{"id":"F2014L01748","name":"Dental Benefits Rules 2014","slug":"dental-benefits-rules-2014","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":92418,"registerId":"commonwealth-F2014L01748-current","compilationNumber":null,"startDate":"2026-04-02","status":"Repealed","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Part 1","sectionType":"part","heading":"Preliminary","content":"Part 1—Preliminary\n\n","sortOrder":0},{"sectionNumber":"1","sectionType":"section","heading":"Name of Rules","content":"1 Name of Rules\n\nThese Rules are the Dental Benefits Rules 2014.\n\n","sortOrder":1},{"sectionNumber":"2A","sectionType":"section","heading":"Authority","content":"2A Authority\n\nThese Rules are made under the Dental Benefits Act 2008.\n\n","sortOrder":2},{"sectionNumber":"4","sectionType":"section","heading":"Definitions","content":"4 Definitions\n\n> Note: A number of expressions used in these Rules are defined in the Act, including the following:\n\n> Note: (a) Chief Executive Medicare;\n\n> Note: (b) dental practitioner;\n\n> Note: (c) dental provider;\n\n> Note: (d) item.\n\nIn these Rules:\n\n> Act means the Dental Benefits Act 2008.\n\n> carer payment has the meaning given by Part 2.5 of the Social Security Act 1991.\n\n> dental hygienist means a person who has general registration in the dental hygienists division of the dental profession under a law of a State or Territory.\n\n> dental prosthetist means a person who has general registration in the dental prosthetists division of the dental profession under a law of a State or Territory.\n\n> dental therapist means a person who has general registration in the dental therapists division of the dental profession under a law of a State or Territory.\n\n> disability support pension has the meaning given by Part 2.3 of the Social Security Act 1991.\n\n> double orphan pension has the meaning given by Part 2.20 of the Social Security Act 1991.\n\n> FTB(A) person has the same meaning as in section 24 of the Act.\n\n> FTB recipient has the same meaning as in section 24 of the Act.\n\n> medicare number has the same meaning as in section 84 of the National Health Act 1953.\n\n> MRCAETS means the Military Rehabilitation and Compensation Act Education and Training Scheme.\n\nNote Military Rehabilitation and Compensation Act Education and Training Scheme 2004 is a legislative instrument.\n\n> oral health therapist means a person who has general registration in the oral health therapists division of the dental profession under a law of a State or Territory.\n\n> parenting payment has the meaning given by the definition of parenting payment in section 18 of the Social Security Act 1991.\n\n> partner has the same meaning as in the Social Security Act 1991.\n\n> provider number has the same meaning as in the Health Insurance Regulations 2018.\n\n> public sector dental provider means:\n\n(a) a dental provider employed by, contracted to, or providing dental services under an arrangement with:\n\n(i) the Commonwealth; or\n\n(ii) a State; or\n\n(iii) an internal Territory; or\n\n(iv) a local governing body; or\n\n(v) an authority established by a law of the Commonwealth, a law of a State or a law of an internal Territory; or\n\n(b) a dental provider on whose behalf another dental provider provides dental services under an arrangement with a body mentioned in subparagraph (a)(i), (ii), (iii), (iv) or (v).\n\n> receive, for disability support pension, parenting payment, special benefit, carer payment and double orphan pension, has the meaning given by section 23 of the Social Security Act 1991.\n\n> registered dentist means a dental provider covered by paragraph 6(1)(a) of the Act.\n\n> relevantly provided, for a dental service, means provided as a service for which dental benefit is payable under the Act.\n\n> special benefit has the meaning given by Part 2.15 of the Social Security Act 1991.\n\n> VCES means the Veterans’ Children Education Scheme.\n\n> Note: Veterans’ Children Education Scheme is a legislative instrument.\n\n","sortOrder":3},{"sectionNumber":"5","sectionType":"section","heading":"Dental Benefits Schedule","content":"5 Dental Benefits Schedule\n\nFor subsection 61(1) of the Act, the Dental Benefits Schedule is set out in Schedule 1.\n\n","sortOrder":4},{"sectionNumber":"6","sectionType":"section","heading":"Dental providers","content":"6 Dental providers\n\n(1) For the purposes of paragraph 6(1)(b) of the Act, a person included in one or more of the following classes of persons is a dental provider in relation to a dental service:\n\n(a) dental hygienists;\n\n(b) dental therapists;\n\n(c) oral health therapists.\n\n> Note: A registered dentist is also a dental provider in relation to a dental service (see the definition of dental provider in paragraph 6(1)(a) of the Act).\n\n(2) For the purposes of paragraph 6(2)(b) of the Act, a dental practitioner is not a dental provider in relation to a dental service if the dental practitioner has not been allocated a provider number by the Chief Executive Medicare.\n\n","sortOrder":5},{"sectionNumber":"7","sectionType":"section","heading":"Persons eligible to render services on behalf of dental providers","content":"7 Persons eligible to render services on behalf of dental providers\n\nDental services rendered on behalf of registered dentists\n\n(1) For the purposes of paragraph 7(a) of the Act, a dental service may be rendered on behalf of a registered dentist who is not a public sector dental provider by a person who is included in one or more of the following classes of persons:\n\n(a) dental hygienists;\n\n(b) dental therapists;\n\n(c) dental prosthetists;\n\n(d) oral health therapists.\n\nDental services rendered on behalf of public sector dental providers\n\n(2) For the purposes of paragraph 7(a) of the Act, a dental service may be rendered on behalf of a public sector dental provider who is a registered dentist by another public sector dental provider.\n\n","sortOrder":6},{"sectionNumber":"Part 2","sectionType":"part","heading":"Payment of dental benefits","content":"Part 2—Payment of dental benefits\n\n","sortOrder":7},{"sectionNumber":"8","sectionType":"section","heading":"Particulars to be recorded (Act, s 17(2))","content":"8 Particulars to be recorded (Act, s 17(2))\n\nPatient billed services\n\n(1) For the payment of dental benefits listed in the Dental Benefits Schedule, the following particulars must be recorded on the account or receipt:\n\n(a) the patient’s name;\n\n(b) the date of the service;\n\n(c) the item number in the Dental Benefits Schedule that corresponds to the service;\n\n(d) the dental provider’s name and provider number;\n\n(e) the amount charged for the service, total amount paid, and any amount outstanding for the service.\n\nBulk billed services\n\n(2) If there is an assignment of dental benefits for an item under the Dental Benefits Schedule, the following particulars must be recorded on the assignment of benefit form:\n\n(a) the patient’s name;\n\n(b) the date of the service;\n\n(c) the item number in the Dental Benefits Schedule that corresponds to the service;\n\n(d) the dental provider’s name and provider number;\n\n(e) the amount of the dental benefit being assigned to the dental provider.\n\n8AA Dental benefit is not payable unless dental services rendered by appropriate dental providers\n\nFor the purposes of subsection 18(1) of the Act, dental benefit is not payable for a dental service specified in an item mentioned in column 1 of an item of the following table unless the condition that the dental service is rendered by, or on behalf of, a dental provider of a kind mentioned in column 2 of that table item is satisfied.\n\n```html\n

Dental benefit payable for dental services rendered by kinds of dental providers

Item

Column 1
Item in the Dental Benefits Schedule

Column 2
Dental provider

1

Item 88314, 88322, 88323, 88324, 88326, 88351, 88392, 88412, 88415, 88416, 88417, 88418, 88419, 88421, 88455, 88458, 88597, 88721, 88722, 88723, 88724, 88731, 88733, 88736, 88741, 88761, 88762, 88764, 88765, 88766, 88768, 88942 or 88943.

