth").
The inflammation and infection of gums, ligaments, bone, and other tissues surrounding the teeth. Gingivitis and periodontitis are the two main forms of periodontal disease. Also called gum disease or pyorrhea.
An abnormal deepening of the gingival crevice. It is caused when disease and infection destroy the ligament that attaches the gum to the tooth and the underlying bone.
A surgical procedure involving the gums and jawbone.
The dental speciality that deals with and treats the gum tissue and bone that supports the teeth.
Inflammation of the supporting structures of the tooth, including the gum, the periodontal ligament, and the jawbone.
The area which surrounds a portion of the root of the tooth.
The thirty-two adult teeth that replace the baby, or primary teeth. Also known as secondary teeth.
Rehabilitation concerned with restoration of function and prevention of physical disability following disease, injury or loss of body part.
A recessed area found on the surface of a tooth, usually where the grooves of the tooth meet.
A film of sticky material containing saliva, food particles, and bacteria that attaches to the tooth surface both above and below the gum line. When left on the tooth it can promote gum disease and tooth decay.
The group or individual to whom an insurance contract is issued.
An artificial tooth used in a bridge to replace a missing tooth.
The process of obtaining certification from the health plan for routine hospital stays or outpatient procedures. The process involves reviewing criteria for benefit coverage determination.
This is the amount of an employee's wages or salary that was in effect and covered by the plan on the day before the disability began.
A health condition (other than a pregnancy) or medical problem that was diagnosed or treated before enrollment in a new health plan or insurance policy.
Pre-Existing Condition Limitations
When an employee has a physical or mental condition that existed prior to the effective date of his or her insurance coverage, it is considered a pre-existing condition. Most plans exclude or decrease disability benefits for an illness or injury for which an employee received medical treatment or consultation within a specified time period before becoming covered under the plan. The limitation generally expires after coverage has been in effect for a specified period of time.
Another name for bicuspid.
An account in which contributions are subtracted from an employee's pay before withholding income tax and Social Security. This ultimately reduces the account-holder's tax liability, since taxes are based on income minus the account contribution.
A drug that has been approved by the Federal Food and Drug Administration which can only be dispensed according to physician's prescription order.
Medical and dental services aimed at early detection and intervention.
Education and treatment devoted to and concerned with preventing the development of dental disease.
Any action taken by the patient, assisted by the dentist, hygienist, and the office staff that serves to prevent dental or other disease. Sealants, cleanings and space maintainers are examples of preventive treatment.
The basic, comprehensive, routine level of health care typically provided by a person's general or family practitioner, internist or pediatrician.
A physician, usually a family or general practitioner, internist or pediatrician, who provides a broad range of routine medical services and refers patients to specialists, hospitals and other providers as necessary. Under some benefits plans, a referral by the primary care physician is required to obtain services from other providers. Each covered family member chooses his or her own PCP from the network's physicians.
The first set of teeth that humans get, lasting until the permanent teeth come in. Also referred to as deciduous teeth or baby teeth.
See Precertification
The scaling and polishing procedure performed to remove calculus, plaque, and stains from the crowns of the teeth.
A device that replaces all or a part of the human body because a part of the body is permanently damaged, is absent or is malfunctioning.
The dental specialty dealing with the replacement of missing teeth and other oral structures.
A licensed health care facility, program, agency, physician or health professional that delivers health care services.
Provider directories are listings of providers who have contracted with a managed care network to provide care to its participants. Participants may refer to the directory to select in-network providers. You can search the CIGNA HealthCare Provider Directory.
A panel of providers contracted by a health plan to deliver medical services to the enrollees.
The hollow chamber inside the crown of the tooth that contains its nerves and blood vessels.
Removal of the entire pulp from the canals in the root.
An often painful inflammation of the dental pulp or nerve.
The removal of a portion of the tooth's pulp.
The dental term for the division of the jaws into four parts, beginning at the midline of the arch and extending towards the last tooth in the back of the mouth. There are four quadrants in the mouth; each quadrant generally contains five to eight teeth.
The process of refitting a denture by replacing the base material.
A condition characterized by the abnormal loss of gum tissue due to infection or bone loss.
The recurrent disability provision is designed to protect an employee who tries to return to work but becomes disabled again from the same or a related cause. If this happens within a certain period of time, the employee will be considered disabled from the original disability, and will not be subject to a new elimination period. This encourages an employee to return to work without fear of losing benefits.
When a dental patient from one office is sent to another dentist, usually a specialist, for treatment or consultation.
