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Health Insurance (Dental Services) Determination 2007

Authoritative Version
Determinations/Health as amended, taking into account amendments up to Disallowance
This Determination sets out the schedule of Medicare items for dental services for people with chronic conditions and complex care needs and the provisions that govern how items are to be used.
Administered by: Health
General Comments: This compilation does not include the amendments made by the Health Insurance (Dental Services) Amendment and Repeal Determination 2008 as this instrument was disallowed by the Senate on 19 June 2008, resulting in the as-made instrument being the current law.
Registered 19 Aug 2008
Start Date 20 Jun 2008
End Date 07 Sep 2012
Date of repeal 30 Nov 2012
Repealed by Self Repealing

Health Insurance (Dental Services) Determination 2007

as amended

made under subsection 3C (1) of the

This compilation was prepared on 20 June 2008
taking into account amendments up to Health Insurance (Dental Services) Amendment and Repeal Determination 2008

Prepared by the Office of Legislative Drafting and Publishing,
Attorney‑General’s Department, Canberra

Contents

                        1     Name of Determination [see Note 1]                                                      3

                        2     Commencement                                                                                  3

                        3     Definitions                                                                                           3

                        4     Dental services                                                                                    4

                        5     Monetary limit on medicare benefits                                                      4

                        6     Patient eligibility                                                                                  5

                        7     Effect of election to claim private health insurance for a dental service      5

                        8     Application of items — dental services provided by eligible providers to eligible patients 5

                        9     Referral                                                                                               5

                       10     Quotation for dental services and reporting                                             6

                       11     Purpose of service                                                                               6

                       12     Limitation on items — dentures and denture components                        6

                       13     Limitation on number of certain services                                                7

                       14     Limitation on provision of certain services                                               8

                       15     Application of item 85433                                                                     8

                       16     Application of item 85455                                                                     8

                       17     Limitation on items 85521 and 85531                                                    8

                       18     Application of item 85572                                                                     8

                       19     Application of items 85733, 86733 and 87733                                         9

                       20     Application of item 86433                                                                     9

                       21     Application of item 86455                                                                     9

                       22     Limitation on items 86521 and 86531                                                    9

                       23     Application of item 86572                                                                     9

Schedule 1             Dental services and fees                                                                 10

Part 1                      Services provided by eligible dentists                                                  10

Part 2                      Services provided by eligible dental specialists                                     19

Part 3                      Services provided by eligible dental prosthetists                                    30

Schedule 2             Specialties                                                                                      33

Notes                                                                                                                              34

 

  

  

1              Name of Determination [see Note 1]

                This Determination is the Health Insurance (Dental Services) Determination 2007.

2              Commencement

                This Determination commences on 1 November 2007.

3              Definitions

                In this Determination:

Act means the Health Insurance Act 1973.

dental service means a dental service mentioned in Schedule 1.

eligible dental prosthetist means an individual:

                (a)    who is registered or entitled to practice as a dental prosthetist under a law of a State or Territory; and

               (b)    whose registration or entitlement to practice as a dental prosthetist entitles the individual to provide services to which any of the items mentioned in Part 3 of Schedule 1 apply; and

                (c)    whose name is entered in the register, kept by the Medicare Australia CEO, of dental prosthetists who can provide services to which any of the items mentioned in Part 3 of Schedule 1 apply.

eligible dental specialist means a person:

                (a)    who is registered or licensed to practice under a law of a State or Territory in a specialty mentioned in Schedule 2; and

               (b)    whose name is entered in the register, kept by the Medicare Australia CEO, of dental specialists who can provide services to which any of the items mentioned in Part 2 of Schedule 1 apply.

eligible dentist means a dental practitioner whose name is entered in the register, kept by the Medicare Australia CEO, of dental practitioners who can provide services to which any of the items mentioned in Part 1 of Schedule 1 apply.

eligible patient has the meaning given by section 6.

GP management plan means a plan to which item 721 or 725 of the general medical services table applies.

multidisciplinary care plan has the meaning given by subrule 36 (2) of the general medical services table.

relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act.

team care arrangements means team care arrangements to which item 723 or 727 of the general medical services table applies.

Note   Unless a contrary intention appears, an expression used in this Determination has the same meaning as in the Health Insurance Act 1973 — see section 13 of the Legislative Instruments Act 2003.

4              Dental services

                A dental service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:

                (a)    it were both a professional service and a medical service; and

               (b)    there were an item in the general medical services table that:

                          (i)    related to the service; and

                         (ii)    specified for the service a fee for each State, being the fee mentioned in the item in Schedule 1 for the service.

Note   For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.

5              Monetary limit on medicare benefits

         (1)   For subsection 3C (2A) of the Act, the total of all amounts of medicare benefit paid or payable for dental services provided to a person in a relevant 2 year period must not exceed $4 250.

         (2)   In this section:

relevant 2 year period, for a person, has the meaning given by subsections (3) and (4).

         (3)   If:

                (a)    a person received a dental service on or after 1 November 2007; and

               (b)    the service is the first dental service that the person has received on or after 1 November 2007;

the calendar year in which the person received that first dental service and the following calendar year is a relevant 2 year period for the person.

         (4)   After that relevant 2 year period, each calendar year in which the person receives a dental health service and the following calendar year is a relevant 2 year period for the person unless the first mentioned year is already part of a relevant 2 year period because of a previous application of this subsection.

Example 1

A person who first receives a dental service on 25 November 2007 will be eligible for not more than $4 250 in medicare benefits for all dental services provided to the person in 2007 and 2008.

A further relevant 2 year period commences for that person in the calendar year when the person first receives a dental service on or after 1 January 2009.

Example 2

A person who first receives a dental service on 15 January 2008 will be eligible for not more than $4 250 in medicare benefits for all dental services provided to the person in 2008 and 2009.

A further relevant 2 year period commences for the person in the calendar year when the patient first receives a dental service on or after 1 January 2010.

6              Patient eligibility

                A person is an eligible patient if:

                (a)    the person has either:

                          (i)    a GP management plan and team care arrangements in place; or

                         (ii)    a multidisciplinary care plan to which item 731 of the general medical services table applies; and

               (b)    his or her oral health is impacting on, or is likely to impact on, his or her general health; and

                (c)    the person has been referred for a dental service under section 9; and

               (d)    the person is not an admitted patient of a hospital.

7              Effect of election to claim private health insurance for a dental service

                An item in Schedule 1 applies to a dental service only if a private health insurance benefit has not been claimed for that service.

8              Application of items — dental services provided by eligible providers to eligible patients

         (1)   An item in Part 1 of Schedule 1 applies only to a dental service provided by an eligible dentist to an eligible patient.

         (2)   An item in Part 2 of Schedule 1 applies only to a dental service provided by an eligible dental specialist to an eligible patient.

         (3)   An item in Part 3 of Schedule 1 applies only to a dental service provided by an eligible dental prosthetist to an eligible patient.

9              Referral

         (1)   A general practitioner may refer an eligible patient for a dental service only to:

                (a)    an eligible dentist; or

               (b)    an eligible dental prosthetist, if the patient:

                          (i)    has no natural teeth and requires only dental prosthetic services; or

                         (ii)    requires only repairs or maintenance to an existing denture.

