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)

450.28

8513

Emergency crown

737.39

+L

T

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

8515

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

285.91

T

8517

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

763.21

+L

T

Provisional treatment

8521

Provisional splinting - extracoronal wire, per sextant

613.65

8523

Provisional splinting - extracoronal wire plus resin, per sextant

898.55

8527

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

285.91

+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

737.39

+L

T

8530

Preformed metal crown

626.06

T

Occlusal adjustment

8551

Major occlusal adjustment

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

853.30

8553

Minor occlusal adjustment

661.31

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

1870.14

+L

T

8555

One surface

2772.11

+L

T

8556

Two surfaces

4002.39

+L

T

8557

Three surfaces

6449.96

+L

T

8558

Four or more surfaces

6449.96

+L

T

Gold restorations (only applicable with prior authorization)

8571

One surface

1331.20

+L

T

8572

Two surfaces

1924.63

+L

T

8573

Three surfaces

2979.32

+L

T

8574

Four or more surfaces

2979.32

+L

T

8577

Pin retention

444.67

T

Posts and copings

8581

Single post

738.94

+L

T

8582

Double post

1062.92

+L

T

8583

Triple post

1332.40

+L

T

8587

Copings

636.27

+L

T

8589

Cast core with pins

1049.90

+L

T

8591

Preformed posts and cores

737.39

T

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

8593

Prefabricated post and core in addition to crown

1367.04

T

Core is built around a prefabricated post(s).

Implants

8592

Osseo-integrated abutment restoration, per abutment

4553.77

+L

T

8600

Cost of implant components

Rule 013

9190

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

1081.93

9191

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

811.26

9192

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

540.17

8597

Connectors

301.72

+L

T

Locks and milled rests

8599

Precision attachments

737.39

+L

T

Crowns

8601

Cast three-quarter crown

2590.71

+L

T

8603

Cast gold crown (authorization needed)

2979.32

+L

T

8605

Acrylic veneered gold crown

3316.27

+L

T

8607

Porcelain jacket crown

2979.32

+L

T

8609

Porcelain veneered metal crown

3720.09

+L

T

Bridges

(Retainers as above)

8611

Sanitary pontic

2247.75

+L

T

8613

Posterior pontic

2770.11

+L

T

8615

Anterior pontic

2979.32

+L

T

Resin bonded retainers

8617

Per abutment

917.76

+L

T

Per pontic (see 8611, 8613, 8615)

Conservative treatment for temporo-mandibular joint dysfunction

8625

Bite plate for TMJ dysfuntion

1137.47

+L

8621

First visit for treatment of TMJ dysfunction

259.28

8623

Follow-up visit for TMJ dysfunction

193.42

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

2607.34

T

8633

Each additional canal

651.48

T

8636

Re-preparation of previously obturated canal, per canal

435.26

T

Other endontic procedures

8635

Apexification of root canal, per visit

435.46

T

8637

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

1216.08

T

9015

Apicectomy including retrograde root filling where necessary - anterior tooth

1442.91

T

9016

Apicectomy including retrograde root filling where necessary - posterior tooth

2155.47

T

8640

Removal of fractured post or instrument from root canal

762.80

T

Prosthetics (Removable)

8641

Complete upper and lower dentures without primary complications

7446.79

+L

8643

Complete upper and lower dentures without major complications

9665.32

+L

8645

Complete upper and lower dentures with major complications

11887.83

+L

8647

Complete upper or lower denture without primary complications

5209.65

+L

8649

Complete upper or lower denture without major complications

5951.83

+L

8651

Complete upper or lower denture with major complications

6693.61

+L

8661

Diagnostic dentures (inclusive of tissue conditioning treatment

5951.83

+L

8662

Remounting and occlusal adjustment of dentures

856.71

+L

8663

Chrome cobalt base base for full denture (extra charge)

1793.28

+L

8664

Remount of crown or bridge for extensive prosthetics

872.91

8665

Re-base, per denture

1201.26

+L

8667

Soft base, per denture (heat cured)

1791.87

+L

8668

Tissue conditioner, per denture

444.46

8669

Intra-oral reline of complete or partial denture

661.31

8671

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

5951.83

+L

8672

Additional fee for altered cast technique for partial denture

233.05

+L

8674

Additive partial denture

2697.03

+L

8679

Repairs

301.72

+L

8273

Additional fee where impression is required for 8679

138.14

+L

8275

Adjustment of denture

138.14

+L

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