{"id":"F2026L00110","name":"Dental Benefits Rules 2026","slug":"dental-benefits-rules-2026","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"in_force","isInForce":true,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":443137,"registerId":"F2026L00110-fast-fetch-1775958054392","compilationNumber":null,"startDate":"2026-04-12","status":"InForce","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"1","sectionType":"section","heading":"Dental Benefits Rules 2026","content":"---\nmeta-content-style-type: text/css\nmeta-content-type: application/xhtml+xml; charset=utf-8\n---\n\n\n\n \n\nDental Benefits Rules 2026\n\nI, Mark Roddam, as delegate of the Minister for Health and Ageing, make the following rules.\n\nDated 16 February 2026\n\nMark Roddam\n\nFirst Assistant Secretary, Department of Health, Disability and Ageing\n\n \n\n \n\n \n\n \n\nContents\n\nPart 1—Preliminary\n\n1 Name\n\n2 Commencement\n\n3 Authority\n\n4 Schedules\n\n5 Definitions\n\n6 Meaning of eligible dental patient\n\n7 Meaning of dental provider\n\n8 Meaning of rendered on behalf of a dental provider\n\nPart 2—When dental benefit is not payable\n\nDivision 1—Dental benefit not payable unless certain conditions satisfied\n\n9 Particulars that must be recorded on accounts etc.\n\n10 Conditions that must be satisfied—certain dental services rendered by kinds of dental providers\n\n11 Condition that must be satisfied—consent to be provided and recorded\n\n12 Condition that must be satisfied—dental services rendered by States and Territories\n\nDivision 2—Dental benefit not payable in certain circumstances\n\n13 Dental benefit not payable if no medicare number\n\n14 Dental benefit not payable if certain personal information not provided\n\n15 Dental benefit not payable if cap reached\n\n16 Dental benefit not payable for certain additional dental services\n\n17 Dental benefit not payable for certain additional dental services rendered by same dental practitioner\n\n18 Dental benefit not payable for certain diagnostic services\n\n19 Dental benefit not payable for certain preventive services\n\n20 Dental benefit not payable for certain periodontic services\n\n21 Dental benefit not payable for certain oral surgery\n\n22 Dental benefit not payable for certain endodontic services\n\n23 Dental benefit not payable for certain restorative services\n\n24 Dental benefit not payable for certain prosthodontic services\n\n25 Dental benefit not payable for certain other prosthodontic services\n\n26 Dental benefit not payable for a certain general service\n\nPart 3—Dental Benefits Schedule\n\n27 Dental Benefits Schedule\n\nPart 4—Application, saving and transitional provisions\n\nDivision 1—Dental Benefits Rules 2026\n\n28 Definitions\n\n29 Application—dental service provided on or after commencement\n\n30 Transitional—dental benefit 2 year cap\n\n31 Something done under the old rules\n\nSchedule 1—Dental Benefits Schedule\n\nDivision 1—Group U0: Diagnostic services\n\n1 Items in Subgroup 1 of Group U0\n\n2 Items in Subgroup 2 of Group U0\n\nDivision 2—Group U1: Preventive services\n\n3 Items in Subgroup 1 of Group U1\n\n4 Item in Subgroup 2 of Group U1\n\n5 Items in Subgroup 3 of Group U1\n\nDivision 3—Group U2: Periodontic services\n\n6 Items in Group U2\n\nDivision 4—Group U3: Oral surgery\n\n7 Items in Subgroup 1 of Group U3\n\n8 Items in Subgroup 2 of Group U3\n\n9 Item in Subgroup 5 of Group U3\n\n10 Items in Subgroup 8 of Group U3\n\nDivision 5—Group U4: Endodontic services\n\n11 Items in Subgroup 1 of Group U4\n\n12 Items in Subgroup 4 of Group U4\n\nDivision 6—Group U5: Restorative Services\n\n13 Items in Subgroup 1 of Group U5\n\n14 Items in Subgroup 2 of Group U5\n\n15 Items in Subgroup 3 of Group U5\n\n16 Items in Subgroup 7 of Group U5\n\nDivision 7—Group U7: Prosthodontics\n\n17 Items in Subgroup 1 of Group U7\n\n18 Item in Subgroup 4 of Group U7\n\n19 Items in Subgroup 6 of Group U7\n\n20 Item in Subgroup 7 of Group U7\n\nDivision 8—Group U9: General services\n\n21 Item in Subgroup 1 of Group U9\n\n22 Items in Subgroup 4 of Group U9\n\nSchedule 2—Dental cap\n\n1 Dental cap\n\nSchedule 3—Repeals\n\nDental Benefits Rules 2014\n\n \n\nPart 1—Preliminary\n\n \n\n1 Name\n\n This instrument is the Dental Benefits Rules 2026.\n\n2 Commencement\n\n (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.\n\n \n\n- Commencement information\n- Column 1 Column 2 Column 3\n- Provisions Commencement Date/Details\n- 1. The whole of this instrument The day after this instrument is registered. 19 February 2026\n\n\nNote: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument.\n\n (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.\n\n3 Authority\n\n This instrument is made under the Dental Benefits Act 2008.\n\n4 Schedules\n\n Each instrument that is specified in Schedule 3 to this instrument is amended or repealed as set out in the applicable items in that Schedule, and any other item in that Schedule has effect according to its terms.\n\n5 Definitions\n\nNote: A number of expressions used in this instrument are defined in the Act, including the following:\n\n(a) ABSTUDY scheme;\n\n(b) dental practitioner;\n\n(c) dental provider;\n\n(d) FTB(A) person;\n\n(e) Human Services Department;\n\n(f) item;\n\n(g) medicare number;\n\n(h) youth allowance.\n\n In this instrument:\n\nAct means the Dental Benefits Act 2008.\n\ncarer payment has the same meaning as in the Social Security Act 1991.\n\ndental cap: see Schedule 2.\n\ndental 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\ndental 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\ndental 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\nDepartment of Veterans’ Affairs means the Department of State that is administered by the Minister administering the Military Rehabilitation and Compensation Act 2004.\n\ndisability support pension has the same meaning as in the Social Security Act 1991.\n\ndouble orphan pension has the same meaning as in the Social Security Act 1991.\n\nmember of a couple has the same meaning as in the Social Security Act 1991.\n\nMRCAETS (short for Military Rehabilitation and Compensation Act Education and Training Scheme) means the scheme determined under section 258 of the Military Rehabilitation and Compensation Act 2004 and approved by the Minister administering that Act, as in force from time to time.\n\noral 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\nparenting payment has the same meaning as in the Social Security Act 1991.