Rehabilitation means the restoration of or improvement in an employee's health and ability to perform the functions of his or her job. It usually involves a program of clinical and vocational services with the goal of returning employees to a satisfying occupation if possible.
The process of resurfacing the tissue side of a denture with a base material.
The return of a tooth to its socket.
Residual benefits can help make up the difference in income if an employee is able to work, but limited in his/her responsibilities due to his/her disability.
The breakdown and assimilation of the bone that supports the tooth, i.e., bone loss.
Any material or devise used to replace lost tooth structure (filling, crown) or to replace a lost tooth or teeth (bridge, dentures, complete or partial).
A removable dental appliance, usually used in orthodontics, that maintains space between teeth or holds teeth in a fixed position until the bone solidifies around them.
A method of sealing the root canal by preparing and filling it from the root tip, generally done at the completion of an apicoectomy.
The part of the tooth below the crown, normally encased in the jawbone. It is made up of dentin, includes the root canal, and is covered by cementum.
The hollow part of the tooth's root. It runs from the tip of the root into the pulp.
The process of treating disease or inflammation of the pulp or root canal. This involves removing the pulp and root's nerve(s) and filling the canal(s) with an appropriate material to permanently seal it.
The process of scaling and planing exposed root surfaces to remove all calculus, plaque, and infected tissue.
A procedure used to remove plaque, calculus and stains from the teeth.
A composite material used to seal the decay-prone pits, fissures, and grooves of children's teeth to prevent decay.
The geographical area covered by a network of health care providers.
The first permanent tooth to erupt, usually between the ages of five and six.
Skilled Nursing Facility (SNF)
A licensed facility that provides nursing care and related services for patients who do not require hospitalization in an acute care setting.
The hole in the jawbone into which the tooth fits.
A dental appliance that fills the space of a lost tooth or teeth and prevents the other teeth from moving into the space. Used especially in orthodontic and pediatric treatment.
Providers whose practices are limited to treating a specific disease (e.g., oncologists), specific parts of the body (e.g., ear, nose and throat), a specific age group (e.g., pediatrician), or specific procedures (e.g., oral surgery).
Treatment to correct a speech impairment that resulted from birth or from disease, injury or prior medical treatment.
A pre-made metal crown, shaped like a tooth, that is used to temporarily cover a seriously decayed or broken down tooth. Used most often on children's teeth.
A lifestyle event that may cause a person to modify their health benefits coverage category. Examples include, but are not limited to, the birth of a child, divorce or marriage.
The removal of calculus and plaque found on the tooth below the gum line.
The date the claim was submitted and/or received by CIGNA HealthCare.
The removal of calculus and plaque found on the tooth above the gum line.
Relating to the whole body.
See calculus.
See CIGNA Tel-Drug.
The connecting hinge mechanism between the upper jaw and the base of the skull.
Temporomandibular joint (TMJ) syndrome
The problems associated with TMJ, usually involving pain or discomfort in the joints and ligaments that attach the lower jaw to the skull or in the muscles used for chewing.
The last of the three molar teeth, also called wisdom teeth. There are four third molars, two in the lower jaw and two in the upper jaw, one on each side. Some people are born without third molars.
A bony elevation or protuberance of normal bone. Usually seen on the upper palate behind the front teeth or under the tongue inside the lower jaw.
When an employer changes insurance carriers, transition plans enable participants already in treatment to transition to an in-network health provider. It gives the patient and their current provider a specific number of days to contact CIGNA HealthCare in order to discuss the patient's treatment plan and obtain authorization to continue treatment at the in-network benefit level for a specified period of time, or to transition to a contracted professional.
A list of the work the dentist proposes to perform on a dental patient based on the results of the dentist's X rays, examination, and diagnosis. Often more than one treatment plan is presented.
When prompt medical attention is needed in a non-emergency situation, that's called "urgent" care. Examples of urgent care needs include ear infections, sprains, high fevers, vomiting and urinary tract infections. Urgent situations are not considered to be emergencies.
Usual, Customary or Reasonable (UCR)
The amount reimbursed to providers based on the prevailing fees in a specific area.
An artificial filling material, usually plastic, composite, or porcelain, that is used to provide an aesthetic covering over the visible surface of a tooth. Most often used on front teeth.
In order to become eligible for coverage under the policy, an employee must satisfy a certain number of continuous days of service as an active, full-time employee. This is known as the waiting period. In addition, a waiting period can also be the time period between when a disability occurs and when payments from the disability insurance policy begin.
When an individual becomes disabled and eligible for benefits, no further disability premium payments are required as long as benefits are being paid out.
See third molar.
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