DeltaCare. USA provided by Alpha Dental Programs, Inc. Quality. Predictable costs. Convenience
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1 DeltaCare USA provided by Alpha Dental Programs, Inc. We ll do whatever it takes and then some. Find a DeltaCare USA dentist Select from among the many conveniently located DeltaCare USA contracted general dentists. To find the most current listing of DeltaCare USA dental offices you can: Visit our website at deltadentalins.com/ enrollees. Under Find a dentist, select DeltaCare USA as your network. Or call Customer Service at for help in finding a DeltaCare USA dentist. Monthly Rates Rates Effective 9/1/15-8/31/17 Employee Only...$11.66 Employee & Spouse...$22.15 Employee & Child(ren)...$23.31 Employee & Family...$36.12 Welcome to DeltaCare USA quality, convenience, predictable costs Alpha Dental Programs is a single service (dental) HMO that provides you and your family with quality dental benefits at an affordable cost. The DeltaCare USA program is designed to encourage you and your family to visit the dentist regularly to maintain your dental health. When you enroll, you select a contract dentist to provide services. The DeltaCare USA network consists of private practice dental facilities that have been carefully screened for quality. Enroll in DeltaCare USA and you ll enjoy these features: Quality Extensive benefits for you and your family No restrictions on pre-existing conditions, except for work in progress Large, stable network of dentists, so you can enjoy a long-term relationship with your dentist Convenience No claim forms to complete Easy access to specialty care Expanded business hours for toll-free customer service, from 7 a.m. to 8 p.m., Central time Predictable costs No deductibles Out-of-pocket costs are clearly defined Emergency dental services coverage No annual or lifetime dollar maximums Administered by Delta Dental Insurance Company SCTX(2005) HL_DCU_TX15A_V15_
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14 The following dental terms have the meanings indicated: Abrasion - The abnormal wearing away of the tooth by chewing, incorrect brushing methods, grinding or similar causes. Alveoloplasty - A surgical procedure to reshape the jaw bones to achieve normal bone contour in preparation for tooth replacement via denture, partials or bridges. Amalgam - A metal alloy used in filling teeth. Apicoectomy - The surgical removal of the root tip. Appliance - A device used to provide function or therapeutic effect. Attrition - The normal loss of tooth substance resulting from friction during chewing. Banding - Application of preformed stainless steel rings that are fitted around the teeth and cemented in place. Banding dentition - Treatment of a tooth which involves banding (for orthodontic purposes). Cephalometric x-rays - X-rays used in studying the measurements of the head in relation to specific soft tissue and bony reference points. Cleft palate - A birth defect resulting in an incomplete closure or formation of the palate. Debridement - The removal of plaque and tartar, above and below the gumline, which makes the ability to evaluate the gum condition difficult. Equilibration - Changing the occlusal forms of the teeth by selective grinding, with the interest of balancing occlusal stresses more evenly on the teeth. Erosion - Chemical or mechanical destruction of tooth substance, the mechanism of which is incompletely known, that leads to the creation of a depression in the tooth surface at the gumline. Exostosis - An excessive growth of bone. Expansion appliance - An appliance used to widen a dental arch to increase the room available for permanent teeth and/or to correct the bite. Frenum - The fibers that attach the cheek, lips or tongue to the tissue lining the mouth. Frenectomy - Surgical removal or loosening of the frenum. Functional appliance - An appliance used to achieve minor tooth movement, to strengthen the muscles of the oral cavity or to maintain space created by the loss or delayed eruption of the teeth. Gingiva - The soft tissue which covers a tooth or the gum surrounding a tooth. Gingivectomy - The surgical removal of the unsupported gingiva to the level where it is attached. Gingivoplasty - Surgical contouring of the gingiva to facilitate maintenance of tissue health and integrity. Headgear - An apparatus encircling the head or neck that provides attachment for an intraoral appliance in use of extraoral anchorage. Implant - A device specially designed to be placed surgically within or on the mandibular or maxillary bone as a means of providing for dental replacement of a missing tooth. Lingual - Pertaining to the tongue. Macrognathia - A definite overgrowth of the mandible and maxilla. Glossary 13