\n\npartner, in relation to a person who is a member of a couple, means the other member of the couple.\n\nprovider number has the same meaning as in the Health Insurance Regulations 2018.\n\npublic 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) a 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 a Territory; or\n\n (b) a dental provider on whose behalf another dental provider provides dental services under an arrangement with a person or body covered by subparagraph (a)(i), (ii), (iii), (iv) or (v).\n\nreceive:\n\n (a) in relation to a payment under the ABSTUDY scheme—has the same meaning as in subsection 24(4) of the Act; and\n\n (b) in relation to the following payments—has the same meaning as in section 23 of the Social Security Act 1991:\n\n (a) carer payment;\n\n (b) disability support pension;\n\n (c) double orphan pension;\n\n (d) parenting payment;\n\n (e) special benefit;\n\n (f) youth allowance; and\n\n (c) in relation to VCES and MRCAETS—has its ordinary meaning.\n\nregistered dentist means a dental practitioner who has general registration, or specialist registration, in the dentists division of the dental profession under a law of a State or Territory.\n\nspecial benefit has the same meaning as in the Social Security Act 1991.\n\nVCES (short for Veterans’ Children Education Scheme) means the scheme determined under subsection 117(1) of the Veterans’ Entitlements Act 1986 and approved by the Minister administering that Act, as in force from time to time.\n\n6 Meaning of eligible dental patient\n\n For the purposes of paragraph 5(1)(b) of the Act, the following classes of eligible persons are eligible dental patients in relation to a dental service:\n\n (a) eligible persons who, at any time in the calendar year in which the dental service is rendered, are aged under 18 years and receive any of the following payments:\n\n (i) carer payment;\n\n (ii) disability support pension;\n\n (iii) parenting payment;\n\n (iv) special benefit;\n\n (v) youth allowance;\n\n (b) eligible persons who, at any time in the calendar year in which the dental service is rendered, are aged under 18 years and either:\n\n (i) who receive a payment under the ABSTUDY scheme; or\n\n (ii) in respect of whom another person receives a payment under the ABSTUDY scheme;\n\n (c) eligible persons who, at any time in the calendar year in which the dental service is rendered, are aged under 18 years and are an FTB(A) person;\n\n (d) eligible persons who, at any time in the calendar year in which the dental service is rendered, are aged 16 or 17 years and either:\n\n (i) who receive a payment under VCES or MRCAETS; or\n\n (ii) in respect of whom another person receives a payment under VCES or MRCAETS;\n\n (e) eligible persons who, at any time in the calendar year in which the dental service is rendered, are aged under 18 years and whose parent, guardian or carer receive either of the following payments in respect of the person:\n\n (i) double orphan pension;\n\n (ii) parenting payment;\n\n (f) eligible persons who, at any time in the calendar year in which the dental service is rendered, are aged under 18 years and whose partner receives parenting payment.\n\n7 Meaning of dental provider\n\n (1) For the purposes of paragraph 6(1)(b) of the Act, the following classes of persons are dental providers in relation to a dental service:\n\n (a) dental hygienists;\n\n (b) dental therapists;\n\n (c) oral health therapists.\n\n (2) For the purposes of paragraph 6(2)(a) of the Act, the class of dental practitioners that are not dental providers in relation to a dental service are dental practitioners who have not been allocated a provider number in respect of the place of practice at which the service is rendered.\n\n8 Meaning of rendered on behalf of a dental provider\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\nPart 2—When dental benefit is not payable\n\nDivision 1—Dental benefit not payable unless certain conditions satisfied\n\n9 Particulars that must be recorded on accounts etc.\n\n (1) For the purposes of subsection 17(2) of the Act, the particulars that must be recorded on an account or receipt for fees, or on a form of an assignment, in respect of a dental service, are the following:\n\n (a) the name of the eligible dental patient in respect of whom the dental service was rendered;\n\n (b) the date on which the dental service was rendered;\n\n (c) the item that corresponds to the dental service;\n\n (d) the name of the dental provider by whom, or on whose behalf, the dental service is rendered;\n\n (e) the dental provider’s provider number in respect of the place of practice at which the dental service was rendered;\n\n (f) for:\n\n (i) an account or receipt for fees—the amount charged by the dental provider for the dental service, and the amount paid or outstanding (if any); or\n\n (ii) a form of an assignment—the amount of dental benefit assigned to the dental provider.\n\n (2) The particulars in subsection (1) are specified in relation to dental services generally.\n\n10 Conditions that must be satisfied—certain dental services rendered by kinds of dental providers\n\n For the purposes of subsection 18(1) of the Act, dental benefit is not payable in respect of a dental service specified in an item listed column 1 in an item in the following table unless the dental service is rendered by or on behalf of a dental provider specified in column 2 of the item.\n\n \n\n| Item | Column 1
A dental service specified in one of the following items… | Column 2
must be rendered by or on behalf of… |\n| --- | --- | --- |\n| 1 | 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
88943 | a registered dentist. |\n| 2 | 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
88587 | (a) a registered dentist; or
(b) a dental therapist; or
