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Dental Benefits Amendment Rules (No. 1) 2021

Authoritative Version
  • - F2021L01035
  • No longer in force
Rules/Other as made
This instrument amends the Dental Benefit Rules 2014 to update the indexation amount of dental benefits payable for dental services in Schedule 1, and the benefit limits cap amount in Schedule 3, effective from 1 January 2022.
Administered by: Health
Registered 28 Jul 2021
Tabling HistoryDate
Tabled HR03-Aug-2021
Tabled Senate03-Aug-2021
Date of repeal 02 Jan 2022
Repealed by Division 1 of Part 3 of Chapter 3 of the Legislation Act 2003
Table of contents.

Commonwealth Coat of Arms of Australia

 

Dental Benefits Amendment Rules (No. 1) 2021

I, Simon Cotterell, as delegate of the Minister for Health and Aged Care, make the following Rules.

Dated 20 July 2021                                        

Simon Cotterell

First Assistant Secretary

Primary Care Division
Primary and Community Care Group

 

 


Contents

1  Name........................................................................................................................................ 1

2  Commencement........................................................................................................................ 1

3  Authority.................................................................................................................................. 1

4  Schedules................................................................................................................................. 1

Schedule 1—Amendments                                                                                           2

Dental Benefits Rules 2014                                                                                                                 2

 

 


1  Name

                   This instrument is the Dental Benefits Amendment Rules (No. 1) 2021.

2  Commencement

             (1)  Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

 

Commencement information

Column 1

Column 2

Column 3

Provisions

Commencement

Date/Details

1.       The whole of this instrument

1 January 2022

1 January 2022

Note:          This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.

             (2)  Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3  Authority

                   This instrument is made under subsection 60(1) of the Dental Benefits Act 2008.

4  Schedules

                   Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule 1Amendments

Dental Benefits Rules 2014

Item 1  Schedule 1

Repeal Schedule 1, substitute:

 Schedule 1    Dental Benefits Schedule

  (rule 5)

 

Item

Service

Benefit ($)

Group U0 – Diagnostic Services

Subgroup 1 – Examinations

88011

Comprehensive oral examination

Evaluation of all teeth, their supporting tissues and the oral tissues in order to record the condition of these structures. This evaluation includes recording an appropriate medical history and any other relevant information.

(Item is subject to Rules 18 and 19)

54.05

88012

Periodic oral examination

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

(Item is subject to Rules 18 and 19)

44.90

88013

Oral examination – limited

A limited oral problem-focussed evaluation carried out immediately prior to required treatment. This evaluation includes recording an appropriate medical history and any other relevant information.

(Item is subject to Rules 17 and 19)

28.20

Subgroup 2 – Radiological examination and interpretation

88022

Intraoral periapical or bitewing radiograph – per exposure

Taking and interpreting a radiograph made with the film inside the mouth.

(Item is subject to Rule 17)

31.25

88025

Intraoral radiograph – occlusal, maxillary, mandibular – per exposure

Taking and interpreting an occlusal, maxillary or mandibular intraoral radiograph. This radiograph shows a more extensive view of teeth and maxillary or mandibular bone.

63.15

Group U1 – Preventive Services

Subgroup 1 – Dental Prophylaxis

88111

Removal of plaque and/or stain

Removal of dental plaque and/or stain from the surfaces of all teeth and/or implants.

(Item is subject to Rules 17 and 20)

55.20

88114

Removal of calculus – first visit

Removal of calculus from the surfaces of teeth.

(Item is subject to Rules 17 and 20)

92.05

88115

Removal of calculus – subsequent visit

This item describes procedures in item 88114 when, because of the extent or degree of calculus, an additional visit(s) is required to remove deposits from the teeth.

(Item is subject to Rules 17 and 20)

59.85

Subgroup 2 – Remineralising Agents

88121

Topical application of remineralisation and/or cariostatic agents, one treatment

Application of remineralisation and/or cariostatic agents to the surfaces of the teeth. This may include activation of the agent. Not to be used as an intrinsic part of the restoration.