         (2)   A referral by a general practitioner must be made in the form published by the Department and described as ‘Referral Form for Dental Services under Medicare’, as existing on 1 November 2007, or a form that substantially complies with that form.

Note   The form is available on the internet — see http://www.health.gov.au.

         (3)   An eligible dentist who has provided a dental service to an eligible patient referred to the eligible dentist under this subsection or subsection (1), (4) or (5) may refer the patient to an eligible dentist, an eligible dental specialist or an eligible dental prosthetist for an additional dental service.

         (4)   An eligible dental specialist who has provided a dental service to an eligible patient referred to the eligible dental specialist under this subsection or subsection (3) may refer the patient to an eligible dentist, an eligible dental specialist or an eligible dental prosthetist for an additional dental service.

         (5)   An eligible dental prosthetist who has provided a dental service to an eligible patient referred to the eligible dental prosthetist under this subsection or subsection (1), (3) or (4) may refer the patient to an eligible dentist or an eligible dental prosthetist for an additional dental service.

10            Quotation for dental services and reporting

         (1)   This section applies if:

                (a)    an eligible dentist, an eligible dental specialist or an eligible dental prosthetist performs an initial examination and assessment of an eligible patient, including consideration of any diagnostic tests; and

               (b)    provides a course of treatment to the patient.

         (2)   An item in Schedule 1 applies to a dental service included in the course of treatment only if, before beginning the course of treatment, the eligible dentist, eligible dental specialist or eligible dental prosthetist:

                (a)    gave to the eligible patient, in writing:

                          (i)    a plan of the course of treatment; and

                         (ii)    a quotation for each dental service and each other service (if any) in the plan; and

               (b)    gave a copy or written summary of the plan to the general practitioner who referred the patient for dental services.

11            Purpose of service

         (1)   An item in Schedule 1 applies to a dental service only if the primary purpose of the service is to improve the oral health or function of the eligible patient.

         (2)   An item in Schedule 1 does not apply to a dental service if the primary purpose of the service is to improve the appearance of the eligible patient.

         (3)   An item in Schedule 1 applies to a dental service if the primary purpose of the service is to improve the oral health or function of the eligible patient and another purpose of the service is to improve the patient’s appearance.

12            Limitation on items — dentures and denture components

         (1)   For any particular eligible patient, a set of dentures applies not more than:

                (a)    once in 8 years; or

               (b)    if exceptional circumstances exist in relation to the patient — twice in 8 years.

         (2)   In this section:

exceptional circumstances exist in relation to an eligible patient if:

                (a)    an eligible dentist, an eligible dental specialist or an eligible dental prosthetist is satisfied that there has been a significant change in the clinical condition of the patient that necessitates a new set of dentures for the patient; or

               (b)    the existing dentures of the patient have been irreparably damaged or lost.

set of dentures means:

                (a)    complete maxillary and mandibular dentures under item 85719, 86719 or 87719; or

               (b)    a complete or partial maxillary denture under item 85711, 85721, 85727, 86711, 86721, 86727, 87711, 87721 or 87727; or

                (c)    a complete or partial mandibular denture under item 85712, 85722, 85728, 86712, 86722, 86728, 87712, 87722 or 87728; or

               (d)    both:

                          (i)    a complete or partial maxillary denture under any of the items mentioned in paragraph (b); and

                         (ii)    a complete or partial mandibular denture under any of the items mentioned in paragraph (c).

13            Limitation on number of certain services

                For any particular eligible patient, an item mentioned in column 2 of the following table is applicable to a service not more than the number of times mentioned in column 3 of the table in the period mentioned in column 4 of the table.

 

Item

Item of service

Number of times

Period

1

85123, 85311, 85314, 85322, 85323, 85324, 86123, 86311, 86314, 86322, 86323, 86324

1

1 day

2

85927, 86927

1

3 months

3

85111, 85114, 85121, 86111, 86114, 86121

1

6 months

4

85039, 85047, 85131, 85141, 85221, 85225, 85245, 85433, 86036, 86039, 86047, 86131, 86141, 86221, 86225, 86245, 86433

1

12 months

5

85753, 86753, 87753

1

24 months

6

85963, 85964, 86963, 86964

1

36 months

7

85222, 86222

2

1 day

8

85115, 85213, 85234, 85986, 86115, 86213, 86234, 86235, 86986

2

12 months

9

85013, 85572, 86013, 86572

3

3 months

10

85458, 86458

3

12 months

11

85231, 85232, 85233, 85971, 86231, 86232, 86233, 86971

4

12 months

12

85771, 86771, 87771

5

3 months

13

85022, 86022

6

1 day

14            Limitation on provision of certain services

                For any particular eligible patient, an item mentioned in column 2 of the following table is applicable to a service provided by a particular eligible dentist, eligible dental specialist or eligible dental prosthetist not more than once in the period mentioned in column 3 of the table.

 

Item

Item of service

Period

1

85012, 86012

6 months

2

86015, 86038, 86082

12 months

3

85011, 87011

24 months

15            Application of item 85433

                For any particular eligible patient, item 85433 does not apply to a service provided to the patient on a day if a service described in item 85431, 85432, 85434, 85436, 85437 or 85438 is provided to the patient on the day.

16            Application of item 85455

                For any particular eligible patient, item 85455 does not apply to a service provided to the patient on a day if a service described in item 85415, 85416, 85417 or 85418 is provided to the patient on the day.

17            Limitation on items 85521 and 85531

                For any particular eligible patient, any combination of items 85521 and 85531 is applicable to not more than 5 services provided to the patient on a day.

18            Application of item 85572

                For any particular eligible patient, item 85572 does not apply to a service provided to the patient on a day if a service described in any of items 85411 to 85418 or items 85431 to 85458 is provided to the patient on the day.

19            Application of items 85733, 86733 and 87733

         (1)   For any particular eligible patient, item 85733 applies to the addition of no more than 12 teeth to a base provided to the patient under item 85721, 85722, 85727 or 85728.

         (2)   For any particular eligible patient, item 86733 applies to the addition of no more than 12 teeth to a base provided to the patient under item 86721, 86722, 86727 or 86728.

         (3)   For any particular eligible patient, item 87733 applies to the addition of no more than 12 teeth to a base provided to the patient under item 87721, 87722, 87727 or 87728.

20            Application of item 86433

                For any particular eligible patient, item 86433 does not apply to a service provided to the patient on a day if a service described in item 86431, 86432, 86434, 86436, 86437 or 86438 is provided to the patient on the day.

21            Application of item 86455

                For any particular eligible patient, item 86455 does not apply to a service provided to the patient on a day if a service described in item 86415, 86416, 86417 or 86418 is provided to the patient on the day.

22            Limitation on items 86521 and 86531

                For any particular eligible patient, any combination of items 86521 and 86531 is applicable to not more than 5 services provided to the patient on a day.

23            Application of item 86572

                For any particular eligible patient, item 86572 does not apply to a service provided to the patient on a day if a service described in any of items 86411 to 86418 or items 86431 to 86458 is provided to the patient on the day.

