The following definitions are provided to help you understand your dental coverage.
A tooth or root that retains or supports a fixed bridge or removable prosthesis.
Acid Etch
Applying a mild acid to a tooth to help it hold a composite filling material.
Plastic materials used to make dentures and crowns; sometimes used as a restorative filling material.
A metal alloy (usually silver, mercury, tin, zinc and copper combined with liquid mercury) used as restorative material.
A device used to provide function, therapeutic (healing) effect, space maintenance or force to teeth to provide movement or growth changes as in orthodontics. Appliances can be:
  • Fixed (attached to the teeth by cement or by adhesive materials)
  • Removable (can be taken in and out of the mouth by the patient)
  • Prosthetic (used to replace a missing tooth)
A type of dental X-ray film with a central tab or wing that is commonly used to detect decay.
Bridgework or Prosthetic Appliance
These can be:
  • Fixed (pontics or replacement teeth held by crowns or inlays cemented to the natural teeth)
  • Fixed-removable (removable by the dentist but not the patient)
  • Removable (a partial denture held by attachments, usually clasps, that permit removal of the denture)
A disease that destroys the teeth due to bacterially produced acids on tooth surfaces.
Tooth-colored filling material used mainly in the front teeth.
A natural crown is the part of a tooth covered by enamel. An artificial crown (cap) restores the anatomy, function and look of the natural crown.
Dental Emergency
Any traumatic dental condition which:
  • Occurs unexpectedly
  • Requires immediate diagnosis and treatment and
  • Is characterized by symptoms such as severe pain and bleeding
A device replacing missing teeth.
Endodontic Therapy
Treatment of diseases of the dental pulp.
A fluorine solution applied to the teeth to help prevent dental decay.
A device surgically inserted into or onto the jaw bone used to support a crown or crowns, partial denture or complete denture, or as an abutment for a fixed bridge.
A mold used to produce a form or cast of selected teeth and/or soft tissues of the mouth.
A restoration (usually of cast metal) made to fit a prepared tooth cavity and then cemented into place.
An abnormal contact and/or position of the opposing teeth when brought together.
The "bite" or contact relationship of the upper and lower teeth.
A cast restoration that covers the entire chewing surface of the tooth.
The branch of dentistry that focuses on detecting, preventing and correcting abnormalities in the way the teeth are positioned in relationship to the jaw.
Used to relieve, but not cure.
Partial Denture
A prosthesis replacing one or more, but less than all, of the natural teeth and associated structures; may be removable or fixed, one side or two sides.
The specialty of children's dentistry.
The science of examining, diagnosing and treating diseases of the teeth's supporting structures.
The part of a fixed bridge that is suspended between the abutments and replaces a missing tooth or teeth.
Teeth cleaning by a dentist or dental hygienist to remove tartar and stains.
A process to refit a denture by replacing the entire denture-base material without changing the teeth's occlusion.
Recognized Charge
The covered expense is only that part of a charge that is the recognized charge.
As to dental expenses, the recognized charge for each service or supply is the lesser of:
  • What the provider bills or submits for that service or supply and
  • The 90th percentile of the Prevailing Charge Rate; for the Geographic Area where the service is furnished
If Aetna has an agreement with a provider (directly, or indirectly through a third party) which sets the rate that Aetna will pay for a service or supply, then the recognized charge is the rate established in such agreement.
Aetna may also reduce the recognized charge by applying Aetna Reimbursement Policies. Aetna Reimbursement Policies address the appropriate billing of services, taking into account factors that are relevant to the cost of the service such as:
  • the duration and complexity of a service
  • whether multiple procedures are billed at the same time, but no additional overhead is required
  • whether an assistant surgeon is involved and necessary for the service
  • if follow-up care is included
  • whether there are any other characteristics that may modify or make a particular service unique and
  • when a charge includes more than one claim line, whether any services described by a claim line are part of or incidental to the primary service provided
Aetna Reimbursement Policies are based on Aetna's review of: the policies developed for Medicare; the generally accepted standards of medical and dental practice, which are based on credible scientific evidence published in peer-reviewed literature generally recognized by the relevant medical or dental community or which is otherwise consistent with physician or dental specialty society recommendations; and the views of physicians and dentists practicing in the relevant clinical areas. Aetna uses a commercial software package to administer some of these policies.
As used above, Geographic Area and Prevailing Charge Rates are defined as follows:
  • Geographic Area: This means an expense area grouping defined by the first three digits of the U.S. Postal Service zip codes. If the volume of charges in a single three-digit zip code is sufficient to produce a statistically valid sample, an expense area is made up of a single three-digit zip code. If the volume of charges is not sufficient to produce a statistically valid sample, two or more three-digit zip codes are grouped to produce a statistically valid sample. When it is necessary to group three-digit zip codes, the grouping never crosses state lines
  • Prevailing Charge Rates: These are the rates reported by FAIR Health, a nonprofit company, in their database. FAIR Health reviews and, if necessary, changes these rates periodically. Aetna updates its systems with these changes within 180 days after receiving them from FAIR Health
Additional Information
Aetna's website may contain additional information which may help you determine the cost of a service or supply. Log on to Aetna Navigator to access the "Estimate the Cost of Care" feature. Within this feature, view the "Cost of Care" and "Member Payment Estimator" tools, or contact Aetna's Customer Service Department for assistance.
To resurface the tissue-borne areas of a denture with new material.
A broad term applied to any inlay, crown, bridge, partial denture or complete denture that restores or replaces loss of tooth structure, teeth or oral tissue. It applies to the end result of repairing and restoring or reforming the shape, form and function of part or all of a tooth or teeth.
Root Canal Therapy
Includes removing a tooth's pulp tissues, sterilizing the pulp chamber and root canals, and filling these spaces with a sealing material.
Removing tartar and stains from teeth with special instruments.
A resinous agent applied to the surface grooves of teeth to reduce decay.
A relatively hard and translucent restorative material that is used mainly in the front teeth.
Stabilizing or immobilizing teeth to gain strength and/or facilitate healing.
Vertical Dimension
The degree of jaw separation when the teeth are in contact.