(c) an oral health therapist. |\n\n\n \n\n11 Condition that must be satisfied—consent to be provided and recorded\n\n (1) For the purposes of subsection 18(1) of the Act, dental benefit is not payable in respect of a dental service unless:\n\n (a) the person incurring the dental expenses in respect of the service:\n\n (i) makes an assignment of the dental benefit in accordance with section 12 of the Act; and\n\n (ii) has signed an approved form known as the Child Dental Benefits Schedule Bulk Billing Patient Consent Form in the calendar year in which the service is rendered; or\n\n (b) the person incurring the dental expenses in respect of the service signs an approved form known as the Child Dental Benefits Schedule Non‑Bulk Billing Patient Consent Form on the day the service is rendered; or\n\n (c) the dental provider by whom, or on whose behalf, the service is rendered:\n\n (i) obtains and records consent to render the service from the eligible dental patient or the patient’s parent or guardian before the service is rendered; and\n\n (ii) informs the person incurring the dental expenses in respect of the service of the amount of dental benefit likely payable for the service and any likely out‑of‑pocket costs before rendering the service; and\n\n (iii) obtains and records the consent of the person mentioned in paragraph (ii) to render the service; and\n\n (iv) obtains a signature from the person or persons providing the consents specified in subparagraph (i) and (iii) on the day the service is rendered.\n\nNote: The approved forms known as the Child Dental Benefits Schedule Bulk Billing Patient Consent Form and the Child Dental Benefits Schedule Non‑Bulk Billing Patient Consent Form could, on 1 April 2025, be viewed on the Department’s website (www.health.gov.au).\n\nException—dental services provided in an emergency\n\n (2) Subsection (1) does not apply if:\n\n (a) the dental provider, or person on behalf of the dental provider, renders the dental service on an emergency basis outside the provider’s usual hours of practice or in a different location to the provider’s usual location of practice; and\n\n (b) either:\n\n (i) the person incurring the dental expenses in respect of the service did not sign a form mentioned in paragraph (1)(a) or (b) on the day the service is rendered; or\n\n (ii) the dental provider is unable to record the consents or obtain the signature or signatures mentioned in paragraph (1)(c) on the day the service is rendered; and\n\n (c) the person signs one of the forms, or the dental provider records the consents or obtains the signature or signatures (as the case requires), as soon as is reasonably practicable after the day the service is rendered.\n\nException—other exceptional circumstances\n\n (3) Subsection (1) does not apply if:\n\n (a) the dental provider is unaware that the eligible dental patient is an eligible dental patient at the time the dental service is rendered; or\n\n (b) the dental provider obtains and records the consents mentioned in subparagraph (1)(c)(i) and (iii) but a person providing a consent:\n\n (i) refuses to provide the provider with the person’s signature; or\n\n (ii) is incapacitated or dies before the person is able to provide the provider with their signature; or\n\n (c) for the purposes of paragraph (1)(a), (b) or (c), a person purports to be a person incurring dental expenses or to be a parent or guardian of an eligible dental patient, but the person is not such a person and the provider is unaware of this fact; or\n\n (d) a requirement set out in subparagraph (1)(c)(i), (iii) or (iv) is not met due to an administrative error by the dental provider or a person working with the provider, where the error occurs outside the provider or person’s (as the case requires) standard operating procedures.\n\n12 Condition that must be satisfied—dental services rendered by States and Territories\n\n For the purposes of subsection 18(1) of the Act, dental benefit is not payable in respect of a dental service rendered to an eligible dental patient by, on behalf of or under an arrangement with a State or Territory unless:\n\n (a) the service is rendered before 1 January 2027; or\n\n (b) the Minister directs that this section does not apply to the arrangement.\n\nDivision 2—Dental benefit not payable in certain circumstances\n\n13 Dental benefit not payable if no medicare number\n\n For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of a dental service rendered to an eligible dental patient if, at the time the service is rendered, the patient has not been assigned a medicare number.\n\n14 Dental benefit not payable if certain personal information not provided\n\n For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of a dental service rendered to an eligible dental patient if:\n\n (a) the patient is an eligible dental patient because they are covered by paragraph 6(d) of this instrument; and\n\n (b) the patient, or the person who receives a payment under VCES or MRCAETS in respect of the patient (as the case requires), has not consented to the Department of Veterans’ Affairs providing personal information (within the meaning of the Privacy Act 1988) about the patient to the Human Services Department.\n\n15 Dental benefit not payable if cap reached\n\n (1) For the purposes of subsection 21(1) of the Act, dental benefit, or an amount of dental benefit, is not payable in respect of a dental service if the payment of the benefit or amount would result in the total amount of dental benefit paid:\n\n (a) in respect of the eligible dental patient to whom the service is rendered; and\n\n (b) in a 2 year period specified in subsection (2);\n\nexceeding the dental cap specified in Schedule 2 to this instrument for the 2 year period.\n\n (2) The 2 year periods specified in this subsection are the following periods:\n\n (a) a 2 year period beginning on 1 January of the year in which dental benefit is first payable in respect of the patient;\n\n (b) any 2 year period beginning on 1 January of the year in which dental benefit is first payable in respect of the patient after the expiry of a previous 2 year period (including a 2 year period under this paragraph).\n\n16 Dental benefit not payable for certain additional dental services\n\n (1) For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of a dental service:\n\n (a) specified in an item listed in column 1 of an item in the following table; and\n\n (b) rendered to an eligible dental patient on a day;\n\nif dental benefit is or was payable in respect of the same service previously rendered to the patient on the number of occasions specified in column 2 of the item, at any time in the period specified in column 3 of the item.\n\n \n\n| Item | Column 1
Dental service specified in the following items | Column 2
Number of occasions dental service previously rendered | Column 3
Period |\n| --- | --- | --- | --- |\n| 1 | 88311
88314
88322
88323
88324 | 1 | The day the service is rendered |\n| 2 | 88111
88114