Schedule 1        Dental services and fees

(section 3)

Part 1                  Services provided by eligible dentists

 

Item

Service

Fee ($)

Group A1 — Diagnostic services

Subgroup 1 — Examinations

85011

Comprehensive oral examination, including:

   (a)  evaluation of all teeth, their supporting tissues and the oral tissues to record the condition of these structures; and

   (b)  recording an appropriate medical history and any other relevant information

(Item is subject to section 14)

47.60

85012

Periodic oral examination and evaluation performed on a patient of record to determine any changes in the patient’s dental and medical health since a previous comprehensive or periodic examination

(Item is subject to section 14)

39.50

85013

Oral examination, limited to a problem‑focused oral evaluation carried out immediately before required treatment, including recording an appropriate medical history and any other relevant information

(Item is subject to section 13)

24.85

Subgroup 2 — Radiological examination and interpretation

85022

Intraoral periapical or bitewing radiograph — each exposure

(Item is subject to section 13)

31.15

85025

Intraoral radiograph (occlusal, maxillary or mandibular) — each exposure

55.55

85031

Extraoral radiograph (maxillary or mandibular) — each exposure

63.35

85037

Panoramic radiograph — each exposure

85.10

85039

Tomography of the skull or parts of the skull

(Item is subject to section 13)

134.25

Subgroup 3 — Other diagnostic services

85047

Caries activity screening test

(Item is subject to section 13)

36.55

85051

Biopsy of tissue

111.85

85071

Diagnostic model — each model

54.55

Group A2 — Preventive services

Subgroup 1 — Dental prophylaxis

85111

Removal of plaque, stain or plaque and stain

(Item is subject to section 13)

48.60

85113

Recontouring pre‑existing restoration or restorations

18.35

85114

Removal of calculus — first visit

(Item is subject to section 13)

81.00

85115

Removal of calculus — each subsequent visit

(Item is subject to section 13)

52.70

85117

Bleaching, internal, for non‑vital discoloured tooth — each tooth

189.80

Subgroup 2 — Remineralising agents

85121

Topical application of remineralising agent — 1 treatment

(Item is subject to section 13)

31.20

85123

Application of concentrated remineralising agent — single tooth

(Item is subject to section 13)

24.45

Subgroup 3 — Other preventive services

85131

Dietary advice — consultation of at least 15 minutes

(Item is subject to section 13)

32.90

85141

Oral hygiene instruction — consultation of at least 15 minutes

(Item is subject to section 13)

44.65

85161

Fissure sealing — each tooth

41.55

85165

Desensitizing procedure — each visit

24.45

85171

Odontoplasty — each tooth

45.85

Group A3 — Periodontics

85213

Treatment of acute periodontal infection — each visit

(Item is subject to section 13)

62.90

85221

Clinical periodontal analysis and recording

(Item is subject to section 13)

47.80

85222

Root planing and subgingival curettage — no more than 8 teeth

(Item is subject to section 13)

117.50

85225

Non‑surgical periodontal treatment where not described in another item — each visit

(Item is subject to section 13)

95.45

85231

Gingivectomy — no more than 8 teeth

(Item is subject to section 13)

153.05

85232

Periodontal flap surgery — no more than 8 teeth

(Item is subject to section 13)

232.65

85233

Osseous surgery — no more than 8 teeth

(Item is subject to section 13)

392.10

85234

Osseous graft — each tooth or implant

(Item is subject to section 13)

448.65

85238

Periodontal flap surgery for crown lengthening — each tooth

216.50

85241

Root resection — each root

180.40

85245

Periodontal surgery involving a tooth or an implant

(Item is subject to section 13)

71.65

Group A4 — Oral surgery

Subgroup 1 — Extractions

85311

Removal of a tooth or part or parts of a tooth, including local anaesthesia and routine and post‑operative care — first tooth extracted on a day

(Item is subject to section 13)

118.50

85314

Sectional removal of a tooth, including local anaesthesia and routine post‑operative care — first sectional removal on a day

(Item is subject to section 13)

151.50

85316

Additional extraction requiring:

   (a)  removal of a tooth or part or parts of a tooth; or

   (b)  sectional removal of a tooth;

on the same day as a service described in item 85311 or 85314 is provided to the patient

87.95

Subgroup 2 — Surgical extractions

85322

Surgical removal of a tooth or tooth fragment, not requiring removal of bone or tooth division, including local anaesthesia and routine post‑operative care — first tooth extracted on a day

(Item is subject to section 13)

192.40

85323

Surgical removal of a tooth or tooth fragment, requiring removal of bone, including local anaesthesia and routine post‑operative care — first tooth extracted on a day

(Item is subject to section 13)

219.75

85324

Surgical removal of a tooth or tooth fragment, requiring removal of bone and tooth division, including local anaesthesia and routine post‑operative care — first tooth extracted on a day

(Item is subject to section 13)

295.65

85326

Additional extraction requiring surgical removal of a tooth or tooth fragment, on the same day as a service described in item 85322, 85323 or 85324 is provided to the patient

185.30

Subgroup 3 — Surgery for prostheses

85331

Alveolectomy, including insertion of sutures, normal post‑operative care and suture removal — each segment

119.95

85337

Reduction of fibrous tuberosity, including insertion of sutures, normal post‑operative care and suture removal

168.60

85338

Reduction of flabby ridge, including insertion of sutures, normal post‑operative care and suture removal — each segment

78.90

85341

Removal of hyperplastic tissue, including insertion of sutures, normal post‑operative care and suture removal

182.80

Subgroup 4 — General surgical

85377

Removal or repair of soft tissue (not described in another item), including insertion of sutures, normal post‑operative care and suture removal

182.95

85378

Surgical removal of foreign body, including insertion of sutures, normal post‑operative care and suture removal

103.55

Subgroup 5 — Other surgical procedures

85381

Surgical exposure of unerupted tooth, including insertion of sutures, normal post‑operative care and suture removal

259.35

85384

Repositioning of displaced tooth, including insertion of sutures, normal post‑operative care and suture removal — each tooth

172.40

85386

Splinting of displaced tooth, including insertion of sutures, normal post‑operative care and suture removal — each tooth

177.80

85387

Replantation and splinting of tooth, including insertion of sutures, normal post‑operative care and suture removal

348.20

85391

Frenectomy, including insertion of sutures, normal post‑operative care and suture removal

159.75

85392

Incision and drainage of abscess or cyst, including insertion of sutures, normal post‑operative care and suture removal

87.50

Group A5 — Endodontics

Subgroup 1 — Pulp and root canal treatments

85411

Direct pulp capping

31.50

85412

Incomplete endodontic therapy — inoperable or fractured

107.75

85414

Pulpotomy

68.70

85415

Complete chemo‑mechanical preparation of root canal — first canal on a tooth

193.40

85416

Complete chemo‑mechanical preparation of root canal — each additional canal on a tooth for which the service described in item 85415 has been performed

92.15

85417

Root canal obturation — first canal on a tooth

188.35

85418

Root canal obturation — each additional canal on a tooth for which the service described in item 85417 has been performed

88.10

85419

Extirpation of pulp or debridement of root canal or canals — emergency or palliative

124.55

Subgroup 2 — Periradicular surgery

85431

Periapical curettage — each root

225.50

85432

Apicectomy, including curettage — each root

279.95

85433

Exploratory periradicular surgery

(Item is subject to sections 13 and 15)