A registered dentist

2

Item 88311, 88316, 88384, 88386, 88387, 88411, 88414, 88511, 88512, 88513, 88514, 88515, 88521, 88522, 88523, 88524, 88525, 88531, 88532, 88533, 88534, 88535, 88574, 88575, 88579, 88586 or 88587.

A dental provider of a kind who is:

(a) a registered dentist; or

(b) a dental therapist; or

(c) an oral health therapist.

\n```\n\n> Note: This condition does not apply for dental services specified in other items in the Dental Benefits Schedule.\n\n","sortOrder":8},{"sectionNumber":"8A","sectionType":"section","heading":"Dental benefits not payable unless conditions satisfied (Act, s 18(2))","content":"8A Dental benefits not payable unless conditions satisfied (Act, s 18(2))\n\n(1) A dental service rendered in a State or internal Territory by or on behalf of or under an arrangement with a State or internal Territory is not eligible for dental benefits unless:\n\n(a) the State or internal Territory in which the service was performed is mentioned in column 1 of Schedule 2; and\n\n(b) the service is provided on or before the date in column 2 of schedule 2 pertaining to that State or internal Territory.\n\n(2) Despite subrule (1) the Minister may direct that a dental service rendered in a State or internal Territory by or on behalf of or under an arrangement with a State or internal Territory is eligible for dental benefits.\n\n(3) A dental benefit is not payable in respect of a dental service unless, at the time the dental service is rendered, the eligible dental patient to whom the dental service is rendered is an eligible person.\n\n","sortOrder":9},{"sectionNumber":"Part 3","sectionType":"part","heading":"Dental benefits vouchers","content":"Part 3—Dental benefits vouchers\n\n","sortOrder":10},{"sectionNumber":"9","sectionType":"section","heading":"Classes of persons who satisfy the means test (Act, s 24(1)(d))","content":"9 Classes of persons who satisfy the means test (Act, s 24(1)(d))\n\nFor paragraph 24(1)(d) of the Act, a person satisfies the means test, in a calendar year, if in the calendar year:\n\n(a) both:\n\n(ii) the person is receiving any of the following payments:\n\n(A) disability support pension;\n\n(B) parenting payment;\n\n(C) special benefit;\n\n(D) carer payment;\n\n(E) payments made under VCES or MRCAETS, if the person is a person mentioned in paragraph (c), in column 3, of item 2 of the table in subsection 22A(1) of A New Tax System (Family Assistance) Act 1999; or\n\n(b) both:\n\n(ii) the person’s parent, carer or guardian is receiving parenting payment or double orphan pension for the person; or\n\n(c) both:\n\n(ii) the person’s partner is receiving parenting payment; or\n\n(d) both:\n\n(ii) another person is receiving payments under VCES or MRCAETS on behalf of the person where that other person is a person referred to in paragraph (c), in column 3, of item 2 of the table in subsection 22A(1) of A New Tax System (Family Assistance) Act 1999.\n\n","sortOrder":11},{"sectionNumber":"10","sectionType":"section","heading":"Issuing more than 1 voucher for a person for a calendar year (Act, s 27 (5))","content":"10 Issuing more than 1 voucher for a person for a calendar year (Act, s 27 (5))\n\n(1) For the Dental Benefits Schedule, more than 1 voucher may be issued for a person for a calendar year if:\n\n(a) the person is an FTB(A) person for whom there is more than 1 FTB recipient; or\n\n(b) the person has more than 1 parent, carer or guardian who is receiving double orphan pension for the person; or\n\n(c) the person’s voucher has been lost or destroyed, or the person has not received it.\n\n(2) For paragraphs (1)(a) and (b), the Chief Executive Medicare may issue 2 vouchers for the person.\n\n(3) For paragraph (1)(c), the Chief Executive Medicare may issue a replacement voucher if the person asks the Department of Human Services for a replacement voucher, stating whether the voucher was lost, destroyed or not received.\n\n","sortOrder":12},{"sectionNumber":"11","sectionType":"section","heading":"When vouchers are not required to be issued (Act, s 29)","content":"11 When vouchers are not required to be issued (Act, s 29)\n\n(1) The Chief Executive Medicare is not required to issue a voucher for a calendar year for a person who qualifies for the voucher if:\n\n(a) the person has not been assigned a medicare number; or\n\n(b) both:\n\n(i) written consent has not been provided by a person mentioned in sub‑subparagraph (ii)(A) or (B) for the Department of Veterans’ Affairs to provide his or her personal information to the Department of Human Services for use in the administration of this Act; and\n\n(ii) either:\n\n(A) the person is eligible for payments under VCES or MRCAETS; or\n\n(B) another person is receiving payments under VCES or MRCAETS on behalf of the person; or\n\n(c) the person has reached the cap set for the relevant 2 year period.\n\n(2) In this rule:\n\ncap and relevant 2 year period have the meanings given in rule 14.\n\n","sortOrder":13},{"sectionNumber":"12","sectionType":"section","heading":"Period of effect of voucher (Act, s 31)","content":"12 Period of effect of voucher (Act, s 31)\n\nFor the Dental Benefits Schedule:\n\n(a) a voucher for the calendar year commencing on 1 January 2014 takes effect on and from that date and remains in effect until the end of 31 December 2014; and\n\n(b) a voucher for a calendar year commencing on 1 January of a subsequent year takes effect at the beginning of 1 January of that year and remains in effect until the end of 31 December of that year.\n\n","sortOrder":14},{"sectionNumber":"13","sectionType":"section","heading":"Persons to whom the vouchers are to be issued (Act, s 32(c))","content":"13 Persons to whom the vouchers are to be issued (Act, s 32(c))\n\nFor the Dental Benefits Schedule, a voucher is to be issued:\n\n(a) if an eligible dental patient is receiving youth allowance — to the eligible dental patient; or\n\n(b) if an eligible dental patient is receiving a payment under the ABSTUDY scheme, or another person or an institution is receiving such a payment in respect of the eligible dental patient:\n\n(i) if the eligible dental patient applied for the payment — to the eligible dental patient; or\n\n(ii) if the eligible dental patient’s parent or guardian applied for the payment — to the parent or guardian who made the application; or\n\n(iii) if an institution applied for the payment — to the institution that made the application; or\n\n(c) if an eligible dental patient is an FTB(A) person:\n\n(i) if there is 1 FTB recipient for the person — to the FTB recipient for the person; or\n\n(ii) if there is more than 1 FTB recipient for the person — to the FTB recipient with the highest percentage of care arrangements for the person; or\n\n(iii) if there is more than 1 FTB recipient for the person and the FTB recipients have equal care arrangements for the person — to a maximum of 2 FTB recipients with the most current records of entitlement; or\n\n(d) if an eligible dental patient is receiving a payment mentioned in subparagraph 9(a) — to the eligible dental patient; or\n\n(e) if an eligible dental patient’s parent, carer or guardian is receiving parenting payment for the eligible dental patient — to the parent, carer or guardian receiving the payment; or\n\n(f) if an eligible dental patient’s carer or guardian is receiving double orphan pension for the eligible dental patient:\n\n(i) if there is 1 carer or guardian receiving the pension for the eligible dental patient — to the carer or guardian receiving the pension; or\n\n(ii) if there is more than 1 carer or guardian receiving the pension for the eligible dental patient — to the carer or guardian receiving the pension with the highest percentage of care arrangements for the eligible dental patient; or\n\n(iii) if there is more than 1 carer or guardian receiving the pension for the eligible dental patient and those carers and/or guardians have equal care arrangements for the eligible dental patient — to a maximum of 2 carers or guardians receiving the pension with the most current records of entitlement; or\n\n(g) if an eligible dental patient is a person mentioned in paragraph 9(c) — to the partner receiving the payment; or\n\n(h) if an eligible dental patient is a person mentioned in paragraph 9(d) — to the person receiving the payment on behalf of the eligible dental patient.\n\n","sortOrder":15},{"sectionNumber":"Part 4","sectionType":"part","heading":"Other conditions, limitations or restrictions for items","content":"Part 4—Other conditions, limitations or restrictions for items\n\n","sortOrder":16},{"sectionNumber":"14","sectionType":"section","heading":"Monetary limit on dental benefits (Act s. 62(2)(c))","content":"14 Monetary limit on dental benefits (Act s. 62(2)(c))\n\n(1) The total of dental benefit payable in respect of dental services provided to an eligible dental patient must not exceed the specified monetary limit for the relevant 2 year period.