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1. Full fee–The fee for a service that is set by the dentist, which reflects the costs of providing the procedure and the value of the dentist’s professional judgment. A contractual relationship does not change a dentist’s full fee. It is always appropriate to report the full fee for each service reported to a third party payer. maximum plan benefit – The reimbursement level determined by the administrator of a dental benefit plan for a specific dental procedure. This may vary widely by geographic region or by benefit plans within a region.

2. Usual fee–The fee which an individual dentist most frequently charges for a specific dental procedure independent of any contractual agreement. It is always appropriate to modify this fee based on the nature and severity of the condition being treated and by any medical or dental complications or unusual circumstances.

Usual, Customary and Reasonable Fees–These are three separate terms that are often incorrectly used interchangeably, synonymously or as a single term abbreviated as "UCR" when describing dental benefit plans. Definitions of these three terms are posted online at http://www.ada.org.

3. Fee-for-service–A method of reimbursement by which the dentist establishes and expects to receive his or her full fee for the specific service(s) performed.

4. Fee schedule–A list of the charges established or agreed to by a dentist for specific dental services.

5. audit: An examination of records or accounts to check their accuracy. A post-treatment record review or clinical examination to verify information reported on claims.

6. beneficiary: A person who is eligible for benefits under a dental benefit contract. See also covered person, insured, and member.

7. benefit: The amount payable by a third party toward the cost of various covered dental services or the dental service or procedure covered by the plan.

8. benefit booklet: A booklet or pamphlet provided to the subscriber that contains a general explanation of the benefits and related provisions of the dental benefit program. Also known as a Summary Plan Description.

9. benefit plan summary: The description or synopsis of employee benefits as required by ERISA that is to be distributed to the employees.


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