88121 | 1 | 5 months ending on the day the service is rendered |\n| 3 | 88942 | 1 | 12 months ending on the day the service is rendered |\n| 4 | 88221
88721
88722 | 1 | 24 months ending on the day the service is rendered |\n| 5 | 88115
88213 | 2 | 12 months ending on the day the service is rendered |\n| 6 | 88013
88572 | 3 | 3 months ending on the day the service is rendered |\n| 7 | 88458 | 3 | 12 months ending on the day the service is rendered |\n| 8 | 88022
88161
88575 | 4 | The day the service is rendered |\n| 9 | 88768 | 8 | 24 months ending on the day the service is rendered |\n\n\n (2) Further, dental benefit is not payable in respect of a dental service specified in item 88111, 88114 or 88121 and rendered to an eligible dental patient on a day if dental benefit is or was payable in respect of the same service previously rendered to the patient twice in the same calendar year in which the day falls.\n\n17 Dental benefit not payable for certain additional dental services rendered by same dental practitioner\n\n (1) For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of a dental service:\n\n (a) specified in an item listed in column 1 of an item in the following table; and\n\n (b) rendered to an eligible dental patient by, or on behalf of, a dental provider on a day;\n\nif dental benefit is or was payable in respect of the same service previously rendered to the patient by, or on behalf of, the same provider at any time in the period listed in column 2 of the item.\n\n \n\n| Item | Column 1
Dental service specified in the following items | Column 2
Period |\n| --- | --- | --- |\n| 1 | 88012 | 5 months ending on the day the service is rendered |\n| 2 | 88011 | 24 months ending on the day the service is rendered |\n\n\n (2) Further, dental benefit is not payable in respect of a dental service specified in item 88012 and rendered to an eligible dental patient by, or on behalf of, a dental provider on a day if dental benefit is or was payable in respect of the same service previously rendered to the patient by, or on behalf of, the same provider twice in the same calendar year in which the day falls.\n\n18 Dental benefit not payable for certain diagnostic services\n\n (1) For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of a dental service specified in an item in Subgroup 1 of Group U0 of the Dental Benefits Schedule and rendered to an eligible dental patient on a day if:\n\n (a) dental benefit is payable in respect of the same service rendered to the patient on the same day; or\n\n (b) dental benefit is payable in respect of a different dental service specified in another item in Subgroup 1 of Group U0 and rendered to the patient on the same day.\n\n (2) For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of a dental service specified in item 88012 and rendered to an eligible dental patient by, or on behalf of, a dental provider on a day if dental benefit is or was payable in respect of a dental service specified in item 88011 and previously rendered to the patient by, or on behalf of, the same provider less than 5 months before the day.\n\n19 Dental benefit not payable for certain preventive services\n\n (1) For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of a dental service specified in an item in Subgroup 1 of Group U1 of the Dental Benefits Schedule and rendered to an eligible dental patient on a day if dental benefit is payable in respect of a different dental service specified in another item in Subgroup 1 of Group U1 and rendered to the patient on the same day.\n\n (2) For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of a dental service specified in an item in Subgroup 3 of Group U1 of the Dental Benefits Schedule and rendered on a tooth on a day if dental benefit is payable in respect of another dental service specified in an item in Subgroup 1, 2 or 3 of Group U5 and rendered on the same tooth on the same day.\n\n20 Dental benefit not payable for certain periodontic services\n\n For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of a dental service specified in item 88213 and rendered on a tooth on a day if dental benefit is payable in respect of a dental service specified in item 88415 and rendered on the same tooth on the same day.\n\n21 Dental benefit not payable for certain oral surgery\n\n For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of the following dental services:\n\n (a) a service specified in item 88311 and rendered to an eligible dental patient on a day if dental benefit is payable in respect of a dental service specified in item 88314 and rendered to the patient on the same day;\n\n (b) a service specified in item 88322 and rendered to an eligible dental patient on a day if dental benefit is payable in respect of a dental service specified in item 88323 or 88324 and rendered to the patient on the same day;\n\n (c) a service specified in item 88323 and rendered to an eligible dental patient on a day if dental benefit is payable in respect of a dental service specified in item 88324 and rendered to the patient on the same day;\n\n (d) a service specified in item 88324 if the service is rendered on a tooth that is not a multi‑rooted tooth;\n\n (e) a service specified in an item in Subgroup 1 or 2 of Group U3 and rendered on a tooth on a day if dental benefit is payable in respect of another dental service also specified in an item in Subgroup 1 or 2 of Group U3 and rendered on the same tooth on the same day;\n\n (f) a service specified in an item in Subgroup 8 of Group U3 and rendered on a tooth if dental benefit is or was payable in respect of a dental service specified in an item in Subgroup 1 or 2 of Group U3 and previously rendered on the same tooth at any time before the service specified in an item in Subgroup 8 of Group U3 was rendered;\n\n (g) a service specified in item 88351 and rendered to an eligible dental patient on a day if the service is not rendered on the same day as a dental service specified in item 88384, 88386 or 88387.