114.90

85434

Apical seal, including apicectomy and periapical curettage — each canal

347.00

85436

Sealing of perforation

214.20

85437

Surgical treatment and repair of an external root resorption — each tooth

349.60

85438

Hemisection

259.35

Subgroup 3 — Other endodontic services

85445

Exploration for a calcified root canal — each canal

95.45

85451

Removal of root filling — each canal

95.45

85452

Removal of cemented root canal post or post crown

95.45

85453

Removal of or bypassing fractured endodontic instrument

79.60

85455

Additional visit for irrigation or dressing, or irrigation and dressing, of the root canal system — each tooth

(Item is subject to section 16)

95.45

85457

Obturation of resorption defect or perforation — non‑surgical

95.45

85458

Interim therapeutic root filling — each tooth

(Item is subject to section 13)

127.25

Group A6 — Restorative services

Subgroup 1 — Metallic restorations — direct

85511

Metallic restoration, 1 surface — direct

94.20

85512

Metallic restoration, 2 surfaces — direct

115.45

85513

Metallic restoration, 3 surfaces — direct

137.70

85514

Metallic restoration, 4 surfaces — direct

157.00

85515

Metallic restoration, 5 surfaces — direct

179.25

Subgroup 2 — Adhesive restorations — anterior teeth — direct

85521

Adhesive restoration, 1 surface, anterior tooth — direct

(Item is subject to section 17)

104.30

85522

Adhesive restoration, 2 surfaces, anterior tooth — direct

126.55

85523

Adhesive restoration, 3 surfaces, anterior tooth — direct

149.85

85524

Adhesive restoration, 4 surfaces, anterior tooth — direct

173.15

85525

Adhesive restoration, 5 surfaces, anterior tooth — direct

203.55

Subgroup 3 — Adhesive Restorations — posterior teeth — direct

85531

Adhesive restoration, 1 surface, posterior tooth — direct

(Item is subject to section 17)

111.40

85532

Adhesive restoration, 2 surfaces, posterior tooth — direct

139.75

85533

Adhesive restoration, 3 surfaces, posterior tooth — direct

168.10

85534

Adhesive restoration, 4 surfaces, posterior tooth — direct

189.40

85535

Adhesive restoration, 5 surfaces, posterior tooth — direct

218.75

Subgroup 4 — Metallic restorations — indirect

85541

Metallic restoration, 1 surface — indirect

405.95

85542

Metallic restoration, 2 surfaces — indirect

536.45

85543

Metallic restoration, 3 surfaces — indirect

701.10

85544

Metallic restoration, 4 surfaces — indirect

819.15

85545

Metallic restoration, 5 surfaces — indirect

871.75

Subgroup 5 — Tooth coloured restorations — indirect

85551

Tooth‑coloured restoration, 1 surface — indirect

496.90

85552

Tooth‑coloured restoration, 2 surfaces — indirect

678.95

85553

Tooth‑coloured restoration, 3 surfaces — indirect

785.00

85554

Tooth‑coloured restoration, 4 surfaces — indirect

888.00

85555

Tooth‑coloured restoration 5 surfaces — indirect

849.40

Subgroup 6 — Other restorative services

85572

Provisional restoration — intermediate or temporary

(Item is subject to sections 13 and 18)

44.00

85574

Metal band — the cementation of a metal band for diagnostic purposes, protective purposes or for the placement of a provisional (intermediate) restoration

37.10

85575

Pin retention — each pin

25.30

85576

Stainless steel crown

191.75

85577

Cusp capping — each cusp

27.35

85578

Restoration of an incisal corner — each corner

27.35

85595

Removal of inlay or onlay

87.50

85596

Recementing of inlay or onlay

71.50

85597

Post, direct — insertion of a post into a prepared root canal to provide an anchor for an artificial crown or other restoration

133.20

Group A7 — Crown and Bridge

Subgroup 1 — Crowns

85613

Full crown, non metallic — indirect

1 096.35

85615

Full crown, veneered — indirect

1 035.30

85618

Full crown, metallic — indirect

974.20

85625

Core for crown including post — indirect

288.65

85627

Preliminary restoration for crown — direct

119.30

85629

Post and root cap — indirect

302.40

Subgroup 2 — Temporary (provisional ) crown and bridge

85631

Provisional crown

137.60

85632

Provisional bridge — each pontic

198.55

Subgroup 3 — Bridges

85642

Bridge pontic, direct — each pontic

532.40

85643

Bridge pontic, indirect — each pontic

810.25

85644

Semi‑fixed attachment

258.35

85645

Precision or magnetic attachment

297.40

85649

Retainer for bonded fixture, indirect — each tooth

288.95

Subgroup 4 — Crown and bridge repairs and other services

85651

Recementing crown or veneer

93.15

85652

Recementing bridge or splint — each abutment

90.90

85653

Rebonding of bridge or splint if retreatment of bridge surface is required

82.75

85655

Removal of crown

55.65

85656

Removal of bridge or splint

167.05

85658

Repair of crown, bridge or splint, including labour and laboratory costs — indirect.

345.05

85659

Repair of crown, bridge or splint — direct

227.45

Subgroup 5 — Implant Prostheses

85661

Fitting of implant abutment — each abutment

520.10

85669

Removal and reattachment of prosthesis fixed to implant or implants — each implant

146.60

85671

Full crown attached to osseointegrated implant, non metallic — indirect

1 096.35

85672

Full crown attached to osseointegrated implant, veneered — indirect

1 233.30

85673

Full crown attached to osseointegrated implant, metallic – indirect

975.45

Group A8 — Prosthodontics

Subgroup 1 — Dentures and denture components

85711

Complete maxillary denture

(Item is subject to section 12)

797.70

85712

Complete mandibular denture

(Item is subject to section 12)

797.70

85716

Metal palate or plate

285.20

85719

Complete maxillary and mandibular dentures

(Item is subject to section 12)

1 364.10

85721

Partial maxillary denture — resin, base only

(Item is subject to section 12)

383.80

85722

Partial mandibular denture — resin, base only

(Item is subject to section 12)

383.80

85727

Partial maxillary denture, base only, consisting of cast metal framework and including provision of casting, clasps, retainers and occlusal rests

(Item is subject to section 12)

1 145.90

85728

Partial mandibular denture, base only, consisting of cast metal framework and including provision of casting, clasps, retainers and occlusal rests

(Item is subject to section 12)

1 145.90

85731

Retainer — each tooth, if a service described in item 85721 or 85722 has been provided to the patient

39.80

85732

Occlusal rest — each rest, if a service described in item 85721 or 85722 has been provided to the patient

19.35

85733

Addition of tooth to the base of a new partial denture — each tooth

(Item is subject to section 19)

41.10

85735

Precision or magnetic attachment

230.15

85736

Immediate tooth replacement — each tooth

8.20

85737

Resilient lining

170.80

85738

Wrought bar — joining sections of a partial prosthesis

159.15

85739

Metal backing — an extension of the casting of a cast metal partial denture to provide a backing for the denture tooth — each backing

71.90

Subgroup 2 — Denture maintenance

85741

Adjustment of a denture to improve comfort and function — not including a routine adjustment following the insertion of a new denture or maintenance or repair of an existing denture