\n\n(2) In this rule:\n\nspecified monetary limit is the cap.\n\n(3) An eligible dental patient shall be subject to a cap as listed in Schedule 3.\n\n(4) The cap is the maximum amount of dental benefits paid for services listed in the Dental Benefits Schedule provided to the eligible dental patient within a relevant 2 year period referred to in column 1 of Schedule 3.\n\n(5) In this rule:\n\nrelevant 2 year period, for an eligible dental patient, has the meaning given by subrules (6), (7), (8) and (9).\n\n(6) If:\n\n(a) an eligible dental patient received a dental service on or after 1 January 2014; and\n\n(b) the dental service is the first dental service that the eligible dental patient has received on or after 1 January 2014;\n\nthe calendar year in which the eligible dental patient received that first dental service and the following calendar year is a relevant 2 year period for the eligible dental patient.\n\n(7) Once the limit set by the cap for a relevant 2 year period has been reached the eligible dental patient will not receive any more benefits in that relevant 2 year period.\n\n(8) Once a relevant 2 year period has ended, the first time thereafter that a dental service listed in the Dental Benefits Schedule is rendered to an eligible dental patient it will trigger the commencement of a subsequent relevant 2 year period.\n\n(9) If there is no cap listed in Schedule 3 for the relevant 2 year period in which a service is provided, the cap for the most recent 2 year period listed in that Schedule shall apply.\n\nExample 1\n\nA person who first receives a dental service on 25 January 2014 will be eligible for not more than $1,000 in dental benefits for all dental services provided to the person in 2014 and 2015.\n\nA further relevant 2 year period commences for that person in the calendar year when the person first receives a dental service on or after 1 January 2016.\n\n","sortOrder":17},{"sectionNumber":"15","sectionType":"section","heading":"Informed financial consent (Act, s 62(2))","content":"15 Informed financial consent (Act, s 62(2))\n\n(1) An item in the Dental Benefits Schedule applies to a dental service only if a dental provider:\n\n(a) obtains consent to provide the dental service from the eligible dental patient or a person able to consent on his/her behalf and informed financial consent to costs from the person who incurs the dental expenses for that dental service before providing any item in the Dental Benefits Schedule; and then:\n\n(b) records the consent to treatment and costs; and\n\n(c) obtains the appropriate signature or signatures on a patient consent form.\n\n(2) In respect of a dental service where there has been an agreement under section 12 of the Act between the eligible dental patient and the dental provider to assign dental benefits, subrule 15(1) is met if a ‘Bulk Billing Patient Consent Form’ was executed on the same day as the service was provided, or on an earlier day in the same calendar year.\n\n(3) In respect of any dental service, subrule 15(1) is met if a ‘Non‑Bulk Billing Patient Consent Form’ was executed on the same day as the service was provided. For the avoidance of doubt, this subrule does not apply to a service if subrule 15(1) is met under subrule 15(2) in respect of that service.\n\n(4) The patient consent form executed under subrule 15(2) must be made in the form published by the Department and described as the ‘Bulk Billing Patient Consent Form’, as existing on 1 January 2014.\n\n Note: The form is available on the internet – see http://www.health.gov.au/dental\n Note: Section 25C of the Acts Interpretation Act 1901 provides that where an Act prescribes a form, then strict compliance with the form is not required and substantial compliance is sufficient.\n\n(5) The patient consent form executed under subrule 15(3) must be made in the form published by the Department and described as the ‘Non‑Bulk Billing Patient Consent Form’, as existing on 1 January 2014.\n\n Note: The form is available on the internet – see http://www.health.gov.au/dental\n Note: Section 25C of the Acts Interpretation Act 1901 provides that where an Act prescribes a form, then strict compliance with the form is not required and substantial compliance is sufficient.\n\n(6) Subrules 15(1)(b) and 15(1)(c) do not apply in respect of a dental service if an ‘extenuating circumstance’ applies in respect of that service.\n\n(7) For this rule, extenuating circumstances are as determined in the ‘Ministerial guidelines for the Child Dental Benefits Schedule: Extenuating circumstances for informed financial consent’ as made by the Minister and as amended from time to time.\n\n Note 1: The guidelines are available on the internet – see http://www.health.gov.au/dental\n Note 2: Section 60 of the Act provides that despite anything in the Legislation Act 2003, the Rules may make provision in relation to a matter by applying, adopting or incorporating any matter contained in any other instrument or writing as in force or existing from time to time.\n\n","sortOrder":18},{"sectionNumber":"16","sectionType":"section","heading":"Clinical records","content":"16 Clinical records\n\n(1) Eligible dental providers must keep clinical records, including relevant patient consent forms for the provision of all services listed in the Dental Benefits Schedule for a period of four years; and\n\n(2) Where a service in the Dental Benefits Schedule pertains to a particular tooth or teeth, the tooth or teeth must be recorded.\n\n","sortOrder":19},{"sectionNumber":"17","sectionType":"section","heading":"Limitation on number of certain services","content":"17 Limitation on number of certain services\n\n(a) an item of the Dental Benefits Schedule mentioned in column 2 of the following table is applicable to a service not more than the number of times mentioned in column 3 of the table in the period mentioned in column 4 of the table;\n\n| Item | Item of service | Number of times | Period |\n| ---- | --------------------------------- | --------------- | --------- |\n| 1 | 88311, 88314, 88322, 88323, 88324 | 1 | 1 day |\n| 2 | 88111, 88114, 88121 | 1 | 5 months |\n| 3 | 88942 | 1 | 12 months |\n| 4 | 88221, 88721, 88722 | 1 | 24 months |\n| 5 | 88115, 88213 | 2 | 12 months |\n| 6 | 88013, 88572 | 3 | 3 months |\n| 7 | 88458 | 3 | 12 months |\n| 8 | 88022, 88161, 88575 | 4 | 1 day |\n| 9 | 88768 | 8 | 24 months |\n\n(b) items 88111, 88114 and 88121 must not be provided more than two times per calendar year.\n\n","sortOrder":20},{"sectionNumber":"18","sectionType":"section","heading":"Limitation on provision of certain services","content":"18 Limitation on provision of certain services\n\n(a) an item of the Dental Benefits Schedule mentioned in column 2 of the following table is applicable to a service provided by a particular eligible dental provider, not more than once in the period mentioned in column 3 of the table:\n\n| Item | Item of service | Period |\n| ---- | --------------- | --------- |\n| 1 | 88012 | 5 months |\n| 2 | 88011 | 24 months |\n\n(b) item 88012 must not be provided more than two times by a particular eligible dental provider per calendar year.\n\n","sortOrder":21},{"sectionNumber":"19","sectionType":"section","heading":"Limitation on Diagnostic Services","content":"19 Limitation on Diagnostic Services\n\n(a) an item listed in Subgroup 1 of Group U0 of the Dental Benefits Schedule:\n\n(i) is applicable to a service once only per day; and\n\n(ii) is not applicable to a service if the service is provided in combination with a service described in any of the other items in the Subgroup on that day that has been relevantly provided;\n\n(b) item 88012 is not applicable to a service if the service is provided within 5 months of a service described in item 88011 being relevantly provided, where both services are provided by the same eligible dental provider.\n\n","sortOrder":22},{"sectionNumber":"20","sectionType":"section","heading":"Limitation on Preventive Services","content":"20 Limitation on Preventive Services\n\n(a) an item listed in Subgroup 1 of Group U1 of the Dental Benefits Schedule is not applicable to a service if:\n\n(i) the service is provided in combination with a service described in any of the other items in the Subgroup (the second service) on that day; and\n\n(ii) the second service is relevantly provided;\n\n(b) an item listed in Subgroup 3 of Group U1 of the Dental Benefits Schedule is not applicable to a service if the service is provided in respect of the same tooth on the same day as a service described in any of the items 88511 to 88535 is relevantly provided.\n\n","sortOrder":23},{"sectionNumber":"21","sectionType":"section","heading":"Limitation on Periodontic Services","content":"21 Limitation on Periodontic Services\n\nFor any particular eligible dental patient item 88213 is not applicable to a service if the service is provided in respect of a tooth on the same day as the service described in item 88415 is relevantly provided in respect of the same tooth.