Insurance Glossary

Dental Insurance Basics

M

Major restorative services

Major restorative (Type/Unit III or class C) services repair or replace severely damaged teeth and gums. They are most often reimbursed at a lower level of benefits. Examples include root canals, complex extractions, crowns, bridges, implants, and periodontal or oral surgery. Dental insurance plans vary in how they categorize services, so it is important to review your open enrollment materials and dental insurance plan summary to understand the coverage levels of services you expect to receive.

Maximum allowable charge

See "Reasonable and customary"

Maximum benefit

See "Annual maximum"

Member

Members are individuals or covered dependents enrolled in a dental insurance plan. Members are also referred to as a covered person or an enrollee.

Member coinsurance

See "Coinsurance"

Minor restorative services

Minor restorative (Type/Unit II or class B) services refer to a wide range of dental procedures that stop the progression of dental disease, treat its effects, or restore teeth to a properly functioning state. Examples include fillings, scaling and root planing, periodontal maintenance, and simple tooth extractions. Dental insurance plans vary in how they categorize services, so it is important to review your open enrollment materials and dental insurance plan summary to understand the coverage levels of services you expect to receive.

Missing tooth exclusion

This is a dental insurance plan clause stating that services related to replacement of a tooth or teeth that was/were missing prior to coverage with your current dental insurance plan sponsor or dental insurance plan administrator may result in denial of coverage.