15 Mandible - The lower jaw. Mandibular - Pertaining to the lower jaw. Maxilla - The upper jaw. Maxillary - Pertaining to the upper jaw. Micrognathia - An abnormal smallness of the jaws, especially the mandible. Myofunctional therapy - Training to curb or eliminate abnormal muscle function of the oral cavity. Occlusal - The chewing surfaces of the posterior teeth. Occlusion - The contact between the upper and lower teeth when in a closed position. Orthodontic appliance - Any appliance used to apply forces for tooth movement during orthodontic treatment. Palate - The roof of the mouth. Palatal - Pertaining to the roof of the mouth. Palliative - Action that relieves pain but does not cure the cause of the pain. Panoramic film - An x-ray that offers a full view of the entire length of the jaws in a single x-ray. Pediatric or Pedodontic - Pertaining to children. Periapical - The area surrounding or enclosing the root tip of a tooth. Periodontitis - Gingival changes that occur due to infection and loss of attachment between the tooth and gums. Periodontitis is a long-term progressive disease. Periradicular - Around the root. Pontic - The term used for the artificial tooth on a bridge. Prophylaxis - The removal of plaque, tartar and stains on the crown portion of the teeth, including polishing. Pulp cap - The covering of an exposed dental nerve with material that protects it from foreign irritants. Quadrant - One of the four equal sections into which the dental arches can be divided; begins at the middle of the arch and goes to the last tooth on either side. Rebase - Process of refitting a denture by replacing the acrylic base material. Resin - Broad term used to indicate an organic substance that is usually tooth colored. Composite resin used in filling teeth, most often in the front of the mouth. Retainer - An appliance used to maintain the positions of the teeth and jaws gained by orthodontic procedures. Retrograde filling - A method of sealing the root canal by preparing and filling it from the root tip. Root planing - A procedure designed to remove bacteria, tartar and diseased root tissue from the root surfaces. Often referred to as deep cleaning. Sealant - Application of a resin material to the biting surfaces of the permanent molars to seal the surface crevices to prevent the formation of decay. Study model - A positive likeness of dental structures (teeth and adjoining tissues) for the purpose of study and treatment planning. Supernumerary - Any tooth in excess of the 32 normal permanent teeth. Glossary 14
16 Temporomandibular joint - The joint formed by the connection of the lower jaw to the skull. Tracing - As it relates to orthodontic treatment, a tracing is a line drawing of pertinent features of a cephalometric x-ray made on a piece of transparent paper placed over an x-ray. The tracing provides measurements of soft tissue and bony reference points that aid in predicting growth patterns and orthodontic diagnosis and treatment planning. Trigeminal nerve - The main nerve that provides feeling to the muscles and tissues of the face, jaws and teeth. Vertical demension - The vertical height of the face with teeth in occulusion. Glossary 15
17 SmileWay Wellness Program Find all of our dental health resources, including a risk assessment tool, articles, videos and a free e-newsletter subscription, at: mysmileway.com. DeltaCare USA Customer Service NOTE: THIS IS ONLY A BRIEF SUMMARY OF THE PLAN. The Group Dental Service Contract must be consulted to determine the exact terms and conditions of coverage. An Evidence of Coverage will be sent to you upon enrollment. If you wish to review an Evidence of Coverage prior to enrollment, you may request a copy by calling Customer Service at In Texas, DeltaCare USA is underwritten by Alpha Dental Programs, Inc. and administered by Delta Dental Insurance Company. These companies are financially responsible for their own products. Customer Service Monday through Friday 7 a.m. to 8 p.m., Central time Provided by: Alpha Dental Programs, Inc Shoal Creek, Suite 240 Highland Village, TX Administered by: Delta Dental Insurance Company P.O. Box 1803 Alpharetta, GA deltadentalins.com/enrollees A REGISTERED MARK OF DELTA DENTAL PLANS ASSOCIATION
DeltaCare. USA provided by Alpha Dental Programs, Inc. Quality. Predictable costs. Convenience
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This schedule applies to services provided by a participating General Dentist and is an extensive list of most common procedures. The purpose of this schedule is to establish the maximum fee that a General
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