Dental Benefits Amendment Rules 2023
I, Simon Cotterell, as delegate of the Minister for Health and Aged Care, make the following Rules.
Dated 8 December 2023
Simon Cotterell
First Assistant Secretary
Primary Care Division
Department of Health and Aged Care
This instrument is the Dental Benefits Amendment Rules 2023.
(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 2024 |
|
Note: This table relates only to the provisions of this instrument as originally made.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.
This instrument is made under subsection 60(1) of the Dental Benefits Act 2008.
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
1 Schedule 1 Dental Benefits Schedule
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) | 57.65 |
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) | 47.90 |
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) | 30.10 |
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) | 33.35 |
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. | 67.40 |
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) | 58.90 |
88114 | Removal of calculus – first visit Removal of calculus from the surfaces of teeth. (Item is subject to Rules 17 and 20) | 98.20 |
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) | 63.85 |
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) | 37.85 |
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) | 50.45 |
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) | 25.25 |
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) | 76.30 |
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) | 58.00 |
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) | 143.75 |
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) | 183.75 |
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) | 90.60 |
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) | 233.30 |
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) | 266.45 |
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) | 358.40 |
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) | 190.85 |
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) | 175.15 |
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) | 209.00 |
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) | 215.60 |
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) | 422.20 |
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) | 106.10 |
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. | 38.15 |
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) | 130.70 |
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) | 83.30 |
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) | 234.50 |
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) | 111.70 |
88417 | Root canal obturation – one canal The filling of a root canal, following chemo-mechanical preparation. (Item is subject to Rule 23) | 228.40 |
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) | 106.80 |
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) | 151.00 |
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) | 130.70 |
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) | 115.70 |
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) | 154.35 |
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) | 114.10 |
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) | 139.95 |
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) | 167.00 |
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) | 190.35 |
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) | 217.30 |
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) | 126.40 |
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) | 153.45 |
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) | 181.75 |
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) | 210.05 |
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) | 246.85 |
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) | 134.95 |
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) | 169.45 |
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) | 203.70 |
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) | 229.65 |
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) | 265.20 |
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) | 53.40 |
88574 | Metal band The cementation of a metal band for diagnostic, protective purposes or for the placement of a provisional (intermediate) restoration. | 44.95 |
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) | 30.65 |
88579 | Bonding of tooth fragment The direct bonding of a tooth fragment as an alternative to placing a restoration. | 106.10 |
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) | 281.50 |
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) | 167.00 |
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) | 96.50 |
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) | 478.10 |
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) | 478.10 |
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) | 358.50 |
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) | 358.50 |
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) | 48.25 |
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) | 39.60 |
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) | 9.95 |
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) | 57.50 |
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. | 157.85 |
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. | 164.95 |
88764 | Repairing broken base of a partial denture Repair, insertion and adjustment of a broken resin partial denture base. | 157.85 |
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. | 164.95 |
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. | 157.85 |
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) | 167.00 |
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. | 50.45 |
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) | 74.85 |
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) | 146.75 |
88943 | Sedation - inhalation Nitrous oxide gas mixed with oxygen is inhaled by the patient while dental treatment is being provided. | 73.35 |
2 Schedule 3 Benefit limits
Repeal Schedule 3, substitute:
(rule 14)
Relevant 2 year period | Cap |
2019-2020 | $1,000 |
2020-2021 | $1,000 |
2021-2022 | $1,013 |
2022-2023 | $1,026 |
2023-2024 | $1,052 |
2024-2025 | $1,095 |