(Item is subject to Rule 17)

35.45

Subgroup 3 – Other Preventive Services

88161

Fissure and/or tooth surface sealing – per tooth (first four services on a day)

Sealing of non-carious pits, fissures, smooth surfaces or cracks in a tooth with an adhesive material. Any preparation prior to application of the sealant is included in this item number.

(Item is subject to Rule 17 and 20)

47.25

88162

Fissure and/or tooth surface sealing – per tooth (subsequent services)

Sealing of non-carious pits, fissures, smooth surfaces or cracks in a tooth with an adhesive material. Any preparation prior to application of the sealant is included in this item number.

(Item is subject to Rule 20)

23.65

Group U2 – Periodontics

88213

Treatment of acute periodontal infection – per visit

This item describes the treatment of acute periodontal infection(s). It may include establishing drainage and the removal of calculus from the affected tooth (teeth). Inclusive of the insertion of sutures, normal post-operative care and suture removal.

(Item is subject to Rules 17 and 21)

71.50

88221

Clinical periodontal analysis and recording

This is a special examination performed as part of the diagnosis and management of periodontal disease. The procedure consists of assessing and recording a patient's periodontal condition. All teeth and six sites per tooth must be recorded. Written documentation of these measurements must be retained.

(Item is subject to Rule 17)

54.35

Group U3 – Oral Surgery

Subgroup 1 – Extractions

88311

Removal of a tooth or part(s) thereof – first tooth extracted on a day

A procedure consisting of the removal of a tooth or part(s) thereof. Inclusive of the insertion of sutures, normal post-operative care and suture removal.

(Item is subject to Rules 17 and 22)

134.75

88314

Sectional removal of a tooth or part(s) thereof – first tooth extracted on a day

The removal of a tooth or part(s) thereof in sections. Bone removal may be necessary. Inclusive of the insertion of sutures, normal post-operative care and suture removal.

(Item is subject to Rules 17 and 22)

172.20

88316

Additional extraction requiring removal of a tooth or part(s) thereof, or sectional removal of a tooth.

Additional extraction provided on the same day as a service described in item 88311 or 88314 is provided to the patient.

(Item is subject to Rule 22)

84.95

Subgroup 2 – Surgical Extractions

88322

Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division – first tooth extracted on a day

Removal of a tooth or tooth fragment where an incision and the raising of a mucoperiosteal flap is required, but where removal of bone or sectioning of the tooth is not necessary to remove the tooth. Inclusive of the insertion of sutures, normal post-operative care and suture removal.

(Item is subject to Rules 17 and 22)

218.65

88323

Surgical removal of a tooth or tooth fragment requiring removal of bone – first tooth extracted on a day

Removal of a tooth or tooth fragment where removal of bone is required after an incision and a mucoperiosteal flap raised. Inclusive of the insertion of sutures, normal post-operative care and suture removal.

(Item is subject to Rules 17 and 22)

249.70

88324

Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division – first tooth extracted on a day

Removal of a tooth or tooth fragment where both removal of bone and sectioning of the tooth are required after an incision and a mucoperiosteal flap raised. The tooth will be removed in portions. Inclusive of the insertion of sutures, normal post-operative care and suture removal.

(Item is subject to Rules 17 and 22)

335.90

88326

Additional extraction requiring surgical removal of a tooth or tooth fragment

Additional surgical extraction provided on the same day as a service described in item 88322, 88323 or 88324 is provided to the patient.

(Item is subject to Rule 22)

178.90

Subgroup 5 – Treatment of Maxillo-facial injuries

88351

Repair of skin and subcutaneous tissue or mucous membrane

The surgical cleaning and repair of a facial skin wound in the region of the mouth or jaws, or the repair of oral mucous membrane, where the wounds involve the subcutaneous tissues. Inclusive of the insertion of sutures, normal post-operative care and suture removal.