47.15

85743

Relining, complete denture — processed

300.80

85744

Relining, partial denture — processed

256.30

85745

Remodelling, complete denture

472.65

85746

Remodelling, partial denture

404.10

85751

Relining, complete denture, chair‑side only, hard or soft material — direct

164.50

85752

Relining, partial denture — direct

138.70

85753

Cleaning and polishing of pre‑existing denture

(Item is subject to section 13)

38.25

Subgroup 3 — Denture repairs

85761

Reattaching pre‑existing tooth or clasp to denture, including labour and laboratory costs

130.20

85762

Replacing clasp on denture

136.05

85763

Repairing broken base of a complete denture, including labour and laboratory costs

117.50

85764

Repairing broken base of a partial denture, including labour and laboratory costs

130.20

85765

Replacing first tooth on denture

136.05

85767

Any repair or tooth replacement in addition to other repairs, alterations or other modifications for the same denture on the same day, including labour and laboratory costs

53.80

85768

Adding tooth to partial denture to replace an extracted or decoronated tooth — each tooth

137.70

85769

Repair or addition to metal casting

164.70

Subgroup 4 — Other prosthodontic services

85771

Tissue conditioning treatment before impressions

(Item is subject to section 13)

62.50

85772

Splint, resin — indirect

244.75

85773

Splint, metal — indirect

259.35

85776

Impression if required for denture repair or modification

41.55

85777

Identification — marking a dental appliance with the name of a patient or other form of enduring patient identification

33.25

Group A9 — Orthodontics

Subgroup 1 — Removable appliances

85811

Passive removable appliance — each arch

293.20

85821

Active removable appliance — each arch

503.85

85823

Functional orthopaedic appliance

439.05

Subgroup 2 — Fixed appliances

85829

Partial banding — each arch

525.30

85831

Full arch banding — each arch

1 329.90

Group A10 — General services

Subgroup 1 — Emergencies

85911

Palliative care — interim care to relieve pain, infection, bleeding or other problems not associated with other services

61.80

Subgroup 2 — Drug therapy

85926

Individually made tray for the application of medicaments to teeth or supporting tissues, other than for bleaching

143.20

85927

Supply, prescription or administration of medications and medicaments required for a service

(Item subject to section 13)

24.85

Subgroup 3 — Anaesthesia and sedation

85949

Treatment under general anaesthesia, if the anaesthetic is administered by a specialist anaesthetist

150.20

Subgroup 4 — Occlusal therapy

85963

Clinical occlusal analysis including muscle and joint palpation

(Item is subject to section 13)

79.60

85964

Registration and mounting of casts for occlusal analysis

(Item is subject to section 13)

68.20

85965

Occlusal splint

474.15

85966

Adjustment of pre‑existing occlusal splint — each visit

66.70

85968

Occlusal adjustment following occlusal analysis — each visit

96.85

85971

Adjunctive physical therapy for temporomandibular joint and associated structures

(Item is subject to section 13)

56.40

85972

Repair or addition of occlusal splint

199.20

Subgroup 5 — Miscellaneous

85981

Splinting and stabilisation, direct — each tooth

87.50

85986

Post‑operative care if not provided for in another item

(Item is subject to section 13)

63.70

Part 2          Services provided by eligible dental specialists

 

Item

Service

Fee ($)

Group B1 — Diagnostic services

Subgroup 1 — Examinations

86012

Periodic oral examination and evaluation performed on a patient of record to determine any changes in the patient’s dental and medical health since a previous periodic examination

(Item is subject to section 14)

39.50

86013

Oral examination, limited to a problem‑focused oral evaluation carried out immediately before required treatment, including recording an appropriate medical history and any other relevant information

(Item is subject to section 13)

24.85

86014

Consultation for advice about or discussion of treatment options for a particular dental or oral complaint, including recording an appropriate medical history and any other relevant information

57.30

86015

Extended consultation for advice about or discussion of treatment options for a particular dental or oral complaint, including recording an appropriate medical history and any other relevant information — consultation of at least 30 minutes

(Item subject to section 14)

93.80

Subgroup 2 — Radiological examination and interpretation

86022

Intraoral periapical or bitewing radiograph — each exposure

(Item is subject to section 13)

31.15

86025



Intraoral radiograph (occlusal, maxillary or mandibular) — each exposure

55.55

86031



Extraoral radiograph (maxillary or mandibular) — each exposure

63.35

86035

Radiograph of temporomandibular joint — each exposure

91.35

86036

Cephalometric radiograph — lateral, antero‑posterior, postero‑anterior or submento‑vertex — each exposure

(Item is subject to section 13)

134.15

86037

Panoramic radiograph — each exposure

85.10

86038

Hand‑wrist radiograph for skeletal age assessment

(Item is subject to section 14)

79.60

86039

Tomography of the skull or parts of the skull

(Item is subject to section 13)

134.25

Subgroup 3 — Other diagnostic services

86047

Caries activity screening test

(Item is subject to item 13)

36.55

86051

Biopsy of tissue

111.85

86071

Diagnostic model — each model

54.55

86082

Tooth‑jaw size prediction analysis

(Item is subject to section 14)

95.45

Group B2 — Preventive services

Subgroup 1 — Dental prophylaxis

86111

Removal of plaque, stain, or plaque and stain

(Item is subject to section 13)

48.60

86113

Recontouring pre‑existing restoration or restorations

18.35

86114

Removal of calculus — first visit

(Item is subject to section 13)

81.00

86115

Removal of calculus — subsequent visit

(Item is subject to section 13)

52.70

86117

Bleaching, internal, for non‑vital discoloured tooth — each tooth

256.25

Subgroup 2 — Remineralising agents

86121

Topical application of remineralising agent — 1 treatment

(Item is subject to section 13)

31.20

86123

Application of concentrated remineralising agent — single tooth

(Item is subject to section 13)

24.45

Subgroup 3 — Other preventive services

86131

Dietary advice — a consultation of at least 15 minutes

(Item is subject to section 13)

32.90

86141

Oral hygiene instruction — a consultation of at least 15 minutes

(Item is subject to section 13)

44.65

86161

Fissure sealing — each tooth

41.55

86165

Desensitizing procedure — each visit

24.45

86171

Odontoplasty — each tooth

45.85

Group B3 — Periodontics

86213

Treatment of acute periodontal infection — each visit

(Item is subject to section 13)

62.90

86221

Clinical periodontal analysis and recording

(Item is subject to section 13)

127.25

86222

Root planing and subgingival curettage — no more than 8 teeth

(Item is subject to section 13)

162.40

86225

Non‑surgical periodontal treatment if not provided for in another item — each visit

(Item is subject to section 13)

127.25

86231

Gingivectomy — no more than 8 teeth

(Item is subject to section 13)

214.20

86232

Periodontal flap surgery — no more than 8 teeth

(Item is subject to section 13)

354.90

86233

Osseous surgery — no more than 8 teeth

(Item is subject to section 13)

515.15

86234

Osseous graft — each tooth or implant

(Item is subject to section 13)

563.65

86235

Gingival graft — each tooth or implant

(Item is subject to section 13)

