II

SPECIALIST PROSTHODONTISTS

(M) See Rule 009

Code

Procedure description

Rc

MP

Fee

Emergency treatment

8511

Emergency treatment for relief of pain (where no other tariff code is applicable)

436.10

8513

Emergency crown

714.15

+L

T

(Not applicable to temporary crowns placed during routine crown and bridge preparation)

8515

Re-cementing of inlay, crown or bridge, per abutment

276.90

T

8517

Re-implantation of an avulsed tooth, including fixation as required

739.16

+L

T

Provisional treatment

8521

Provisional splinting - extracoronal wire, per sextant

594.31

8523

Provisional splinting - extracoronal wire plus resin, per sextant

870.23

8527

Provisional splinting - intercoronal wire or pins or cast bar, plus amalgam or resin, per dental unit included in the splint

276.90

+L

8529

Provisional crown

Crown utilized as an interim restoration for at least six weeks during restorative treatment to allow adequate time for healing or completion of other procedures. This includes, but is not limited to, changing vertical dimension, completing periodontal therapy or cracked tooth syndrome. This code should not be utilised for a temporary crown in a routine prosthetic restoration

714.15

+L

T

8530

Preformed metal crown

606.30

T

Occlusal adjustment

8551

Major occlusal adjustment

This procedure can not be carried out without study models mounted on an adjustable articulator

826.42

8553

Minor occlusal adjustment

640.47

Ceramic and/or resin bonded inlays and veneers

In some of the procedures below (e.g. Direct hybrid inlays) +L may not apply

8554

Bonded veneers

2082.89

+L

T

8555

One surface

2684.76

+L

T

8556

Two surfaces

3876.27

+L

T

8557

Three surfaces

6246.72

+L

T

8558

Four or more surfaces

6246.72

+L

T

Gold restorations (only applicable with prior authorization)

8571

One surface

1289.26

+L

T

8572

Two surfaces

1863.98

+L

T

8573

Three surfaces

2885.44

+L

T

8574

Four or more surfaces

2885.44

+L

T

8577

Pin retention

430.66

T

Posts and copings

8581

Single post

715.66

+L

T

8582

Double post

1029.43

+L

T

8583

Triple post

1290.42

+L

T

8587

Copings

616.22

+L

T

8589

Cast core with pins

1016.82

+L

T

Preformed posts and cores

8591

Core build-up, including all pins

Refers to the building up of an anatomical crown when a restorative crown will be placed, whether or not pins are used

714.15

T

8593

Prefabricated post and core in addition to crown

1323.96

T

Core is built around a prefabricated post(s).

Implants

8592

Osseo-integrated abutment restoration, per abutment

4410.28

+L

T

8600

Cost of implant components

Rule 013

9190

Exposure of a single osseo-integrated implant and placement of a transmucosal element

1047.84

9191

Exposure of a second osseo-integrated implant and placement of a transmucosal element in the same jaw

785.70

9192

Exposure of a third and subsequent osseo-integrated implant in the same jaw, per implant

523.15

Connectors

8597

Locks and milled rests

292.21

+L

T

8599

Precision attachments

714.15

+L

T

Crowns

8601

Cast three-quarter crown

2885.44

+L

T

8603

Cast gold crown (authorization needed)

2885.44

+L

T

8605

Acrylic veneered gold crown

3211.77

+L

T

8607

Porcelain jacket crown

2885.44

+L

T

8609

Porcelain veneered metal crown

3602.87

+L

T

Bridges

(Retainers as above)

8611

Sanitary pontic

2176.92

+L

T

8613

Posterior pontic

2682.82

+L

T

8615

Anterior pontic

2885.44

+L

T

Resin bonded retainers

8617

Per abutment

888.84

+L

T

Per pontic (see 8611, 8613, 8615)

Conservative treatment for temporo-mandibular joint dysfunction

8625

Bite plate for TMJ dysfuntion

1101.63

+L

8621

First visit for treatment of TMJ dysfunction

251.11

8623

Follow-up visit for TMJ dysfunction

187.32

The number of visits and fees therefore depend on the relationship between the practitioner and the patient, and the problems involved in the case

Endodontic procedures

Root canal therapy

Procedure codes 8631, 8633 and 8636 include all X-rays and repeat visits

8631

Root canal therapy, first canal

2525.18

T

8633

Each additional canal

630.96

T

8636

Re-preparation of previously obturated canal, per canal

421.54

T

Other endontic procedures

8635

Apexification of root canal, per visit

421.74

T

8637

Hemisection of a tooth, resection of a root or tunnel preparation (as an isolated procedure)

1177.76

T

9015

Apicectomy including retrograde root filling where necessary - anterior tooth

1397.44

T

9016

Apicectomy including retrograde root filling where necessary - posterior tooth

2087 55

T

8640

Removal of fractured post or instrument from root canal

738.76

T

Prosthetics (Removable)

8641

Complete upper and lower dentures without primary complications

7212.14

+L

8643

Complete upper and lower dentures without major complications

9360.76

+L

8645

Complete upper and lower dentures with major complications

11513.24

+L

8647

Complete upper or lower denture without primary complications

5045.49

+L

8649

Complete upper or lower denture without major complications

5764.29

+L

8651

Complete upper or lower denture with major complications

6482.70

+L

8661

Diagnostic dentures (inclusive of tissue conditioning treatment

5764.29

+L

8662

Remounting and occlusal adjustment of dentures

829.71

+L

8663

Chrome cobalt base base for full denture (extra charge)

1736.77

+L

8664

Remount of crown or bridge for extensive prosthetics

845.41

8665

Re-base, per denture

1163.40

+L

8667

Soft base, per denture (heat cured)

1735.41

+L

8668

Tissue conditioner, per denture

430.46

8669

Intra-oral reline of complete or partial denture

640.47

8671

Metal (e.g. Chrome cobalt or gold) partial denture

5764.29

+L

8672

Additional fee for altered cast technique for partial denture

225.70

+L

8674

Additive partial denture

2612.04

+L

8679

Repairs

292.21

+L

8273

Additional fee where impression is required for 8679

133.79

+L

8275

Adjustment of denture

133.79

+L

(After six months or for a patient of another practitioner)