(Item is subject to Rule 22)

164.15

Subgroup 8 – Other Surgical Procedures

88384

Repositioning of displaced tooth/teeth – per tooth

A procedure following trauma where the position of the displaced tooth/teeth is corrected by manipulation. Stabilising procedures are itemised separately. Inclusive of the insertion of sutures, normal post-operative care and suture removal.

(Item is subject to Rule 22)

195.85

88386

Splinting of displaced tooth/teeth – per tooth

A procedure following trauma where the position of the displaced tooth/teeth may be stabilized by splinting. Inclusive of the insertion of sutures, normal post-operative care and suture removal.

(Item is subject to Rule 22)

202.05

88387

Replantation and splinting of a tooth

Replantation of a tooth which has been avulsed or intentionally removed. It may be held in the correct position by splinting. Inclusive of the insertion of sutures, normal post-operative care and suture removal.

(Item is subject to Rule 22)

395.65

88392

Drainage of abscess

Drainage and/or irrigation of an abscess other than through a root canal or at the time of extraction. The drainage may be through an incision or inserted tube. Inclusive of the insertion of sutures, normal post-operative care and suture removal.

(Item is subject to Rule 22)

99.40

Group U4 – Endodontics

Subgroup 1 – Pulp and Root Canal Treatments

88411

Direct pulp capping

A procedure where an exposed pulp is directly covered with a protective dressing or cement.

35.75

88412

Incomplete endodontic therapy (tooth not suitable for further treatment)

A procedure where in assessing the suitability of a tooth for endodontic treatment a decision is made that the tooth is not suitable for restoration.

(Item is subject to Rule 23)

122.50

88414

Pulpotomy

Amputation within the pulp chamber of part of the vital pulp of a tooth. The pulp remaining in the canal(s) is then covered with a protective dressing or cement.

(Item is subject to Rule 23)

78.05

88415

Complete chemo-mechanical preparation of root canal – one canal

Complete chemo-mechanical preparation including removal of pulp or necrotic debris from a canal.

(Item is subject to Rule 23)

219.75

88416

Complete chemo-mechanical preparation of root canal – each additional canal

Complete chemo-mechanical preparation including removal of pulp or necrotic debris from each additional canal of a tooth with multiple canals.

(Item is subject to Rule 23)

104.70

88417

Root canal obturation – one canal

The filling of a root canal, following chemo-mechanical preparation.

(Item is subject to Rule 23)

214.05

88418

Root canal obturation – each additional canal

The filling, following chemo-mechanical preparation, of each additional canal in a tooth with multiple canals.

(Item is subject to Rule 23)

100.10

88419

Extirpation of pulp or debridement of root canal(s) – emergency or palliative

The partial or thorough removal of pulp and/or debris from the root canal system of a tooth. This is an emergency or palliative procedure distinct from visits for scheduled endodontic treatment.

(Item is subject to Rule 23)

141.50

88421

Resorbable root canal filling – primary tooth

The placement of resorbable root canal filling material in a primary tooth.

(Item is subject to Rule 23)

122.50

Subgroup 4 – Other Endodontic Services

88455

Additional visit for irrigation and/or dressing of the root canal system – per tooth

Additional debridement irrigation and short-term dressing required where evidence of infection or inflammation persists following prior opening of the root canal and removal of its contents.

(Item is subject to Rule 26)

108.45

88458

Interim therapeutic root filling – per tooth

A procedure consisting of the insertion of a long-term provisional (temporary) root canal filling with therapeutic properties which facilitates healing/development of the root and periradicular tissues over an extended time.