394.70

86236

Guided tissue regeneration — each tooth or implant

466.70

86237

Guided tissue regeneration — membrane removal

203.00

86238

Periodontal flap surgery for crown lengthening — each tooth

364.95

86241

Root resection — each root

225.50

86245

Periodontal surgery involving a tooth or an implant

(Item is subject to section 13)

143.20

Group B4 — Oral surgery

Subgroup 1 — Extractions

86311

Removal of a tooth or part or parts of a tooth, including local anaesthesia and routine post‑operative care — first tooth extracted on a day

(Item is subject to section 13)

147.30

86314

Sectional removal of a tooth, including local anaesthesia and routine post‑operative care — first sectional removal on a day

(Item is subject to section 13)

201.60

86316

Additional extraction requiring:

   (a)  removal of a tooth or part or parts of a tooth; or

   (b)  sectional removal of a tooth;

performed on the same day as a service described in item 86311 or 86314

112.20

Subgroup 2 — Surgical extractions

86322

Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division, including local anaesthesia and routine post‑operative care — first tooth extracted on a day

(Item is subject to section 13)

255.85

86323

Surgical removal of a tooth or tooth fragment requiring removal of bone, including local anaesthesia and routine post‑operative care — first tooth extracted on a day

(Item is subject to section 13)

317.65

86324

Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division, including local anaesthesia and routine post‑operative care — first tooth extracted on a day

(Item is subject to section 13)

393.25

86326

Additional extraction requiring surgical removal of a tooth or tooth fragment, on the same day as a service described in item 86322, 86323 or 86324 is provided to the patient

245.20

Subgroup 3 — Surgery for prostheses

86331

Alveolectomy, including insertion of sutures, normal post‑operative care and suture removal — each segment

151.10

86332

Ostectomy, including insertion of sutures, normal post‑operative care and suture removal — each jaw

417.25

86337

Reduction of fibrous tuberosity, including insertion of sutures, normal post‑operative care and suture removal

224.25

86338

Reduction of flabby ridge, including insertion of sutures, normal post‑operative care and suture removal — each segment

112.75

86341

Removal of hyperplastic tissue, including insertion of sutures, normal post‑operative care and suture removal

246.75

86343

Repositioning of muscle attachment, including insertion of sutures, normal post‑operative care and suture removal

304.50

86344

Vestibuloplasty, including insertion of sutures, normal post‑operative care and suture removal

716.25

86345

Vestibuloplasty with skin or mucosal graft, including insertion of sutures, normal post‑operative care and suture removal

716.25

Subgroup 4 — General surgical

86371

Removal of tumour, cyst or scar — cutaneous, subcutaneous or in mucous membrane, including insertion of sutures, normal post‑operative care and suture removal

185.55

86373

Removal of tumour, cyst or scar involving muscle, bone or other deep tissue, including insertion of sutures, normal post‑operative care and suture removal

624.40

86375

Surgery to salivary duct, including insertion of sutures, normal post‑operative care and suture removal

557.60

86376

Surgery to salivary gland, including insertion of sutures, normal post‑operative care and suture removal

196.35

86377

Removal or repair of soft tissue not provided for in another item, including insertion of sutures, normal post‑operative care and suture removal

243.55

86378

Surgical removal of foreign body, including insertion of sutures, normal post‑operative care and suture removal

137.60

86379

Marsupialisation of cyst, including insertion of sutures, normal post‑operative care and suture removal

293.20

Subgroup 5 — Other surgical procedures

86381

Surgical exposure of unerupted tooth, including insertion of sutures, normal post‑operative care and suture removal

314.00

86382

Surgical exposure and attachment of device for orthodontic traction, including insertion of sutures, normal post‑operative care and suture removal

356.15

86384

Repositioning of displaced tooth, including insertion of sutures, normal post‑operative care and suture removal — each tooth

229.75

86385

Surgical repositioning of unerupted tooth, including insertion of sutures, normal post‑operative care and suture removal

356.15

86386

Splinting of displaced tooth, including insertion of sutures, normal post‑operative care and suture removal — each tooth

239.55

86387

Replantation and splinting of a tooth, including insertion of sutures, normal post‑operative care and suture removal

459.00

86388

Transplantation of tooth or tooth bud, including insertion of sutures, normal post‑operative care and suture removal

517.10

86389

Surgery to isolate and preserve neurovascular tissue, including insertion of sutures, normal post‑operative care and suture removal

169.85

86391

Frenectomy, including insertion of sutures, normal post‑operative care and suture removal

212.35

86392

Incision and drainage of abscess or cyst, including insertion of sutures, normal post‑operative care and suture removal

111.45

86393

Surgery involving the maxillary antrum, including insertion of sutures, normal post‑operative care and suture removal

715.75

86394

Surgery for osteomylitis, including insertion of sutures, normal post‑operative care and suture removal

460.05

86395

Repair of nerve trunk, including insertion of sutures, normal post‑operative care and suture removal

858.05

Group B5 — Endodontics

Subgroup 1 — Pulp and root canal treatments

86411

Direct pulp capping

41.75

86412

Incomplete endodontic therapy — inoperable or fractured

172.40

86414

Pulpotomy

79.60

86415

Complete chemo‑mechanical preparation of root canal — first canal on a tooth

358.00

86416

Complete chemo‑mechanical preparation of root canal — each additional canal on a tooth for which the service described in item 86415 has been performed

182.95

86417

Root canal obturation — first canal on a tooth

358.00

86418

Root canal obturation — each additional canal on a tooth for which the service described in item 86417 has been performed

182.95

86419

Extirpation of pulp or debridement of root canal or canals — emergency or palliative

149.50

Subgroup 2 — Periradicular surgery

86431

Periapical curettage — each root

304.05

86432

Apicectomy, including curettage — each root

304.50

86433

Exploratory periradicular surgery

(Item is subject to sections 13 and 20)

143.65

86434

Apical seal, including apicectomy and periapical curettage — each canal

473.65

86436

Sealing of perforation

281.90

86437

Surgical treatment and repair of an external root resorption — for each tooth

458.20

86438

Hemisection

338.30

Subgroup 3 — Other endodontic services

86445

Exploration for a calcified root canal — each canal

127.25

86451

Removal of root filling — each canal

127.25

86452

Removal of cemented root canal post or post crown

119.30

86453

Removal of or bypassing fractured endodontic instrument

111.45

86455

Additional visit for irrigation or dressing, or irrigation and dressing of the root canal system — each tooth

(Item is subject to section 21)

127.25

86457

Obturation of resorption defect or perforation, non‑surgical

127.25

86458

Interim therapeutic root filling — each tooth

(Item is subject to section 13)

143.20

Group B6 — Restorative services

Subgroup 1 — Metallic restorations — direct

86511

Metallic restoration, 1 surface — direct

94.20

86512

Metallic restoration, 2 surfaces — direct

115.45

86513

Metallic restoration, 3 surfaces — direct

137.70

86514

Metallic restoration, 4 surfaces — direct

157.00

86515

Metallic restoration, 5 surfaces — direct

179.25

Subgroup 2 — Adhesive restorations — anterior teeth — direct

86521

Adhesive restoration, 1 surface, anterior tooth — direct

(Item is subject to section 22)

