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R 385
Code |
Procedure description |
DM/+ |
MP |
TC |
General Dental Practice |
Maxillo-facial and Oral Surgery |
Prosthodontics |
C. RESTORATIVE |
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AMALGAM RESTORATIONS (including polishing) |
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All adhesives, liners and bases are included as part of the restoration. If pins are used, they should be reported separately |
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8341 |
Amalgam - one surface |
|
T |
B |
327.31 |
- |
- |
8342 |
Amalgam - two surfaces |
|
T |
B |
409.73 |
- |
- |
8343 |
Amalgam - three surfaces |
|
T |
B |
492.33 |
- |
- |
8344 |
Amalgam - four or more surfaces |
|
T |
B |
490.97 |
- |
- |
RESIN-BASED COMPOSITE RESTORATIONS |
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Resin refers to a broad category of materials including but not limited to composites and may include bonded composite, light-cured |
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8351 |
Resin - one surface, anterior |
|
T |
B |
320.14 |
- |
- |
8352 |
Resin - two surfaces, anterior |
|
T |
B |
408.95 |
- |
- |
8353 |
Resin - three surfaces, anterior |
|
T |
B |
540.80 |
- |
- |
8354 |
Resin - four or more surfaces, anterior |
|
T |
B |
600.51 |
- |
- |
|
Use to report the involvement of four or more surfaces or the incisal line angle. The incisal line angle is the junction of the incisal and the mesial or distal surface of an anterior tooth. |
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8367 |
Resin one surface, posterior |
|
T |
B |
387.04 |
- |
- |
|
This is not a preventative procedure and should only be used to restore a carious lesion or a deeply eroded area into a natural tooth. |
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8368 |
Resin two surfaces, posterior |
|
T |
B |
530.33 |
- |
- |
8369 |
Resin three surfaces, posterior |
|
T |
B |
578.42 |
- |
- |
8370 |
Resin - four or more surfaces, posterior |
|
T |
B |
613.51 |
- |
- |
Inlay / Onlay restorations |
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METAL INLAYS / ONLAYS |
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8361 |
Inlay, metallic - one surface, posterior |
+L |
T |
A |
656.36 |
- |
984.54 |
8362 |
Inlay/onlay - metal - two surfaces |
+L |
T |
A |
849.10 |
- |
1 273.65 |
8363 |
Inlay/onlay - metal - three surfaces |
+L |
T |
A |
1 751.12 |
- |
2 626.68 |
8364 |
Inlay/onlay - metal - four or more surfaces |
+L |
T |
A |
1 751.32 |
- |
2 626.98 |
CERAMIC AND / OR RESIN INLAYS |
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Porcelain / ceramic inlays include either all ceramic or porcelain inlays. Composite / resin inlays must be laboratory processed |
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8371 |
Inlay - porcelain - one surface |
+L |
T |
A |
594.31 |
- |
891.47 |
8372 |
Inlay/onlay - porcelain - two surfaces |
+L |
T |
A |
868.29 |
- |
1 302.44 |
8373 |
Inlay/onlay - porcelain - three surfaces |
+L |
T |
A |
1 449.04 |
- |
2 173.56 |
8374 |
Inlay/onlay - porcelain - four or more surfaces |
+L |
T |
A |
1 751.32 |
- |
2 626.98 |
CROWNS - SINGLE RESTORATIONS |
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Use these codes for single crown restorations. See the Fixed Prosthodontic Service section for crown bridge retainers and the |
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8401 |
Crown - full cast metal |
+L |
T |
A |
2 079.97 |
- |
2 885.44 |
8403 |
Crown - 3/4 cast metal |
+L |
T |
A |
2 079.97 |
- |
2 885.44 |
8404 |
Crown - 3/4 porcelain/ceramic |
+L |
T |
A |
2 079.97 |
- |
2 885.44 |
8405 |
Crown - resin laboratory |
+L |
T |
A |
2 079.97 |
- |
2 885.44 |
|
Refers to all resin-based crowns that are indirectly fabricated. All fiber, porcelain or ceramic reinforced polymer materials/systems are considered resin-based crowns |
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8407 |
Crown - resin with metal |
+L |
T |
A |
2 220.36 |
- |
3 211.77 |
8409 |
Crown - porcelain/ceramic |
+L |
T |
A |
2 220.36 |
- |
2 885.44 |
8411 |
Crown - porcelain with metal |
+L |
T |
A |
2 220.36 |
- |
3 602.87 |
Other restorative |
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8133 |
Recement inlay, onlay, crown or veneer |
|
T |
B |
190.62 |
- |
285.93 |
|
Use to report the recementation of a permanent single inlay, onlay, crown or veneer. See code 8514 in the Fixed Prosthodontic Section for the recementation of a bridge retainer. Comment: This code may not be used for the recementation of temporary or provisional restorations, which is included as part of the restoration.