(Item is subject to Rules 17 and 23)

144.65

Group U5 – Restorative Services

Subgroup 1 – Metallic Restorations – Direct

88511

Metallic restoration – one surface – direct

Direct metallic restoration involving one surface of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

106.95

88512

Metallic restoration – two surfaces – direct

Direct metallic restoration involving two surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

131.15

88513

Metallic restoration – three surfaces – direct

Direct metallic restoration involving three surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

156.50

88514

Metallic restoration – four surfaces – direct

Direct metallic restoration involving four surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

178.40

88515

Metallic restoration – five surfaces – direct

Direct metallic restoration involving five surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

203.65

Subgroup 2 – Adhesive Restorations – Anterior Teeth – direct

88521

Adhesive restoration – one surface – anterior tooth – direct

Direct restoration, using an adhesive technique and a tooth-coloured material, involving one surface of an anterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rules 24 and 27)

118.45

88522

Adhesive restoration – two surfaces – anterior tooth – direct

Direct restoration, using an adhesive technique and a tooth-coloured material, involving two surfaces of an anterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

143.80

88523

Adhesive restoration – three surfaces – anterior tooth – direct

Direct restoration, using an adhesive technique and a tooth-coloured material, involving three surfaces of an anterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

170.35

88524

Adhesive restoration – four surfaces – anterior tooth – direct

Direct restoration, using an adhesive technique and a tooth-coloured material, involving four surfaces of an anterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

196.90

88525

Adhesive restoration – five surfaces – anterior tooth – direct

Direct restoration, using an adhesive technique and a tooth-coloured material, involving five surfaces of an anterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

231.35

Subgroup 3 – Adhesive Restorations – Posterior Teeth – direct

88531

Adhesive restoration – one surface – posterior tooth – direct

Direct restoration, using an adhesive technique and a tooth-coloured material, involving one surface of an posterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rules 24 and 27)

126.50

88532

Adhesive restoration – two surfaces – posterior tooth – direct

Direct restoration, using an adhesive technique and a tooth-coloured material, involving two surfaces of an posterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

158.85

88533

Adhesive restoration – three surfaces – posterior tooth – direct

Direct restoration, using an adhesive technique and a tooth-coloured material, involving three surfaces of an posterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

190.95

88534

Adhesive restoration – four surfaces – posterior tooth – direct

Direct restoration, using an adhesive technique and a tooth-coloured material, involving four surfaces of an posterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

215.20

88535

Adhesive restoration – five surfaces – posterior tooth – direct

Direct restoration, using an adhesive technique and a tooth-coloured material, involving five surfaces of an posterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care.

(Item is subject to Rule 24)

248.55

Subgroup 7 – Other Restorative Services

88572

Provisional (intermediate/temporary) restoration – per tooth

The provisional (intermediate) restoration of a tooth designed to last until the definitive restoration can be constructed or the tooth is removed. This item should only be used where the provisional (intermediate) restoration is not an intrinsic part of treatment. It does not include provisional (temporary) sealing of the access cavity during endodontic treatment or during construction of indirect restorations.

(Item is subject to Rules 17 and 28)

50.05

88574

Metal band

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

42.15

88575

Pin retention – per pin

Use of a pin to aid the retention and support of direct or indirect restorations in a tooth.

(Item is subject to Rules 17 and 24)

28.75

88579

Bonding of tooth fragment

The direct bonding of a tooth fragment as an alternative to placing a restoration.

99.40

88586

Crown - metallic - with tooth preparation – preformed

Placing a preformed metallic crown as a coronal restoration for a tooth.

(Item is subject to Rule 27A)

263.80

88587

Crown - metallic - minimal tooth preparation – preformed

Placing a preformed metallic crown as a coronal restoration for a tooth and where minimal or no restoration of the tooth is required. Commonly referred to as a ‘Hall’ crown.

(Item is subject to Rule 27A)

156.50

88597

Post – direct

Insertion of a post into a prepared root canal to provide an anchor for an artificial crown or other restoration.

(Item is subject to Rule 24)

90.45

Group U7 – Prosthodontics

Subgroup 1 – Dentures and Denture Components

88721

Partial maxillary denture – resin, base only

Provision of a resin base for a removable dental prosthesis for the maxilla where some natural teeth remain.

