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cafeteria plan: Employee benefit plan in which employees select their medical insurance coverage and other nontaxable fringe benefits from a list of options provided by the employer. Cafeteria plan participants may receive additional, taxable cash compensation if they select less expensive benefits.

calculus: Hard deposit of mineralized substance adhering to crowns and/or roots of teeth or prosthetic devices.

canal: A relatively narrow tubular passage or channel.

root canal – Space inside the root portion of a tooth containing pulp tissue.

mandibular canal – The passage which transmits vessels and nerves through the jaw to branches that distributes them to the teeth.

cantilever extension: Part of a fixed prosthesis that extends beyond the abutment to which it is attached and has no additional support.

capitation: A capitation program is one in which a dentist or dentists contract with the programs’ sponsor or administrator to provide all or most of the dental services covered under the program to subscribers in return for payment on a per-capita basis.

caries: Commonly used term for tooth decay.

carious lesion: A cavity caused by caries.

carrier: See third-party.

case management: The monitoring and coordination of treatment rendered to patients with specific diagnoses or requiring high cost or extensive services. May include complex treatment plans or discussion between multiple practitioners.

A process of identifying patients with special health care needs, developing a healthcare strategy that meets those needs, and coordinating and monitoring the care, with the ultimate goal of achieving the optimum health care outcome in an efficient and cost-effective manner.

cast: See diagnostic cast or study model.

cavity: Missing tooth structure. A cavity may be due to decay, erosion or abrasion. If caused by caries; also referred to as carious lesion.

cement base: Material used under a filling to replace lost tooth structure.

cementum: Hard connective tissue covering the outer surface of a tooth root.

Centers for Medicare and Medicaid Services (CMS): The federal agency responsible for administering the Medicare, Medicaid, State . Children’s Health Insurance Program (SCHIP), HIPAA, and the Clinical Laboratory Improvement Amendments (CLIA) programs. CMS is part of the U.S. Department of Health and Human Services.

cephalometric image: A standardized, extraoral projection utilized in the scientific study of the measurements of the head.

ceramic: Non-metal, non-resin inorganic refractory compounds processed at high temperatures (600°C/1112°F and above) and pressed, polished or milled – including porcelains, glasses, and glass-ceramics. See porcelain/ceramic.

claim: A request for payment under a dental benefit plan; a statement listing services rendered, the dates of services, and itemization of costs. The completed request serves as the basis for payment of benefits.

claim form: A form, paper or electronic, used to report dental procedures to a third-party payer in order to file for benefits under a dental benefit program. The paper claim form was developed by the American Dental Association.

claimant: Person or authorized provider who files a claim for benefits. Patient or certificate holder who files a claim for benefits.

claims payment fraud: The intentional manipulation or alteration of facts or procedure codes submitted by a treating dentist resulting in a lower payment to the beneficiary and/or the treating dentist than would have been paid if the manipulation had not occurred.

claims reporting fraud: The intentional misrepresentation of material facts concerning treatment provided and/or charges made, in that this misrepresentation would cause a higher payment.

Classification of Metals: See metals, classification of (source: ADA Council on Scientific Affairs).

cleft palate: Congenital deformity resulting in lack of fusion of the soft and/or hard palate, either partial or complete.

clenching: The clamping and pressing of the jaws and teeth together in centric occlusion, frequently associated with psychological stress or physical effort.

clinical crown: That portion of a tooth not covered by tissues.

closed panel: A dental insurance benefit plan which requires the eligible patients to receive their dental care from a specific dentist who has contractually agreed to the terms, payments and benefits of the plan.  Usually only a limited number of dentists in an area are allowed to participate in these types of plans.

closed reduction: The re-approximation of segments of a fractured bone without direct visualization of the boney segments.

CMS: See Centers for Medicare and Medicaid Services.

COB: See coordination of benefits.

Code on Dental Procedures and Nomenclature (Code): A listing of dental procedure codes and their descriptive terms published by the American Dental Association (ADA); used for recording dental services on the patient record as well as for reporting dental services and procedures to dental benefit plans. The Code is printed in a manual titled Current Dental Terminology (CDT).

coinsurance: A provision of a dental benefit program by which the beneficiary shares in the cost of covered services, generally on a percentage basis.  The percentage of a covered dental expense that a beneficiary must pay (after the deductible is paid).  A typical coinsurance arrangement is one in which the third party pays 80% of the allowed benefit of the covered dental service and the beneficiary pays the remainder of the amount due the dentist.  Percentages vary and may apply to table of allowance plans; maximum allowable benefit plans and direct reimbursement programs.

complete denture: A prosthetic for the edentulous maxillary or mandibular arch, replacing the full dentition.  Usually includes six anterior teeth and eight posterior teeth.

complete series:A n entire set of radiographs.  A set of intraoral radiographs usually consisting of 14 to 22 periapical and posterior bitewing images intended to display the crowns and roots of all teeth, periapical areas and alveolar bone crest (source: FDA/ADA radiographic guidelines).

composite: A dental restorative material made up of disparate or separate parts (e.g. resin and quartz particles).

compound fracture: Break in bone which is exposed to external contamination.

comprehensive oral evaluation:  See evaluation.