\n\n","sortOrder":24},{"sectionNumber":"22","sectionType":"section","heading":"Limitation on Oral Surgery","content":"22 Limitation on Oral Surgery\n\n(a) item 88311 is not applicable to a service if the service is provided on the same day as the service described in item 88314 is relevantly provided;\n\n(b) item 88322 is not applicable to a service if the service is provided on the same day as a service described in either item 88323 or 88324 is relevantly provided;\n\n(c) item 88323 is not applicable to a service if the service is provided on the same day as the service described in item 88324 is relevantly provided;\n\n(d) item 88324 is applicable to a service provided in respect of a multi‑rooted tooth only;\n\n(e) for any tooth, only one of items 88311 to 88326 is applicable to a service provided in respect of that tooth;\n\n(f) items 88384 to 88392 are not applicable to a service if the service is provided in respect of a tooth on any date after any of items 88311 to 88326 has been relevantly provided in respect of the same tooth;\n\n(g) item 88351 is only applicable to a service if the service is provided on the same day as any of items 88384, 88386 or 88387 are relevantly provided.\n\n","sortOrder":25},{"sectionNumber":"23","sectionType":"section","heading":"Limitation on Endodontic Services","content":"23 Limitation on Endodontic Services\n\n(a) item 88412 is applicable once only to a service provided in respect of a particular tooth;\n\n(b) an item in Group U4 of the Dental Benefits Schedule is not applicable to a service if the service is provided in respect of a tooth at any time after item 88412 has been relevantly provided in respect of that same tooth;\n\n(c) item 88415 is applicable once only to a service provided in respect of a particular tooth on a day;\n\n(d) item 88416 is applicable to a service provided in respect of a particular tooth to a maximum of twice on a day;\n\n(e) item 88417 is applicable once only to a service provided in respect of a particular tooth on a day;\n\n(f) item 88418 is applicable to a service provided in respect of a particular tooth up to a maximum of twice on a day;\n\n(g) item 88414 is not applicable to a service provided in respect of a tooth on the same day as the service described in item 88421 is relevantly provided in respect of that tooth;\n\n(h) item 88418 is not applicable to a service provided in respect of a tooth on the same day as the service described in item 88419 is relevantly provided in respect of that tooth;\n\n(i) item 88419 is not applicable to a service provided in respect of a tooth on the same day as any of items 88311 to 88326, 88411 to 88417, 88421, 88455, 88458 or 88511 to 88535 is relevantly provided in respect of that tooth;\n\n(j) item 88421:\n\n(i) is applicable to a service once only per primary tooth; and\n\n(ii) is not applicable to a service if the service described in item 88414 is relevantly provided in respect of the same tooth on the same day;\n\n(k) item 88458 may apply to a service provided on the same day as a service described in either item 88415 or 88416 is relevantly provided but no other item in Group U4 of the Dental Benefits Schedule, other than item 88455, will apply to a service until at least three months has elapsed.\n\n","sortOrder":26},{"sectionNumber":"24","sectionType":"section","heading":"Limitation on Restorative Services","content":"24 Limitation on Restorative Services\n\n(a) only one of any of items 88511 to 88535 applies to a service provided in respect of a particular tooth on a day;\n\n(b) item 88575:\n\n(i) only applies to a service provided in respect of a tooth if a service described in one of the items 88511 to 88535 has been relevantly provided in respect of that tooth on the same day; and\n\n(ii) may apply to a service provided in respect of a particular tooth up to a maximum of twice on a day;\n\n(c) item 88597:\n\n(i) only applies to a service provided in respect of a particular tooth if a service described in one of the items 88511 to 88535 has been relevantly provided in respect of that tooth on the same day; and\n\n(ii) may apply to a service provided in respect of a particular tooth up to a maximum of twice on a day.\n\n","sortOrder":27},{"sectionNumber":"24A","sectionType":"section","heading":"Limitation on Denture Bases","content":"24A Limitation on Denture Bases\n\n(a) item 88721 does not apply to a service provided within a 6 month period of a service described in item 88723;\n\n(b) item 88722 does not apply to a service provided within a 6 month period of a service described in item 88724;\n\n(c) item 88723 must not be provided more than once;\n\n(d) item 88724 must not be provided more than once.\n\n","sortOrder":28},{"sectionNumber":"25","sectionType":"section","heading":"Limitation on Prosthodontics","content":"25 Limitation on Prosthodontics\n\n(a) item 88731:\n\n(i) only applies to a service provided in respect of a denture base relevantly provided to the patient under item 88721, 88722, 88723 or 88724; and\n\n(ii) applies to a service a maximum of 4 times in respect of each denture base;\n\n(b) item 88733:\n\n(i) only applies to a service provided in respect of a denture base relevantly provided to the patient under item 88721, 88722, 88723 or 88724; and\n\n(ii) applies to a service a maximum of 4 times in respect of each denture base; and\n\n(iii) applies to the fitting of an anterior tooth only;\n\n(c) item 88736:\n\n(i) only applies to a service provided in respect of a denture base relevantly provided to the patient under item 88721, 88722, 88723 or 88724; and\n\n(ii) applies to a service a maximum of 4 times in respect of each denture base;\n\n(d) item 88741 does not apply to a service provided by a particular dental provider if the service is provided within a 12 month period of a service described in item 88721, 88722, 88723 or 88724being relevantly provided by the same dental provider.\n\n","sortOrder":29},{"sectionNumber":"26","sectionType":"section","heading":"Application of item 88455","content":"26 Application of item 88455\n\n(a) For any particular eligible dental patient, item 88455 does not apply to a service provided in respect of a tooth on a day if a service described in item 88414, 88415, 88416, 88417, 88418 or 88421 is relevantly provided in respect of the same tooth on the day.\n\n(b) For any particular eligible dental patient, item 88455 applies to a service only if a service described in item 88415 or 88416 has been relevantly provided to the patient in the previous three months.\n\n","sortOrder":30},{"sectionNumber":"27","sectionType":"section","heading":"Limitation on items 88521 and 88531","content":"27 Limitation on items 88521 and 88531\n\n(a) For any particular eligible dental patient, any combination of items 88521 and 88531 is applicable to not more than 5 services provided to the patient on a day.\n\n(b) For the maximum of 5 services where it is possible to claim for item 88531 that item should be claimed.\n\n","sortOrder":31},{"sectionNumber":"27A","sectionType":"section","heading":"Limitation on items 88586 and 88587","content":"27A Limitation on items 88586 and 88587\n\nFor any particular eligible dental patient, only one of either item 88586 or 88587 is applicable for a service provided in respect of a particular tooth on a day.\n\n","sortOrder":32},{"sectionNumber":"28","sectionType":"section","heading":"Application of item 88572","content":"28 Application of item 88572\n\nFor any particular eligible dental patient, item 88572 does not apply to a service provided to the patient on a day if a service described in any of items 88411 to 88418 or items 88421 to 88458 is relevantly provided to the patient on the same day.\n\n","sortOrder":33},{"sectionNumber":"29","sectionType":"section","heading":"Application of item 88911","content":"29 Application of item 88911\n\nFor any particular eligible dental patient, item 88911 is not applicable to a service provided to the patient by a dental provider if another service in the Dental Benefits Schedule is relevantly provided to the patient by the same dental provider on the same day.\n\nPart 5—Application, savings and transitional provisions\n\nDivision 1—Amendments made by the Dental Benefits Amendment (Allied Dental Practitioners) Rules 2022\n\n30 Application of amendments\n\nThe amendments made by the Dental Benefits Amendment (Allied Dental Practitioners) Rules 2022 apply in relation to the payment of dental benefits for dental services that are rendered on or after 1 July 2022.\n\n","sortOrder":34},{"sectionNumber":"Sch 1","sectionType":"schedule","heading":"Dental Benefits Schedule","content":"Schedule 1 Dental Benefits Schedule\n\n(rule 5)\n\n```html\n