(Item is subject to Rules 17 and 24A)

448.05

88722

Partial mandibular denture – resin, base only

Provision of a resin base for a removable dental prosthesis for the mandible where some natural teeth remain.

(Item is subject to Rules 17 and 24A)

448.05

88723

Provisional partial maxillary denture

Provision of a patient removable partial dental prosthesis replacing the natural teeth and adjacent tissues in the maxilla which is designed to last until the definitive prosthesis can be constructed. This item should only be used where a provisional denture is not an intrinsic part of item 88721.

(Item is subject to Rules 24A and 25)

336.00

88724

Provisional partial mandibular denture

Provision of a patient removable partial dental prosthesis replacing the natural teeth and adjacent tissues in the mandible which is designed to last until the definitive prosthesis can be constructed. This item should only be used where a provisional denture is not an intrinsic part of item 88722.

(Item is subject to Rules 24A and 25)

336.00

88731

Retainer – per tooth

A retainer or attachment fitted to a tooth to aid retention of a partial denture. The number of retainers should be indicated.

(Item is subject to Rule 25)

45.20

88733

Tooth/teeth (partial denture)

An item to describe each tooth added to the base of a new partial denture. The number of teeth should be indicated.

(Item is subject to Rule 25)

37.10

88736

Immediate tooth replacement – per tooth

Provision within a denture to allow immediate replacement of an extracted tooth. The number of teeth so replaced should be indicated.

(Item is subject to Rule 25)

9.30

Subgroup 4 – Denture Maintenance

88741

Adjustment of a denture

Adjustment of a denture to improve comfort, function or aesthetics. This item does not apply to routine adjustments following the insertion of a new denture or the maintenance or repair of an existing denture.

(Item is subject to Rule 25)

53.90

Subgroup 6 – Denture Repairs

88761

Reattaching pre-existing clasp to denture

Repair, insertion and adjustment of a denture involving re-attachment of a pre-existing clasp.

147.95

88762

Replacing/adding clasp to denture - per clasp

Repair, insertion and adjustment of a denture involving replacement or addition of a new clasp or clasps.

154.60

88764

Repairing broken base of a partial denture

Repair, insertion and adjustment of a broken resin partial denture base.

147.95

88765

Replacing/adding new tooth on denture – per tooth

Repair, insertion and adjustment of a denture involving replacement with or addition of a new tooth or teeth to a previously existing denture.

154.60

88766

Reattaching existing tooth on denture – per tooth

Repair, insertion and adjustment of a denture involving reattachment of a pre-existing denture tooth or teeth.

147.95

88768

Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth

Modification, insertion and adjustment of a partial denture involving an addition to accommodate the loss of a natural tooth or its coronal section.

(Item is subject to Rule 17)

156.50

Subgroup 7 – Other Prosthodontic Services

88776

Impression - dental appliance repair/modification

An item to describe taking an impression where required for the repair or modification of a dental appliance.

47.25

Group U9 – General Services

Subgroup 1– Emergencies

88911

Palliative care

An item to describe interim care to relieve pain, infection, bleeding or other problems not associated with other treatment.

(Item is subject to Rule 29)

70.15

Subgroup 4– Sedation

88942

Sedation - intravenous

Sedative drug(s) administered intravenously, usually in increments. The incremental administration may continue while dental treatment is being provided.

(Item is subject to rule 17)

137.50

88943

Sedation - inhalation

Nitrous oxide gas mixed with oxygen is inhaled by the patient while dental treatment is being provided.

68.75




Item 2  Schedule 3

Repeal Schedule 3, substitute:

Schedule 3     Benefit limits

(rule 14)

 

Relevant 2 year period

Cap

2019-2020

$1,000

2020-2021

$1,000

2021-2022

$1,013

2022-2023

$1,026