Consolidated Omnibus Budget Reconciliation Act (COBRA): Legislation relative to mandated benefits for all types of employee benefit plans.  The most significant aspects within this context are the requirements for continued coverage for employees and/or their dependents for 18 months who would otherwise lose coverage (30 months for dependents in the event of the employee’s death).

consultation: In a dental setting, a diagnostic service provided by a dentist where the dentist, patient, or other parties (e.g., another dentist, physician, or legal guardian) discuss the patient’s dental needs and proposed treatment modalities.

contiguous: Adjacent; touching.

contract: A legally enforceable agreement between two or more individuals or entities that confers rights and duties on the parties. Common types of contracts include: 1) contracts between a dental benefit organization and an individual dentist to provide dental treatment to members of an alternative benefit plan. These contracts define the dentist’s duties both to beneficiaries of the dental benefit plan and the dental benefit organization, and usually define the manner in which the dentist will be reimbursed; and 2) contracts between a dental benefit organization and a group plan sponsor. These contracts typically describe the benefits of the group plan and the rates to be charged for those benefits.

contract dentist: Any dentist who has a contractual agreement with a dental benefit organization to render care to eligible persons.

contract fee schedule plan: A dental benefit plan in which participating dentists agree to accept a list of specific fees for dental treatment provided.

contract practice: A dental practice or organization that has a contractual arrangement with an insurer for the provision of services under an insurance contract.

contract term: Usually a 12 months period of time for which a contract is written and during which a group’s deductibles, maximums and other provisions apply.  This may or may not be the same as a calendar year.  Also known as the benefit year.

contributory program: A dental benefit program in which the enrollee shares in the monthly premium of the program with the program sponsor (usually the employer).  Generally done through payroll deduction.

coordination of benefits (COB): A method of integrating benefits payable for the same patient under more than one plan.  Benefits from all sources should not exceed 100% of the total charges.

copayment: Beneficiary’s share of the dentist’s fee after the benefit plan has paid.

coping: A thin covering of the coronal portion of the tooth usually without anatomic conformity. Custom made or pre-fabricated thimble-shaped core or base layer designed to fit over a natural tooth preparation, a post core, or implant abutment so as to act as a substructure onto which other components can be added to give final form to a restoration or prosthesis. It can be used as a definitive restoration or as part of a transfer procedure.

core buildup: the replacement of a part or all of the crown of a tooth whose purpose is to provide a base for the retention of an indirectly fabricated crown.

coronal: Refers to the crown of a tooth.

cosmetic dentistry: Those services provided by dentists solely for the purpose of improving the appearance when form and function are satisfactory and no pathologic conditions exist [source: ADA policy “Cosmetic Dentistry (1976:850)].

cost containment: Features of a dental benefit program or of the administration of the program designed to reduce or eliminate certain charges to the plan.

cost sharing: The share of health expenses that a beneficiary must pay, including the deductibles, copayments, coinsurance, and charges over the amount reimbursed by the dental benefit plan.

coverage: Benefits available to an individual covered under a dental benefit plan.

covered charges: Services and supplies which are reimbursed in whole or in part under the conditions of the dental benefit plan, subject to all the terms and conditions of the agreement or  insurance policy. Charges are subject to any contractual agreements, exclusions and limitations. Any charges not covered by the plan are considered non-covered charges.

covered person: An individual who is eligible for benefits under a dental benefit program.

covered services: Services for which payment is provided under the terms of the dental benefit contract.

cracked tooth syndrome: A collection of symptoms characterized by transient acute pain experienced when chewing.

crown:  An artificial replacement that restores missing tooth structure by surrounding the remaining coronal tooth structure, or is placed on a dental implant. It is made of metal, ceramic or polymer materials or a combination of such materials.  It is retained by luting cement or mechanical means. (American College of Prosthodontics; The Glossary of Prosthodontic Terms). See also abutment crown, anatomical crown, clinical crown.

crown lengthening: A surgical procedure exposing more tooth for restorative purposes by apically positioning the gingival margin and removing supporting bone.

culture and sensitivity test: Clinical laboratory test which identifies a microorganism and the ability of various antibiotics to control the microorganism.

curettage: Scraping and cleaning the walls of a real or potential space, such as a gingival pocket or bone, to remove pathologic material.

Current Dental Terminology (CDT): The ADA reference manual that contains the Code on Dental Procedures and Nomenclature and other information pertinent to patient record keeping and claim preparation by a dental office; published biennially (e.g., CDT 2009-2010).

Current Procedural Terminology (CPT): A listing of descriptive terms and identifying codes developed by the American Medical Association (AMA) for reporting practitioner services and procedures to medical plans and Medicare.

cusp: Pointed or rounded eminence on or near the masticating surface of a tooth.

cuspid: Single cusped tooth located between the incisors and bicuspids.

customary fee: See fee.

cyst: Pathological cavity, usually lined with epithelium, containing fluid or soft matter.

odontogenic cyst–Cyst derived from the epithelium of odontogenic tissue (developmental, primordial).

periapical cyst–An apical inflammatory cyst containing a sac-like epithelium-lined cavity that is open to and continuous with the root canal.

cytology: The study of cells, including their anatomy, chemistry, physiology and pathology.