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)

60.95

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)

50.70

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)

31.80

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)

35.30

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.

71.30

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)

62.30

88114

Removal of calculus – first visit

Removal of calculus from the surfaces of teeth.

(Item is subject to Rules 17 and 20)

103.90

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)

67.50

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)

40.05

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)

53.35

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)

26.70

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)

80.70

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)

61.35

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)

152.05

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)

194.35

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)

95.85

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)

246.80

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)

281.85

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)

379.10

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)

201.90

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)

185.25

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)

221.05

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)

228.10

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)

446.60

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)

112.20

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.

40.35

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)

138.25

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)

88.15

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)

248.05

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)

118.15

88417

Root canal obturation – one canal

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

(Item is subject to Rule 23)

241.60

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)

113.00

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)

159.75

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)

138.25

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)

122.40

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)

163.25

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)

120.70

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)

148.05

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)

176.65

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)

201.35

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)

229.85

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)

133.70

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)

162.30

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)

192.25

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)

222.20

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)

261.10

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)

142.75

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)

179.25

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)

215.50

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)

242.90

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)

280.50

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)

56.45

88574

Metal band

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

47.55

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)

32.45

88579

Bonding of tooth fragment

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

112.20

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)

297.75

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)

176.65

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)

102.10

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)

505.70

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)

505.70

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)

379.25

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)

379.25

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)

51.05

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)

41.90

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)

10.55

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)

60.80

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.

166.95

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.

174.45

88764

Repairing broken base of a partial denture

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

166.95

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.

174.45

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.

166.95

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)

176.65

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.