104.30

86522

Adhesive restoration, 2 surfaces, anterior tooth — direct

126.55

86523

Adhesive restoration, 3 surfaces, anterior tooth — direct

149.85

86524

Adhesive restoration, 4 surfaces, anterior tooth — direct

173.15

86525

Adhesive restoration, 5 surfaces, anterior tooth — direct

242.05

Subgroup 3 — Adhesive restorations — posterior teeth — direct

86531

Adhesive restoration, 1 surface, posterior tooth — direct

(Item is subject to section 22)

111.40

86532

Adhesive restoration, 2 surfaces, posterior tooth — direct

139.75

86533

Adhesive restoration, 3 surfaces, posterior tooth — direct

168.10

86534

Adhesive restoration, 4 surfaces, posterior tooth — direct

189.40

86535

Adhesive restoration, 5 surfaces, posterior tooth — direct

283.45

Subgroup 4 — Metallic restorations — indirect

86541

Metallic restoration, 1 surface — indirect

405.95

86542

Metallic restoration, 2 surfaces — indirect

536.45

86543

Metallic restoration, 3 surfaces — indirect

701.10

86544

Metallic restoration, 4 surfaces — indirect

819.15

86545

Metallic restoration, 5 surfaces — indirect

1 014.15

Subgroup 5 — Tooth coloured restorations — indirect

86551

Tooth‑coloured restoration, 1 surface — indirect

640.38

86552

Tooth‑coloured restoration, 2 surfaces — indirect

717.05

86553

Tooth‑coloured restoration, 3 surfaces — indirect

889.55

86554

Tooth‑coloured restoration, 4 surfaces — indirect

956.65

86555

Tooth‑coloured restoration, 5 surfaces — indirect

1 014.15

Subgroup 6 — Other restorative services

86572

Provisional restoration — intermediate or temporary

(Item is subject to sections 13 and 23)

44.00

86574

Metal band — the cementation of a metal band for diagnostic purposes, protective purposes or for the placement of a provisional (intermediate) restoration

37.10

86575

Pin retention — each pin

25.30

86576

Stainless steel crown

259.35

86577

Cusp capping — each cusp

27.35

86578

Restoration of an incisal corner — each corner

27.35

86595

Removal of inlay or onlay

127.25

86596

Recementing of inlay or onlay

71.50

86597

Post, direct — insertion of a post into a prepared root canal to provide an anchor for an artificial crown or other restoration

159.35

Group B7 — Crown and bridge

Subgroup 1 — Crowns

86613

Full crown, non metallic — indirect

1 436.75

86615

Full crown, veneered — indirect

1 578.60

86618

Full crown, metallic — indirect

1 275.90

86625

Core for crown including post — indirect

383.85

86627

Preliminary restoration for crown — direct

159.15

86629

Post and root cap — indirect

389.85

Subgroup 2 — Temporary (provisional) crown and bridge

86631

Provisional crown

137.60

86632

Provisional bridge — each pontic

268.05

Subgroup 3 — Bridges

86642

Bridge pontic, direct — each pontic

695.90

86643

Bridge pontic, indirect — each pontic

1 071.00

86644

Semi‑fixed attachment

383.40

86645

Precision or magnetic attachment

378.15

86649

Retainer for bonded fixture, indirect — each tooth

394.70

Subgroup 4 — Crown and bridge repairs and other services

86651

Recementing crown or veneer

105.95

86652

Recementing bridge or splint — each abutment

120.95

86653

Rebonding of bridge or splint if retreatment of bridge surface is required

113.00

86655

Removal of crown

71.65

86656

Removal of bridge or splint

167.05

86658

Repair of crown, bridge or splint, including labour and laboratory costs — indirect

422.20

86659

Repair of crown, bridge or splint — direct

307.05

Subgroup 5 — Implant prostheses

86661

Fitting of implant abutment — each abutment

654.70

86663

Removal of implant

515.75

86664

Fitting of bar for denture — each abutment

777.10

86666

Prosthesis with metal frame attached to implants — each tooth

630.75

86669

Removal and reattachment of prosthesis fixed to implant or implants — each implant

203.00

86671

Full crown attached to osseointegrated implant, non metallic — indirect

1 436.75

86672

Full crown attached to osseointegrated implant, veneered — indirect

1 578.60

86673

Full crown attached to osseointegrated implant, metallic — indirect

1 275.90

86679

Surgical implant guide

347.75

86684

Insertion of first stage of 2‑stage endosseous implant, including cost of hardware — each implant

1 353.70

86688

Insertion of 1‑stage endosseous implant, including cost of hardware — each implant

1 479.80

86691

Second stage surgery of 2‑stage endosseous implant, including hardware — each implant

501.10

Group B8 — Prosthodontics

Subgroup 1 — Denture and denture components

86711

Complete maxillary denture

(Item is subject to section 12)

797.70

86712

Complete mandibular denture

(Item subject to section 12)

797.70

86716

Metal palate or plate

285.20

86719

Complete maxillary and mandibular dentures

(Item is subject to section 12)

1 364.10

86721

Partial maxillary denture — resin, base only

(Item is subject to section 12)

383.80

86722

Partial mandibular denture — resin, base only

(Item is subject to section 12)

383.80

86727

Partial maxillary denture, base only, consisting of cast metal framework and including provision of casting, clasps, retainers and occlusal rests

(Item is subject to section 12)

1 145.90

86728

Partial mandibular denture, base only, consisting of cast metal framework including provision of casting, clasps, retainers and occlusal rests

(Item is subject to section 12)

1 145.90

86731

Retainer — each tooth, if a service described in item 86721 or 86722 has been provided to the patient

39.80

86732

Occlusal rest — each rest, if a service described in item 86721 or 86722 has been provided to the patient

19.35

86733

Addition of tooth to the base of a new partial denture — each tooth

(Item is subject to item 19)

41.10

86735

Precision or magnetic attachment

230.15

86736

Immediate tooth replacement — each tooth

8.20

86737

Resilient lining

170.80

86738

Wrought bar — joining sections of a partial prosthesis.

159.15

86739

Metal backing — an extension of the casting of a cast metal partial denture to provide a backing for the denture tooth — each backing

71.90

Subgroup 2 — Denture maintenance

86741

Adjustment of a denture to improve comfort and function — not including a routine adjustment following the insertion of a new denture or maintenance or repair of an existing denture

47.15

86743

Relining, complete denture — processed

436.20

86744

Relining, partial denture — processed

339.25

86745

Remodelling, complete denture

557.90

86746

Remodelling, partial denture

458.20

86751

Relining, complete denture, chair‑side only, hard or soft material — direct

203.00

86752

Relining, partial denture — direct

159.00

86753

Cleaning and polishing of pre‑existing denture

(Item is subject to section 13)

50.90

Subgroup 3 — Denture repairs

86761

Reattaching pre‑existing tooth or clasp to denture including labour and laboratory costs

130.20

86762

Replacing clasp on denture

136.05

86763

Repairing broken base of a complete denture including labour and laboratory costs

117.50

86764

Repairing broken base of a partial denture including labour and laboratory costs

130.20

86765

Replacing first tooth on denture

136.05

86767

Any repair or tooth replacement in addition to other repairs, alterations or modifications for the same denture on the same day, including labour and laboratory costs