\n\n22 Dental benefit not payable for certain endodontic services\n\n (1) For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of the following dental services:\n\n (a) a service specified in item 88412 and rendered on a tooth on a day if dental benefit is or was payable in respect of the same service previously rendered on the same tooth at any time;\n\n (b) a service specified in any item in Group U4 of the Dental Benefits Schedule and rendered on a tooth if dental benefit is or was payable in respect of a service specified in item 88412 and previously rendered on the same tooth at any time;\n\n (c) a service specified in item 88415 and rendered on a tooth on a day if dental benefit is payable in respect of the same service rendered on the same tooth on the same day;\n\n (d) a service specified in item 88416 and rendered on a tooth on a day if dental benefit is payable in respect of the same service rendered on the same tooth twice on the same day;\n\n (e) a service specified in item 88417 and rendered on a tooth on a day if dental benefit is payable in respect of the same service rendered on the same tooth on the same day;\n\n (f) a service specified in item 88418 and rendered on a tooth on a day if dental benefit is payable in respect of the same service rendered on the same tooth twice on the same day;\n\n (g) a service specified in item 88414 and rendered on a tooth on a day if dental benefit is payable in respect of a dental service specified in item 88421 and rendered on the same tooth on the same day;\n\n (h) a service specified in item 88418 and rendered on a tooth on a day if dental benefit is payable in respect of a dental service specified in item 88419 and rendered on the same tooth on the same day;\n\n (i) a service specified in item 88419 and rendered to a tooth on a day if dental benefit is payable in respect of a dental service specified in item 88311 to 88326, 88411 to 88417, 88421, 88455, 88458 or 88511 to 88535 and rendered on the same tooth on the same day;\n\n (j) a service specified in item 88421 and rendered on a primary tooth on a day if dental benefit is or was payable in respect of:\n\n (i) the same service previously rendered on the same tooth at any time; or\n\n (ii) a dental service specified in item 88414 and rendered on the same tooth on the same day;\n\n (k) a service specified in item 88455 and rendered to a tooth on a day if:\n\n (i) dental benefit is payable in respect of a dental service specified in item 88414, 88415, 88416, 88417, 88418, or 88421 and rendered on the same tooth on the same day; or\n\n (ii) dental benefit is not, or was not, payable in respect of a dental service specified in item 88415 or 88416 and rendered on the same tooth in the 3 month period ending on the day.\n\nDental service specified in item 88458\n\n (2) For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of a dental service specified in an item in Group U4 of the Dental Benefits Schedule and rendered to an eligible dental patient on a day if dental benefit is or was payable in respect of a dental service specified in item 88458 and previously rendered to the patient in the 3 month period ending on the day.\n\n (3) Subsection (2) does not apply if the dental service:\n\n (a) is a service specified in item 88415 or 88416 and rendered to the patient on the same day as a dental service specified in item 88458; or\n\n (b) is a service specified in item 88455.\n\n23 Dental benefit not payable for certain restorative services\n\n For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of the following dental services:\n\n (a) a service specified in an item in Subgroup 1, 2 or 3 of Group U5 and rendered on a tooth on a day if dental benefit is payable in respect of another dental service also specified in an item in Subgroup 1, 2 or 3 of Group U5 and rendered on the same tooth on the same day;\n\n (b) a service specified in item 88521 or 88531 and rendered to an eligible dental patient on a day if dental benefit is payable in respect of dental services specified in either or both of those items on 5 occasions on the same day;\n\n (c) a service specified in item 88521 and rendered to an eligible dental patient on a day if dental benefit is payable in respect of a dental service specified in item 88531 and rendered to the patient on the same day;\n\n (d) a service specified in item 88572 and rendered to an eligible dental patient on a day if dental benefit is payable in respect of a dental service specified in item 88411 to 88418 or 88421 to 88458 and rendered to the patient on the same day;\n\n (e) a service specified in item 88575 and rendered on a tooth on a day if:\n\n (i) dental benefit is not payable in respect of a dental service specified in Subgroup 1, 2 or 3 of Group U5 and rendered in respect of the same tooth on the same day; or\n\n (ii) dental benefit is payable in respect of the same service rendered to the same tooth twice on the day;\n\n (f) a service specified in item 88586 or 88587 and rendered on a tooth on a day if dental benefit is payable in respect of a dental service specified in either of those items and rendered on the same tooth on the same day;\n\n (g) a service specified in item 88597 and rendered on a tooth on a day if:\n\n (i) dental benefit is not payable in respect of a dental service specified in Subgroup 1, 2 or 3 of Group U5 and rendered in respect of the same tooth on the same day; or\n\n (ii) dental benefit is payable in respect of the same service rendered to the same tooth twice on the same day.\n\n24 Dental benefit not payable for certain prosthodontic services\n\n For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of the following dental services:\n\n (a) a service specified in item 88721 and rendered to an eligible dental patient on a day if dental benefit is or was payable in respect of a dental service specified in item 88723 and previously rendered to the patient in the 6 month period ending on the day;\n\n (b) a service specified in item 88722 and rendered to an eligible dental patient on a day if dental benefit is or was payable in respect of a dental service specified in item 88724 and previously rendered to the patient in the 6 month period ending on the day;\n\n (c) a service specified in item 88723 and rendered to an eligible dental patient if dental benefit is or was payable in respect of the same service previously rendered to the patient at any time;\n\n (d) a service specified in item 88724 and rendered to an eligible dental patient if dental benefit is or was payable in respect of the same service previously rendered to the patient at any time.