Chapter 15 - Dental Insurance Processing Exam
Questions Solved Accurately
Fee for Service - CORRECT ANSWER✅✅✅Dental benefits paid for each dental service or
procedure performed by the dental practitioner, instead of payment that is salary or capitation
based.
Fee Schedule - CORRECT ANSWER✅✅✅A list of charges for dental services &
procedures established by the dentist or a dental benefits provider and mutually agreed on.
Health Maintenance Organization (HMO) - CORRECT ANSWER✅✅✅A healthcare
delivery system with a network of providers who will accept payment for services on a per capita
basis or limited fee schedule. The purpose is to contain NO costs through control of services
provided. MUST seek dental treatment from the assigned provider.
Preferred Provider Organization (PPO) - CORRECT ANSWER✅✅✅A contract between a
dental benefits plan organization & a provider of dental care that states that, in return for the
referral of dental patients, the dentist will provide services & procedures at a reduced fee or
according to a pre-established fee schedule. The purpose is to cut costs for the dental benefits
plan organization & to provide a patient base for the dental professional.
Table of allowances - CORRECT ANSWER✅✅✅Lists of procedures covered by an
insurance company & their respective dollar amounts. Fees are the same for all dentists,
regardless of location. Difference in fees can be charged to the patient.
Fixed fee schedule - CORRECT ANSWER✅✅✅Government assistant programs & other
programs that include preestablished fees that are charged by all dentists, regardless of
geographic area.
Direct reimbursement - CORRECT ANSWER✅✅✅Method of payment that bypasses an
insurance company & pays fees directly from a fund established by an employer.
Questions Solved Accurately
Fee for Service - CORRECT ANSWER✅✅✅Dental benefits paid for each dental service or
procedure performed by the dental practitioner, instead of payment that is salary or capitation
based.
Fee Schedule - CORRECT ANSWER✅✅✅A list of charges for dental services &
procedures established by the dentist or a dental benefits provider and mutually agreed on.
Health Maintenance Organization (HMO) - CORRECT ANSWER✅✅✅A healthcare
delivery system with a network of providers who will accept payment for services on a per capita
basis or limited fee schedule. The purpose is to contain NO costs through control of services
provided. MUST seek dental treatment from the assigned provider.
Preferred Provider Organization (PPO) - CORRECT ANSWER✅✅✅A contract between a
dental benefits plan organization & a provider of dental care that states that, in return for the
referral of dental patients, the dentist will provide services & procedures at a reduced fee or
according to a pre-established fee schedule. The purpose is to cut costs for the dental benefits
plan organization & to provide a patient base for the dental professional.
Table of allowances - CORRECT ANSWER✅✅✅Lists of procedures covered by an
insurance company & their respective dollar amounts. Fees are the same for all dentists,
regardless of location. Difference in fees can be charged to the patient.
Fixed fee schedule - CORRECT ANSWER✅✅✅Government assistant programs & other
programs that include preestablished fees that are charged by all dentists, regardless of
geographic area.
Direct reimbursement - CORRECT ANSWER✅✅✅Method of payment that bypasses an
insurance company & pays fees directly from a fund established by an employer.