53.80

86768

Adding tooth to partial denture to replace an extracted or decoronated tooth — each tooth

137.70

86769

Repair or addition to metal casting

164.70

Subgroup 4 — Other prosthodontic services

86771

Tissue conditioning treatment before impressions

(Item is subject to section 13)

62.50

86772

Splint, resin — indirect

338.30

86773

Splint, metal — indirect

338.30

86776

Impression if required for denture repair or modification

41.55

86777

Identification — marking a dental appliance with a patient’s name or other form of enduring patient identification

33.25

Group B9 — Orthodontics

Subgroup 1 — Removable appliances

86811

Passive removable appliance — each arch

394.70

86821

Active removable appliance — each arch

717.05

86823

Functional orthopaedic appliance

563.65

Subgroup 2 — Fixed appliances

86829

Partial banding — each arch

678.70

86831

Full arch banding — each arch

1 747.25

86862

Bonding of attachment for application of orthodontic force

146.60

Group B10 — General services

Subgroup 1 — Emergencies

86911

Palliative care — interim care to relieve pain, infection, bleeding or other problems not associated with other treatment

82.15

Subgroup 2 — Drug therapy

86926

Individually made tray for the application of medicaments to the teeth or supporting tissues, other than for bleaching

143.20

86927

Supply, prescription or administration of medications and medicaments required for a service

(Item is subject to section 13)

24.85

Subgroup 3 — Anaesthesia and sedation

86949

Treatment under general anaesthesia, if the anaesthetic is administered by a specialist anaesthetist

150.20

Subgroup 4 — Occlusal therapy

86963

Clinical occlusal analysis including muscle and joint palpation

(Item is subject to section 13)

111.45

86964

Registration and mounting of casts for occlusal analysis

(Item is subject to section 13)

84.50

86965

Occlusal splint

656.65

86966

Adjustment of pre‑existing occlusal splint — each visit

83.00

86968

Occlusal adjustment following occlusal analysis — each visit

116.90

86971

Adjunctive physical therapy for temporomandibular joint and associated structures

(Item is subject to section 13)

67.70

86972

Repair or addition — occlusal splint

199.20

Subgroup 5 — Miscellaneous

86981

Splinting and stabilisation, direct — each tooth

111.45

86986

Post‑operative care if not provided for in another item

(Item is subject to section 13)

79.60

Part 3          Services provided by eligible dental prosthetists

 

Item

Service

Fee ($)

Group C1 — Diagnostic services

Subgroup 1 — Examinations and diagnostic services

87011

Initial denture examination, including:

   (a)  assessment of any existing dentures and any teeth, supporting tissues and oral tissues to construct a removable dental prosthesis or refer to an appropriate clinician; and

   (b)  recording an appropriate medical history and any other relevant information

(Item is subject to section 14)

42.85

87014

Consultation for advice about or discussion of treatment options for a removable dental prosthesis, including the recording of an appropriate medical history and any other relevant information

34.55

87071

Diagnostic model — each model

49.05

Group C2 — Prosthodontics

Subgroup 1 — Dentures and denture components

87711

Complete maxillary denture

(Item is subject to section 12)

724.50

87712

Complete mandibular denture

(Item is subject to section 12)

724.50

87716

Metal palate or plate

285.20

87719

Complete maxillary and mandibular dentures

(Item is subject to section 12)

1 234.25

87721

Partial maxillary denture — resin, base only

(Item is subject to section 12)

342.65

87722

Partial mandibular denture — resin, base only

(Item is subject to section 12)

342.65

87727

Partial maxillary denture, base only, consisting of cast metal framework and including provision of casting, clasps, retainers and occlusal rests

(Item is subject to section 12)

1 067.70

87728

Partial mandibular denture, base only, consisting of cast metal framework and including provision of casting, clasps, retainers and occlusal rests.

(Item is subject to section 12)

1 067.70

87731

Retainer — each tooth, if a service described in item 87721 or 87722 has been provided to the patient

35.80

87732

Occlusal rest — each rest, if a service described in item 87721 or 87722 has been provided to the patient

17.40

87733

Addition of tooth to the base of a new partial denture — each tooth

(Item is subject to section 19)

37.15

87736

Immediate tooth replacement — each tooth

7.35

87737

Resilient lining

153.70

87738

Wrought bar — bar joining sections of a partial prosthesis

143.25

87739

Metal backing — extension of the casting of a cast metal partial denture to provide a backing for the denture tooth — each backing

64.70

Subgroup 2 — Denture maintenance

87741

Adjustment of pre‑existing denture to improve comfort and function — not including a routine adjustment following the insertion of a new denture or maintenance or repair of an existing denture

42.40

87743

Relining, complete denture — processed

270.65

87744

Relining, partial denture — processed

230.70

87745

Remodelling, complete denture

431.40

87746

Remodelling, partial denture

363.65

87751

Relining, complete denture, chair‑side only, hard or soft material — direct

148.05

87752

Relining, partial denture — direct

124.80

87753

Cleaning and polishing of pre‑existing denture

(Item is subject to section 13)

34.45

Subgroup 3 — Denture repairs

87761

Reattaching pre‑existing tooth or clasp to denture including labour and laboratory costs

117.25

87762

Replacing clasp on denture

122.45

87763

Repairing broken base of a complete denture including labour and laboratory costs

105.70

87764

Repairing broken base of a partial denture including labour and laboratory costs

117.25

87765

Replacing first tooth on denture

122.45

87767

Any repair or tooth replacement in addition to other repairs, alterations or modifications for the same denture on the same day, including labour and laboratory costs

48.35

87768

Adding tooth to partial denture to replace an extracted or decoronated tooth — each tooth

123.90

87769

Repair or addition to metal casting

164.70

Subgroup 4 — Other prosthodontic services

87771

Tissue conditioning treatment before impressions

(Item is subject to section 13)

56.25

87776

Impression if required for denture repair

37.35

87777

Identification — marking a dental appliance with a patient’s name or other form of enduring patient identification

29.95

Schedule 2        Specialties

(section 3)

  

 

Item

Specialty

1

dento‑maxillofacial radiologist

2

endodontist

3

oral and maxillofacial surgeon

4

oral surgeon

5

orthodontist

6

pedeodontist

7

periodontist

8

prosthodontist

9

specialist in oral medicine

10

specialist in oral pathology

11

specialist in oral pathology and oral medicine

12

specialist in special needs dentistry

Notes to the Health Insurance (Dental Services) Determination 2007

Note 1

The Health Insurance (Dental Services) Determination 2007 (in force under subsection 3C (1) of the Health Insurance Act 1973) as shown in this compilation is amended as indicated in the Tables below.

Table of Instruments

Title

Date of FRLI registration

Date of
commencement

Application, saving or
transitional provisions

Health Insurance (Dental Services) Determination 2007

29 Oct 2007

1 Nov 2007

—

Health Insurance (Dental Services) Amendment and Repeal Determination 2008

28 Mar 2008 (see F2008L00965)

(a)

—

(a)    The Health Insurance Dental Services) Amendment and Repeal Determination 2008 was disallowed by the Senate on 19 June 2008.