\n\n25 Dental benefit not payable for certain other prosthodontic services\n\n For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of the following dental services:\n\n (a) a service specified in item 88731 and rendered to an eligible dental patient if:\n\n (i) the service is rendered in respect of a dental service that is not a service specified in item 88721, 88722, 88723 or 88724; or\n\n (ii) the service is rendered more than 4 times in respect of a dental service specified in each of item 88721, 88722, 88723 or 88724 and dental benefit was payable in respect of the 4 dental services previously rendered;\n\n (b) a service specified in item 88733 and rendered to an eligible dental patient if:\n\n (i) the service is not rendered in respect of a dental service specified in item 88721, 88722, 88723 or 88724; or\n\n (ii) the service is rendered more than 4 times in respect of a dental service specified in each of item 88721, 88722, 88723 or 88724 and dental benefit is or was payable in respect of the 4 dental services previously rendered; or\n\n (iii) the service is rendered to a tooth which is not an anterior tooth;\n\n (c) a service specified in item 88736 and rendered to an eligible dental patient if:\n\n (i) the service is not rendered in respect of a dental service specified in item 88721, 88722, 88723 or 88724; or\n\n (ii) the service is rendered more than 4 times in respect of a dental service specified in each of item 88721, 88722, 88723 or 88724 and dental benefit is or was payable in respect of the 4 dental services previously rendered;\n\n (d) a service specified in item 88741 and rendered by, or on behalf of, a dental provider on a day if dental benefit is or was payable in respect of a dental service specified in item 88721, 88722, 88723 or 88724 and previously rendered by or on behalf of the same dental provider less than 12 months before the day.\n\n26 Dental benefit not payable for a certain general service\n\n For the purposes of subsection 21(1) of the Act, dental benefit is not payable in respect of a dental service specified in item 88911 and rendered to an eligible dental patient by, or on behalf of, a dental provider on a day if any other dental service specified in an item in the Dental Benefits Schedule is rendered to the patient by, or on behalf of, the same provider on the same day and dental benefit is payable in respect of that other dental service.\n\nPart 3—Dental Benefits Schedule\n\n \n\n27 Dental Benefits Schedule\n\n For the purposes of subsection 61(1) of the Act, the Dental Benefits Schedule is Schedule 1 to this instrument.\n\nPart 4—Application, saving and transitional provisions\n\nDivision 1—Dental Benefits Rules 2026\n\n28 Definitions\n\n In this Part:\n\ncommencement time means the time this section commences.\n\nold rules means the Dental Benefits Rules 2014.\n\n29 Application—dental service provided on or after commencement\n\n This instrument applies in relation to dental services rendered to an eligible dental patient on or after the commencement of this section.\n\n30 Transitional—dental benefit 2 year cap\n\n (1) If a relevant 2 year period was in effect in relation to an eligible dental patient under section 14 of the old rules immediately before the commencement of this section, the relevant 2 year period continues in effect:\n\n (a) in relation to the patient; and\n\n (b) after commencement;\n\nas if it were a 2 year period specified in subsection 15(2) of this instrument.\n\n (2) The period remains in force for the balance of the relevant 2 year period.\n\n31 Something done under the old rules\n\n (1) If:\n\n (a) something was done for a particular purpose under the old rules as in force immediately before the commencement time; and\n\n (b) the thing could be done for that purpose under this instrument;\n\nthe thing has effect for the purposes of this instrument as if it had been done for that purpose under this instrument.\n\n (2) Without limiting subsection (1), a reference in that subsection to something being done includes a reference to a notice, application or other instrument being given or made.\n\nSchedule 1—Dental Benefits Schedule\n\nNote: See section 27.\n\n \n\nDivision 1—Group U0: Diagnostic services\n\n1 Items in Subgroup 1 of Group U0\n\n This clause sets out items in Subgroup 1 of Group U0.\n\n \n\n- Group U0: Diagnostic services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 1—Examinations\n- 88011 Comprehensive oral examinationEvaluation of all teeth, their supporting tissues and the oral tissues in order to record the condition of these structures. This evaluation includes recording an appropriate medical history and any other relevant information. 60.95\n- 88012 Periodic oral examinationAn evaluation performed on a patient of record to determine any changes in the patient’s dental and medical health status since a previous comprehensive or periodic examination. 50.70\n- 88013 Oral examination—limitedA limited oral problem‑focussed evaluation carried out immediately prior to required treatment. This evaluation includes recording an appropriate medical history and any other relevant information. 31.80\n\n\n2 Items in Subgroup 2 of Group U0\n\n This clause sets out items in Subgroup 2 of Group U0.\n\n \n\n- Group U0: Diagnostic services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 2—Radiological examination and interpretation\n- 88022 Intraoral periapical or bitewing radiograph—per exposureTaking and interpreting a radiograph made with the film inside the mouth. 35.30\n- 88025 Intraoral radiograph—occlusal, maxillary, mandibular—per exposureTaking 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\n\n\nDivision 2—Group U1: Preventive services\n\n3 Items in Subgroup 1 of Group U1\n\n This clause sets out items in Subgroup 1 of Group U1.\n\n \n\n- Group U1: Preventive services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 1—Dental prophylaxis\n- 88111 Removal of plaque and/or stainRemoval of dental plaque and/or stain from the surfaces of all teeth and/or implants. 62.30\n- 88114 Removal of calculus—first visitRemoval of calculus from the surfaces of teeth. 103.90\n- 88115 Removal of calculus—subsequent visitProcedures in item 88114 when, because of the extent or degree of calculus, an additional visit(s) is required to remove deposits from the teeth. 67.50\n\n\n4 Item in Subgroup 2 of Group U1\n\n This clause sets out items in Subgroup 2 of Group U1.\n\n \n\n- Group U1: Preventive services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 2—Remineralising agents\n- 88121 Topical application of remineralisation and/or cariostatic agents, one treatmentApplication 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. 