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8135 |
Removal of inlays and crowns (per unit) and bridges (per abutment) or sectioning of a bridge, part of which is to be retained as a crown following the failure of a bridge
|
|
T |
A |
374.43 |
- |
374.43 |
|
This procedure involves the removal of a permanent inlay, onlay or crown. Comment: This code may not be used for the removal of temporary or provisional restorations, which is included as part of the restoration
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8137 |
Emergency crown (chair-side) |
+L |
T |
A |
640.47 |
- |
640.47 |
|
A temporary crown. usually made of resin and in the surgery, which is fitted over a damaged tooth for the immediate protection in tooth injury. Includes emergency crowns manufactured for the replacement of previously fitted, lost or damaged permanent crowns. Comment: This code should not be used as an interim restoration during restorative treatment and should not be reported on the same day on which an impression is taken to replace a previously fitted lost or damaged permanent crown.
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8330 |
Removal of root canal obstruction |
|
T |
B |
250.73 |
- |
- |
|
This procedure involves the treatment of a non-negotiable root canal blocked by foreign bodies (e.g. removal and/or bypassing of a fractured instrument) or calcification of 50% or more of a root to achieve an apical seal and forego surgical treatment - Report per canal. This code may be submitted by the servicing provider and on the same day as a root canal therapy if the obstruction is not iatrogenic by that provider.
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8345 |
Prefabricated post retention, per post (in addition to restoration) |
|
T |
B |
276.90 |
- |
- |
|
Should not be used with codes 8398 or 8376 (Core build-ups) Remuneration excludes cost of posts - See code 8379 |
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8347 |
Pin retention - first pin (in addition to restoration |
|
T |
B |
190.62 |
- |
- |
|
Should not be used with codes 8398 or 8376 (Core build-ups). |
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8348 |
Pin retention - each additional pin (in addition to restoration) |
|
T |
B |
164.63 |
- |
- |
|
Should not be used with codes 8398 or 8376 (Core build-ups). Limitation: A maximum of two additional pins may be levied.
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8355 |
Veneer - resin (chair-side) |
|
T |
B |
607.11 |
- |
607.11 |
|
Involves direct layering of material over tooth. No laboratory processing. |
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8357 |
Prefabricated metal crown |
|
T |
B |
403.13 |
- |
403.13 |
|
Includes all preformed metal crowns e.g. stainless steel, nickel-chrome and gold anodised crowns, with or without resin window.
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8366 |
Pin retention as part of cast restoration, irrespective of number of pins. |
|
T |
A |
294.35 |
- |
441.53 |
8376 |
Core build-up with prefabricated posts |
|
T |
B |
982.50 |
- |
982.50 |
|
The direct build-up of a mutilated crown around a prefabricated post to provide a rigid base for retention of a crown restoration.This procedure includes posts and core material. Remuneration excludes cost of posts - See code 8379. |
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8379 |
Cost of prefabricated posts - add on to 8376 |
|
T |
A |
Rule 013 |
- |
Rule 013 |
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Applicable to pre-fabricated noble metal, ceramic, iridium and titanium posts - see code 8345 and 8376 |
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8391 |
Cast core with single post |
+L |
T |
A |
446.17 |
- |
- |
|
Report in addition to crown. |
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8392 |
Cast post (each additional) |
+L |
T |
A |
357.00 |
- |
- |
|
to be used with 8391 for each additional cast posts on the same tooth. |
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8397 |
Cast core with pins (any number of pins) |
+L |
T |
A |
714.15 |
- |
1 071.23 |
|
The cast cor with pins is intended to be used on grossly broken down vital teeth. Report in addition to crown. |
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8398 |
Core build-up, including any pins. Refers to the building up of an anatomical crown when a restorative crown will be placed, irrespective of the number of pins used. |
|
T |
B |
714.15 |
- |
714.15 |
|
The direct build-up of a mutilated crown to provide a rigid base for retention of a crown restoration irrespective of the number of pins used. This code should not be reported when the procedure only involves a filler to eliminate any undercut, concave irregularity in the preparation,etc.
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8413 |
Repair crown (permanent or provisional) |
+L |
T |
A |
436.02 |
- |
436.02 |
|
This procedure involves the repair of a permanent crown (e.g. facing replacement). Excludes the removal (8153) and recementation (8133) of the crown. This code may also be reported for the repair/replacement of a provisional crown (8410) after a period of two months. This code may not be used for the repair/replacement of a temporary restorations, which is included as part of the restoration
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8414 |
Additional fee for provision of a crown within an existing clasp or rest |
+L |
T |
A |
136.73 |
- |
- |