53.35

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)

79.20

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)

155.25

88943

Sedation ‑ inhalation

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

77.60

\n```\n\n","sortOrder":35},{"sectionNumber":"Sch 2","sectionType":"schedule","heading":"Eligibility of dental services rendered in a State or internal Territory by or on behalf of or under an arrangement with a State or internal Territory","content":"Schedule 2 Eligibility of dental services rendered in a State or internal Territory by or on behalf of or under an arrangement with a State or internal Territory\n\n(rule 8A)\n\n| Column 1State/ internal Territory | Column 2Date service must be provided on or before: |\n| --------------------------------- | --------------------------------------------------- |\n| New South Wales | 31 December 2026 |\n| Victoria | 31 December 2026 |\n| Queensland | 31 December 2026 |\n| Western Australia | 31 December 2026 |\n| South Australia | 31 December 2026 |\n| Tasmania | 31 December 2026 |\n| Australian Capital Territory | 31 December 2026 |\n| Northern Territory | 31 December 2026 |\n\n","sortOrder":36},{"sectionNumber":"Sch 3","sectionType":"schedule","heading":"Benefit limits","content":"Schedule 3 Benefit limits\n\n(rule 14)\n\n| Relevant 2 year period | Cap |\n| ---------------------- | ------- |\n| 2019‑2020 | $1,000 |\n| 2020‑2021 | $1,000 |\n| 2021‑2022 | $1,013 |\n| 2022‑2023 | $1,026 |\n| 2023‑2024 | $1,052 |\n| 2024‑2025 | $1,095 |\n| 2025‑2026 | $1,132 |\n| 2026‑2027 | $ 1,158 |\n\n> Note: Endnotes\n\n> Note: Endnote 1—About the endnotes\n\nThe endnotes provide information about this compilation and the compiled law.\n\nThe following endnotes are included in every compilation:\n\nEndnote 1—About the endnotes\n\nEndnote 2—Abbreviation key\n\nEndnote 3—Legislation history\n\nEndnote 4—Amendment history\n\nAbbreviation key—Endnote 2\n\nThe abbreviation key sets out abbreviations that may be used in the endnotes.\n\nLegislation history and amendment history—Endnotes 3 and 4\n\nAmending laws are annotated in the legislation history and amendment history.\n\nThe legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are not included in this compilation.\n\nThe amendment history in endnote 4 provides information about amendments at the provision (generally section or equivalent) level. It also includes information about any provision of the compiled law that has been repealed in accordance with a provision of the law.\n\nEditorial changes\n\nThe Legislation Act 2003 authorises First Parliamentary Counsel to make editorial and presentational changes to a compiled law in preparing a compilation of the law for registration. The changes must not change the effect of the law. Editorial changes take effect from the compilation registration date.\n\nIf the compilation includes editorial changes, the endnotes include a brief outline of the changes in general terms. Full details of any changes can be obtained from the Office of Parliamentary Counsel.\n\nMisdescribed amendments\n\nA misdescribed amendment is an amendment that does not accurately describe how an amendment is to be made. If, despite the misdescription, the amendment can be given effect as intended, then the misdescribed amendment can be incorporated through an editorial change made under section 15V of the Legislation Act 2003.\n\nIf a misdescribed amendment cannot be given effect as intended, the amendment is not incorporated and “(md not incorp)” is added to the amendment history.\n\n> Note: Endnote 2—Abbreviation key\n\n| ad = added or inserted | orig = original |\n| ---------------------------------------------- | ---------------------------------------- |\n| am = amended | p = page(s) |\n| amdt = amendment | para = paragraph(s)/subparagraph(s) |\n| C[x] = Compilation No. x | /sub‑subparagraph(s) |\n| ch = Chapter(s) | pres = present |\n| cl = clause(s) | prev = previous |\n| cont. = continued | (prev…) = previously |\n| def = definition(s) | pt = Part(s) |\n| Dict = Dictionary | r = regulation(s)/Court rule(s) |\n| disallowed = disallowed by Parliament | reloc = relocated |\n| div = Division(s) | renum = renumbered |\n| ed = editorial change | rep = repealed |\n| exp = expires/expired or ceases/ceased to have | rs = repealed and substituted |\n| effect | s = section(s)/subsection(s) |\n| gaz = gazette | /rule(s)/subrule(s)/order(s)/suborder(s) |\n| LA = Legislation Act 2003 | sch = Schedule(s) |\n| LIA = Legislative Instruments Act 2003 | SLI = Select Legislative Instrument |\n| (md) = misdescribed amendment can be given | SR = Statutory Rules |\n| effect | sub ch = Sub‑Chapter(s) |\n| (md not incorp) = misdescribed amendment | sub div = Subdivision(s) |\n| cannot be given effect | sub pt = Subpart(s) |\n| mod = modified/modification | underlining = whole or part not |\n| No. = Number(s) | commenced or to be commenced |\n| Ord = Ordinance | |\n\n> Note: Endnote 3—Legislation history\n\n| Name | Registration | Commencement | Application, saving and transitional provisions |\n| ------------------------------------------------------------------ | ------------------------------ | -------------------------------------------------------------------------------------------- | ----------------------------------------------- |\n| Dental Benefits Rules 2014 | 18 December 2014 (F2014L01748) | 1 January 2015 | |\n| Dental Benefits Amendment Rules 2015 | 18 June 2015 (F2015L00845) | 1 July 2015 | — |\n| Dental Benefits Amendment Rules 2016 | 19 May 2016 (F2016L00813) | 1 July 2016 | — |\n| Dental Benefits Amendment Rule 2016 (No. 2) | 19 December 2016 (F2016L01986) | 1 January 2017Note: sch 1 (item 2) was disallowed by the Senate on 8 February 2017 at 18:18. | — |\n| Dental Benefits Amendment Rule 2017 (No. 1) | 8 February 2017 (F2017L00105) | 1 January 2017 | — |\n| Dental Benefits Amendment Rule 2017 (No.2) | 1 January 2017 (F2017L01502) | 1 January 2018 | — |\n| Dental Benefits Amendment Rule (No.1) 2019 | 3 April 2019(F2019L00517) | 3 April 2019 | — |\n| Dental Benefits Amendment Rules (No. 1) 2020 | 25 November 2020 (F2020L01480) | 1 January 2021 | — |\n| Dental Benefits Amendment Rules (No. 1) 2021 | 28 July 2021 (F2021L01035) | 1 January 2022 | — |\n| Dental Benefits Amendment (Allied Dental Practitioners) Rules 2022 | 15 June 2022 (F2022L00773) | 1 July 2022 | — |\n| Dental Benefits Amendment Rules (No. 1) 2022 | 12 December 2022 (F2022L01625) | 1 January 2023 | — |\n| Dental Benefits Amendment Rules (No. 2) 2022 | 16 December 2022 (F2022L01671) | 1 January 2023 | — |\n| Dental Benefits Amendment Rules 2023 | 15 December 2023 (F2023L01676) | 1 January 2024 | — |\n| Dental Benefits Amendment Rules (No. 1) 2024 | 5 December 2024 (F2024L01576) | 1 January 2025 | — |\n| Dental Benefits Amendment Rules (No. 1) 2025 | 20 January 2025 (F2025L00025) | 1 January 2025 | — |\n| Dental Benefits Amendment Rules (No.2) 2025 | 8 October 2025 (F2025L01238) | 1 January 2026 | — |\n\n> Note: Endnote 4—Amendment history\n\n| Provision affected | How affected |\n| ------------------------- | ----------------------------------------------------------------------------------------------- |\n| Part 1 | |\n| Part 1 heading........... | ad F2022L00773 |\n| r 2................... | rep LA s 48D |\n| r 3................... | rep LA s 48C |\n| r 4................... | rs F2019L00517 |\n| | am F2022L00773 |\n| r 6................... | rs F2022L00773 |\n| r 7................... | rs F2022L00773 |\n| Part 2 | |\n| Part 2 heading........... | ad F2022L00773 |\n| r 8AA................ | ad F2022L00773 |\n| r 8A................. | am F2016L00813 |\n| Part 3 | |\n| Part 3 heading........... | ad F2022L00773 |\n| Part 4 | |\n| Part 4 heading........... | ad F2022L00773 |\n| Note 2 to r 15........... | am F2016L00813 |\n| r 17.................. | rs F2017L01502 |\n| r 18.................. | rs F2017L01502 |\n| r 19.................. | am F2017L01502 |\n| r 24A................. | ad F2017L01502 |\n| r 25.................. | am F2017L01502 |\n| r 27A................. | ad F2017L01502 |\n| Part 5 | |\n| Part 5................ | ad F2022L00773 |\n| Division 1 | |\n| r 30.................. | ad F2022L00773 |\n| Schedule 1 | |\n| Schedule 1............. | am F2017L01502 |\n| | rs F2020L01480; F2021L01035; F2022L01625; F2023L01676; F2024L01576 |\n| | am F2025L01238 |\n| Schedule 2 | |\n| Schedule 2............. | rs F2015L00845, F2016L00813, F2016L01986, F2019L00517; F2022L01671 |\n| Schedule 3 | |\n| Schedule 3............. | am F2016L01986 (disallowed) |\n| | rs F2017L00105; F2020L01480; F2021L01035; F2022L01625; F2023L01676; F2024L01576 (md not incorp) |\n| | am F2025L00025; F2025L01238 |","sortOrder":37}],"analysis":{"flash_summary":{"complexity_score":7,"scope_assessment":{"changed":true,"description":"The Rules as compiled include a number of amendments and additions since the original instrument that change operational scope. Concretely: (1) the set of recognised dental providers has been expanded and clarified to list dental hygienists, dental therapists and oral health therapists as classes of dental providers and to specify who may render services on behalf of registered dentists or public sector dental providers (rules 4, 6, 7). (2) Item‑level restrictions were added that require some services to be rendered by a registered dentist to attract benefit (rule 8AA). (3) The Rules incorporate allied dental practitioner amendments and make those amendments applicable to services rendered on or after 1 July 2022 (rule 30). (4) The Rules set and update monetary caps for successive relevant 2‑year periods up to 2026‑2027 (rule 14; Schedule 3). (5) Schedule 2 lists State/internal Territory dates (extended to 31 December 2026) limiting eligibility for State‑rendered services unless the Minister directs otherwise (rule 8A; Schedule 2). (6) Administrative implementation detail is formalised by reference to Department forms and Ministerial guidelines (rule 15(4)–(7)), giving the Department and Minister practical control over some procedural requirements without further changes to the Rules themselves. These changes are shown in the text and in the compilation’s amendment history (rule 30; rule 15; Schedule 3; Schedule 2; Endnotes)."},"complexity_factors":["Large, itemised Dental Benefits Schedule with many services and dollar amounts (Schedule 1) requiring precise mapping between clinical acts and item numbers (rule 5; Schedule 1).","Extensive cross‑referencing between rules and schedule items (rules 8, 8AA, 14–29), producing many conditional interactions that must be checked for each claim.","Multiple external references to other legislation and programmes (Social Security Act definitions, ABSTUDY, VCES, MRCAETS) that affect eligibility (rule 4 definitions; rule 9).","Two‑year rolling relevant period mechanism for caps with per‑period caps that change over time (rule 14; Schedule 3).","Administrative discretion and incorporation of external Department forms and Ministerial guidelines (rule 15(4)–(7) and notes), creating runtime implementation complexity.","Detailed documentation and record‑keeping requirements (rule 8; rule 16) that impose evidentiary and operational burdens on providers.","Specific provider‑type restrictions on particular items (rule 8AA) and addition of allied dental practitioners via amendments (rule 30) which alter provider eligibility rules over time."],"plain_english_summary":"## What these Rules do, mechanically\n\n- They set out the list of dental services for which a dental benefit can be paid (the Dental Benefits Schedule) and the dollar amount for each listed service (Schedule 1) (rule 5; Schedule 1). \n- They define which classes of practitioners and providers can supply those services and which persons may render services on behalf of others (registered dentists, dental hygienists, dental therapists, dental prosthetists, oral health therapists and public sector dental providers) (rules 4, 6, 7). \n- They set administrative conditions for payment: what must be recorded on accounts and assignment forms (rule 8), requirements for informed financial consent and specified patient consent forms (rule 15), and required clinical record‑keeping (four years) (rule 16). \n- They impose limits on how often particular items may be claimed, item‑specific interaction rules (for example, which items may not be claimed together or which are tooth‑specific), and caps on the total benefit payable to an eligible dental patient in a two‑year period (rules 17–29; rule 14; Schedule 3). \n- They set the rules for the dental benefits voucher system (who satisfies the means test, who receives a voucher, when multiple or replacement vouchers may be issued, and when vouchers need not be issued) (rules 9–13). \n- They limit eligibility for services rendered by or under arrangements with States or internal Territories by reference to the States listed and dates in Schedule 2, while allowing the Minister to make directions in particular cases (rule 8A; Schedule 2). \n- They record that amendments expanding allied dental practitioners take effect for services rendered on or after 1 July 2022 (rule 30).\n\n## Who is affected\n\n- Eligible dental patients who qualify under the Dental Benefits Act 2008 and these Rules (rules 9, 11, 13). \n- Dental providers and persons who render services on their behalf: registered dentists, dental hygienists, dental therapists, dental prosthetists, oral health therapists and public sector dental providers (rules 4, 6, 7). \n- Administrators of the scheme: the Chief Executive Medicare (who may issue vouchers and allocate provider numbers) and the Minister (who can direct eligibility in some State cases and whose guidelines determine extenuating circumstances) (rules 6(2), 10–11, 8A(2), 15(7)).