40.05\n\n\n5 Items in Subgroup 3 of Group U1\n\n This clause sets out items in Subgroup 3 of Group U1.\n\n \n\n- Group U1: Preventive services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 3—Other preventive services\n- 88161 Fissure and/or tooth surface sealing—per tooth (first four services on a day)Sealing of non‑carious pits, fissures, smooth surfaces or cracks in a tooth with an adhesive material. Any preparation prior to application of the sealant is included in this item number. 53.35\n- 88162 Fissure and/or tooth surface sealing – per tooth (subsequent services)Sealing of non‑carious pits, fissures, smooth surfaces or cracks in a tooth with an adhesive material. Any preparation prior to application of the sealant is included in this item number. 26.70\n\n\nDivision 3—Group U2: Periodontic services\n\n6 Items in Group U2\n\n This clause sets out items in Group U2.\n\n \n\n- Group U2: Periodontic services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- 88213 Treatment of acute periodontal infection—per visitTreatment 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. 80.70\n- 88221 Clinical periodontal analysis and recordingA 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. 61.35\n\n\n \n\nDivision 4—Group U3: Oral surgery\n\n7 Items in Subgroup 1 of Group U3\n\n This clause sets out items in Subgroup 1 of Group U3.\n\n \n\n- Group U3: Oral surgery\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 1—Extractions\n- 88311 Removal of a tooth or part(s) thereof—first tooth extracted on a dayA procedure consisting of the removal of a tooth or part(s) thereof. Inclusive of the insertion of sutures, normal post‑operative care and suture removal. 152.05\n- 88314 Sectional removal of a tooth or part(s) thereof—first tooth extracted on a dayThe removal of a tooth or part(s) thereof in sections. Bone removal may be necessary. Inclusive of the insertion of sutures, normal post‑operative care and suture removal. 194.35\n- 88316 Additional extraction requiring removal of a tooth or part(s) thereof, or sectional removal of a toothAdditional extraction rendered on the same day as a service described in item 88311 or 88314 is rendered to the patient. 95.85\n\n\n8 Items in Subgroup 2 of Group U3\n\n This clause sets out items in Subgroup 2 of Group U3.\n\n \n\n- Group U3: Oral surgery\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 2—Surgical extractions\n- 88322 Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division—first tooth extracted on a dayRemoval 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. 246.80\n- 88323 Surgical removal of a tooth or tooth fragment requiring removal of bone—first tooth extracted on a dayRemoval 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. 281.85\n- 88324 Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division—first tooth extracted on a dayRemoval 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. 379.10\n- 88326 Additional extraction requiring surgical removal of a tooth or tooth fragmentAdditional surgical extraction rendered on the same day as a service described in item 88322, 88323 or 88324 is rendered to the patient. 201.90\n\n\n9 Item in Subgroup 5 of Group U3\n\n This clause sets out items in Subgroup 5 of Group U3.\n\n \n\n- Group U3: Oral surgery\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 5—Treatment of maxillo‑facial injuries\n- 88351 Repair of skin and subcutaneous tissue or mucous membraneThe surgical cleaning and repair of a facial skin wound in the region of the mouth or jaws, or the repair of oral mucous membrane, where the wounds involve the subcutaneous tissues. Inclusive of the insertion of sutures, normal post‑operative care and suture removal. 185.25\n\n\n10 Items in Subgroup 8 of Group U3\n\n This clause sets out items in Subgroup 8 of Group U3.\n\n \n\n- Group U3: Oral surgery\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 8—Other surgical procedures\n- 88384 Repositioning of displaced tooth/teeth—per toothA 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. 221.05\n- 88386 Splinting of displaced tooth/teeth—per toothA 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. 228.10\n- 88387 Replantation and splinting of a toothReplantation 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. 446.60\n- 88392 Drainage of abscessDrainage 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. 112.20\n\n\nDivision 5—Group U4: Endodontic services\n\n11 Items in Subgroup 1 of Group U4\n\n This clause sets out items in Subgroup 1 of Group U4.\n\n \n\n- Group U4: Endodontic services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 1 of Group U4—Pulp and root canal treatments\n- 88411 Direct pulp cappingA procedure where an exposed pulp is directly covered with a protective dressing or cement. 40.35\n- 88412 Incomplete endodontic therapy (tooth not suitable for further treatment)A procedure where in assessing the suitability of a tooth for endodontic treatment a decision is made that the tooth is not suitable for restoration. 138.25\n- 88414 PulpotomyAmputation within the pulp chamber of part of the vital pulp of a tooth. The pulp remaining in the canal(s) is then covered with a protective dressing or cement. 88.15\n- 88415 Complete chemo‑mechanical preparation of root canal—one canalComplete chemo‑mechanical preparation including removal of pulp or necrotic debris from a canal. 248.05\n- 88416 Complete chemo‑mechanical preparation of root canal—each additional canalComplete chemo‑mechanical preparation including removal of pulp or necrotic debris from each additional canal of a tooth with multiple canals. 118.15\n- 88417 Root canal obturation—one canalThe filling of a root canal, following chemo‑mechanical preparation. 241.60\n- 88418 Root canal obturation—each additional canalThe filling, following chemo‑mechanical preparation, of each additional canal in a tooth with multiple canals. 113.00\n- 88419 Extirpation of pulp or debridement of root canal(s)—emergency or palliativeThe partial or thorough removal of pulp and/or debris from the root canal system of a tooth. This is an emergency or palliative procedure distinct from visits for scheduled endodontic treatment. 159.75\n- 88421 Resorbable root canal filling—primary toothThe placement of resorbable root canal filling material in a primary tooth. 138.25\n\n\n12 Items in Subgroup 4 of Group U4\n\n This clause sets out items in Subgroup 4 of Group U4.