Online Dental Education Library

Our team of dental specialists and staff strive to improve the overall health of our patients by focusing on preventing, diagnosing and treating conditions associated with your teeth and gums. Please use our dental library to learn more about dental problems and treatments available. If you have questions or need to schedule an appointment, contact us.

 

INSURANCE

Usual and Customary. What Does It Mean?

 

Every once in a while a patient calls us after receiving a statement from their dental insurance company and asks: “Your fee for this is over what my dental insurance company calls ‘usual and customary,’ does that mean you are overcharging me?” 

That’s a good question, one we’re happy to answer. 

Each separate insurance company has its own “usual and customary” fees for all dental procedures for a certain geographical region. When our state dental association asks these companies for data to see how the numbers were arrived at and which dentists (if any) were surveyed, they are told that this is privileged company information and they do not reveal that. 

The fact is that different insurance companies have different “usual and customary” fees for the same area.  If the calculations were done correctly they should all have the same fees.  But they don’t! In fact the ranges are quite broad. 

Because the insurance companies establish artificially low fees in an effort to keep their profit margins as high as possible, animosity can be created between the dentist and the patient.  The insurance companies’ main goal is to collect as much in premiums as possible while paying out as little as possible and delaying payment for as long as possible. That is how they make their money.  Unlike us, they do not have the patients’ best interest at heart.

What is Dental Insurance?

Dental insurance is nothing more than a contract between the employer and the insurance company to partially pay for certain services.  It exists to help in covering the costs; it was never intended to cover all the costs. There are deductibles, some services get paid at 50 % or 85 % and some aren’t covered at all. 

The type of insurance coverage your employer is willing to buy is determined by how much the employer is willing to pay for.  The employer selects as many or as fewer benefits they want.  The higher the premium paid by your employee – the higher is your usual and customary fee.

How Are Our Fees Set?

Our fees are set by the actual cost of doing business in this particular office.  Costs vary from office to office depending on rent, the salaries of out employees, quality of materials used, lab costs and many other "cost of doing business" factors.

For example, we will not compromise on sterilization because it’s just too important for our patients.  Likewise we will not use inferior materials for our dental restorations just to “save money”.  The fact is you never save money this way because the cheaper materials don’t last as long and the patient ends up back in the dental chair in a few years complaining that their crown or filling failed. We hire only the best, well trained staff, who love their jobs and give 110% every day to our patients care and customer service.

                          (information taken from Dr. Alex Shvartsman)

 



A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A
Amalgam - Material made from mercury and other alloy mixtures used to restore a drilled portion of a tooth.
Anesthesia - Medications used to relieve pain.
Anterior teeth - Front teeth. Also called incisors and cuspids.
Arch - The upper or lower jaw.
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B
Baby bottle tooth decay - Caused by sugary substances in breast milk and some juices, which combine with saliva to form pools inside the baby's mouth.
Bicuspids -A premolar tooth; tooth with two cusps, which are pointed or rounded eminences on or near the masticating surface of a tooth.
Bitewings - X-rays that help a dentist diagnose cavities.
Bonding - Application of tooth-colored resin materials to the surface of the teeth.
Bridge - A prosthetic replacement of one or more missing teeth cemented or otherwise attached to the abutment teeth or implant replacements.
Bruxism - Teeth grinding.
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C
Calculus - A hard deposit of mineralized substance adhering to crowns and/or roots of teeth or prosthetic devices.
Canal - The narrow chamber inside the tooth's root.
Canines - Also called cuspids.
Canker sore - One that occurs on the delicate tissues inside your mouth. A canker sore is usually light-colored at its base and can have a red exterior border.
Caries - A commonly used term for tooth decay, or cavities.
Cold sore - Usually occurs on the outside of the mouth, usually on or near the nose or lips. A cold sore is contagious because it is caused by the herpes simplex virus, and it is usually painful and filled with fluid.
Composite filling - Tooth colored restorations, also known as resin fillings.
Composite resin - A tooth colored resin combined with silica or porcelain and used as a restoration material.
Contouring - The process of reshaping teeth.
Crown - An artificial tooth replacement that restores missing tooth structure by surrounding the remaining coronal tooth structure. It is also placed on a dental implant.
Cusps - The pointed parts on top of the back teeth's chewing surface.
Cuspids - Front teeth that typically have a protruding edge.
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D
Dentin - The tooth layer underneath the enamel.
Denture - A removable set of teeth.
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E
Endodontics - A form of dentistry that addresses problems affecting the tooth's root or nerve.
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F
Fluoride - A harmless over-exposure to fluoride resulting in tooth discoloration.
Fluorosis - A harmless over-exposure to fluoride and resulting sometimes in tooth discoloration.
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G
Gingiva - Another word for gum tissue.
Gingivitis - A minor disease of the gums caused by plaque.
Gum disease - An infection of the gum tissues. Also called periodontal disease.
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I
Impacted teeth - A condition in which a tooth fails to erupt or only partially erupts.
Implant - A permanent appliance used to replace a missing tooth.
Incisor - Front teeth with cutting edges; located in the center or on the sides near the front.
Inlay - An artificial filling made of various materials, including porcelain, resin, or gold.
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L
Laminate veneer - A shell that is bonded to the enamel of a front tooth. The shell is usually thin and made from porcelain resin.
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M
Malocclusion - Bad bite relationship.
Mandible - The lower jaw.
Maxilla - The upper jaw.
Molar - Usually the largest teeth, near the rear of the mouth. Molars have large chewing surfaces.
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N
Neuromuscular Dentistry - Addresses more than the aches and pains felt in and around the neck and head that are associated with your teeth and jaw.

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O
Onlay - A filling designed to protect the chewing surface of a tooth.
Orthodontics - A field of dentistry that deals with tooth and jaw alignment.
Overdenture - A non-fixed dental appliance applied to a small number of natural teeth or implants.
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P
Palate - Roof of the mouth.
Partial denture - A removable appliance that replaces missing teeth.
Pediatric Dentistry - A field of dentistry that deals with children’s teeth
Perio pocket - An opening formed by receding gums.
Periodontal disease - Infection of the gum tissues. Also called gum disease.
Periodontist - A dentist who treats diseases of the gums.
Permanent teeth - The teeth that erupt after primary teeth. Also called adult teeth.
Plaque - A sticky, colorless substance that covers the teeth after sleep or periods between brushing.
Posterior teeth - The bicuspids and molars. Also called the back teeth.
Primary teeth - A person's first set of teeth. Also called baby teeth or temporary teeth.
Prophylaxis - The act of cleaning the teeth.
Prosthodontics - The field of dentistry that deals with artificial dental appliances.
Pulp - The inner tissues of the tooth containing blood, nerves and connective tissue.
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R
Receding gum - A condition in which the gums separate from the tooth, allowing bacteria and other substances to attack the tooth's enamel and surrounding bone.
Resin filling - An artificial filling used to restore teeth. Also called a composite filling.
Root canal - A procedure in which a tooth's nerve is removed and an inner canal cleansed and later filled.
Root planing - Scraping or cleansing of teeth to remove heavy buildup of tartar below the gum line.
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S
Sealant - A synthetic material placed on the tooth's surface that protects the enamel and chewing surfaces.
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T
TMJ - Temporomandibular joint disorder. Health problems related to the jaw joint just in front of the ear.
Tarter - A hardened substance (also called calculus) that sticks to the tooth’s surface.
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V
Veneer - A laminate applied or bonded to the tooth.
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W
Whitening - A process that employs special bleaching agents for restoring the color of teeth.
Wisdom tooth - Third set of molars that erupt last in adolescence.
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