\n\n## Why it matters (stated purpose and how that maps to costs, incentives and implementation)\n\n- Stated function: these Rules implement the payment mechanics under the Dental Benefits Act 2008 by specifying which services attract benefits, at what rates, and on what conditions (rule 2A; rule 5). \n\n- Who pays and who claims: the Rules operate the dental benefit payment process under the Act. Providers must meet the documentation, consent and provider‑eligibility conditions in order to receive payment for items claimed (rules 6, 8, 15, 16). The Chief Executive Medicare controls voucher issue and provider numbers (rules 10–11; rule 6(2)). \n\n- Costs and caps: the Rules constrain total benefits payable to an eligible dental patient by setting a monetary cap for each 2‑year relevant period (rule 14; Schedule 3). That cap limits aggregate scheme outlays per patient over the relevant period. \n\n- Administrative discretion and implementation risk: the Rules incorporate external Department forms and Ministerial guidelines (rule 15(4)–(7) and notes). That allows the Department and Minister to change implementation details without amending the Rules themselves, concentrating operational discretion in the administration (rule 15(7) and accompanying notes). The Minister also has a power to direct eligibility for State‑rendered services in specified cases (rule 8A(2)). \n\n- Compliance burden on providers: providers must (a) hold an allocated provider number to be a dental provider (rule 6(2)); (b) record specific account particulars for billed and bulk‑billed services (rule 8); (c) obtain and record informed financial consent and relevant patient signatures using Department forms (rule 15); and (d) retain clinical records and tooth identifiers for four years (rule 16). Those obligations create record‑keeping, consent‑form and procedural compliance tasks before benefits are payable. \n\n- Behavioural incentives and limits: the Rules limit the frequency and combinations of specific items (rules 17–29). These constraints change the set of services that providers can legitimately claim for the same patient and day, and can affect treatment sequencing and administrative decisions about whether to claim an item or use an alternative item that is payable. \n\n- Eligibility interactions with other laws and payments: means‑test and voucher rules cross‑reference Social Security and other legislation (rule 4 definitions; rule 9). That ties eligibility and voucher issuance to existing social security payment statuses. \n\n- Concentration of effects: the Rules concentrate benefits on persons who meet the eligibility and means tests (rules 9, 13) and concentrate administrative decision‑making with Medicare and the Minister (rules 6(2), 10–11, 8A(2), 15(7)). The Rules also create clearly delimited limits (item and cap limits) that can produce substitution between claimable items where an item is excluded by an interaction rule (rules 17–29).\n\n## Key citations (mechanical map)\n- Dental Benefits Schedule (list and dollar benefits): rule 5; Schedule 1.\n- Who counts as dental provider and who may render on behalf of others: rules 4, 6, 7.\n- Account and bulk‑billing particulars required: rule 8.\n- Item‑by‑item provider‑type restrictions (which items require a registered dentist): rule 8AA.\n- State/internal Territory eligibility and Ministerial direction: rule 8A; Schedule 2.\n- Voucher means test and issue rules: rules 9–13; Chief Executive Medicare roles: rules 10–11.\n- Caps and two‑year relevant periods: rule 14; Schedule 3.\n- Informed financial consent, Department forms, extenuating circumstances and Ministerial guidelines: rule 15(1)–(7) and notes.\n- Clinical record retention: rule 16.\n- Item frequency, tooth‑specific and interaction limits: rules 17–29.\n- Application of allied dental practitioner amendments: rule 30.\n\nThis summary describes what the Rules do and how they operate mechanically, followed by the concrete implementation and incentive consequences traceable to the textual provisions cited above."},"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-realtime","completionTokens":2845},"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":true,"description":"The scope has expanded significantly since 2014. The 2022 amendments (Allied Dental Practitioners) broadened eligible providers beyond dentists to include dental hygienists, therapists, and oral health therapists. Additionally, Schedule 2 has been repeatedly extended (now to 31 December 2026) to maintain eligibility for state/territory public dental services, and monetary caps in Schedule 3 have increased incrementally from the original $1,000 base."},"complexity_factors":["24 defined terms importing definitions from four other Acts (Dental Benefits Act 2008, Social Security Act 1991, National Health Act 1953, Health Insurance Regulations 2018)","Detailed Dental Benefits Schedule with 60+ service items organized into 7 clinical groups and 9 subgroups","29 operational rules including 13 complex limitation rules (Rules 17-29) governing service combinations, frequencies, and exclusions","Rolling 2-year monetary cap calculation with trigger dates and fallback provisions (Rule 14)","Provider eligibility matrix restricting specific item numbers to specific practitioner types (Rule 8AA)","State and Territory specific eligibility cut-off dates in Schedule 2 requiring cross-referencing"],"plain_english_summary":"**What this is:** These Rules operate the Child Dental Benefits Schedule (CDBS) — a federal program that helps cover dental costs for eligible children aged 2 to 17.\n\n**Who qualifies:** Children in families receiving certain income support payments, including Family Tax Benefit Part A, Disability Support Pension, Parenting Payment, or benefits under the Veterans’ Children Education Scheme. Eligibility is determined through a \"means test\" based on these payments.\n\n**How it works:**\n- **Benefit Cap:** The government pays benefits for dental services up to a monetary limit (cap) over a rolling 2‑year period. For 2026‑2027, the cap is $1,158 per child. Once the cap is reached, no more benefits are paid until a new 2‑year period begins.\n- **Vouchers:** Eligible children are issued annual vouchers that entitle them to benefits. Vouchers go to the child, parent, guardian, or institution depending on who receives the government payment.\n- **Services Covered:** Schedule 1 lists specific services (exams, X‑rays, fillings, extractions, root canals, dentures, etc.) with set benefit amounts ranging from roughly $30 to $500.\n- **Who can treat:** Registered dentists, dental hygienists, dental therapists, oral health therapists, and dental prosthetists — though some services can only be performed by specific provider types (for example, complex surgical extractions must be done by dentists).\n- **Payment:** Benefits can be assigned directly to the dental provider (bulk billing) or paid to the family.\n\n**Key restrictions:**\n- Services have strict frequency limits (for example, only one comprehensive oral exam every 24 months, and some services limited to once per day or per tooth).\n- Certain services cannot be claimed together on the same day for the same tooth.\n- Public dental services arranged by States or Territories are only eligible until 31 December 2026 (unless the Minister directs otherwise).\n- Dental providers must obtain informed financial consent (explaining costs before treatment) and keep clinical records for four years."}},"importantCases":[],"_links":{"self":"/api/acts/dental-benefits-rules-2014","history":"/api/acts/dental-benefits-rules-2014/history","analysis":"/api/acts/dental-benefits-rules-2014/analysis","conflicts":"/api/acts/dental-benefits-rules-2014/conflicts","importantCases":"/api/acts/dental-benefits-rules-2014/important-cases","documents":"/api/acts/dental-benefits-rules-2014/documents"}}