\n\n \n\n- Group U4: Endodontic services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 4—Other endodontic services\n- 88455 Additional visit for irrigation and/or dressing of the root canal system—per toothAdditional 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. 122.40\n- 88458 Interim therapeutic root filling—per toothA 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. 163.25\n\n\nDivision 6—Group U5: Restorative Services\n\n13 Items in Subgroup 1 of Group U5\n\n This clause sets out items in Subgroup 1 of Group U5.\n\n \n\n- Group U5: Restorative Services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 1 of Group U5—Metallic restorations—direct\n- 88511 Metallic restoration—one surface—directDirect metallic restoration involving one surface of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post‑operative care. 120.70\n- 88512 Metallic restoration—two surfaces—directDirect metallic restoration involving two surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post‑operative care. 148.05\n- 88513 Metallic restoration—three surfaces—directDirect metallic restoration involving three surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post‑operative care. 176.65\n- 88514 Metallic restoration—four surfaces—directDirect metallic restoration involving four surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post‑operative care. 201.35\n- 88515 Metallic restoration—five surfaces—directDirect metallic restoration involving five surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post‑operative care. 229.85\n\n\n14 Items in Subgroup 2 of Group U5\n\n This clause sets out items in Subgroup 2 of Group U5.\n\n \n\n- Group U5: Restorative Services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 2 of Group U5—Adhesive restorations—anterior teeth—direct\n- 88521 Adhesive restoration—one surface—anterior tooth—directDirect 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. 133.70\n- 88522 Adhesive restoration—two surfaces—anterior tooth—directDirect 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. 162.30\n- 88523 Adhesive restoration—three surfaces—anterior tooth—directDirect 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. 192.25\n- 88524 Adhesive restoration—four surfaces—anterior tooth—directDirect 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. 222.20\n- 88525 Adhesive restoration—five surfaces—anterior tooth—directDirect 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. 261.10\n\n\n15 Items in Subgroup 3 of Group U5\n\n This clause sets out items in Subgroup 3 of Group U5.\n\n \n\n- Group U5: Restorative Services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 3 of Group U5—Adhesive restorations—posterior teeth—direct\n- 88531 Adhesive restoration—one surface—posterior tooth—directDirect restoration, using an adhesive technique and a tooth‑coloured material, involving one surface of a 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. 142.75\n- 88532 Adhesive restoration—two surfaces—posterior tooth—directDirect restoration, using an adhesive technique and a tooth‑coloured material, involving two surfaces of a 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. 179.25\n- 88533 Adhesive restoration—three surfaces—posterior tooth—directDirect restoration, using an adhesive technique and a tooth‑coloured material, involving three surfaces of a 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. 215.50\n- 88534 Adhesive restoration—four surfaces—posterior tooth—directDirect restoration, using an adhesive technique and a tooth‑coloured material, involving four surfaces of a 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. 242.90\n- 88535 Adhesive restoration—five surfaces—posterior tooth—directDirect restoration, using an adhesive technique and a tooth‑coloured material, involving five surfaces of a 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. 280.50\n\n\n16 Items in Subgroup 7 of Group U5\n\n This clause sets out items in Subgroup 7 of Group U5.\n\n \n\n- Group U5: Restorative Services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 7 of Group U5—Other restorative services\n- 88572 Provisional (intermediate/temporary) restoration—per toothThe 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. 56.45\n- 88574 Metal bandThe cementation of a metal band for diagnostic, protective purposes or for the placement of a provisional (intermediate) restoration. 47.55\n- 88575 Pin retention—per pinUse of a pin to aid the retention and support of direct or indirect restorations in a tooth. 32.45\n- 88579 Bonding of tooth fragmentThe direct bonding of a tooth fragment as an alternative to placing a restoration. 112.20\n- 88586 Crown—metallic—with tooth preparation—preformedPlacing a preformed metallic crown as a coronal restoration for a tooth. 297.75\n- 88587 Crown—metallic—minimal tooth preparation—preformedPlacing 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. 176.65\n- 88597 Post—directInsertion of a post into a prepared root canal to provide an anchor for an artificial crown or other restoration. 102.10\n\n\nDivision 7—Group U7: Prosthodontics\n\n17 Items in Subgroup 1 of Group U7\n\n This clause sets out items in Subgroup 1 of Group U7.\n\n \n\n- Group U7: Prosthodontics\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 1 of Group U7—Dentures and denture components\n- 88721 Partial maxillary denture—resin, base onlyProvision of a resin base for a removable dental prosthesis for the maxilla where some natural teeth remain. 505.70\n- 88722 Partial mandibular denture—resin, base onlyProvision of a resin base for a removable dental prosthesis for the mandible where some natural teeth remain. 505.70\n- 88723 Provisional partial maxillary dentureProvision of a patient removable partial dental prosthesis replacing the natural teeth and adjacent tissues in the maxilla which is designed to last until the definitive prosthesis can be constructed. This item should only be used where a provisional denture is not an intrinsic part of item 88721. 379.25\n- 88724 Provisional partial mandibular dentureProvision of a patient removable partial dental prosthesis replacing the natural teeth and adjacent tissues in the mandible which is designed to last until the definitive prosthesis can be constructed. This item should only be used where a provisional denture is not an intrinsic part of item 88722. 379.25\n- 88731 Retainer—per toothA retainer or attachment fitted to a tooth to aid retention of a partial denture. The number of retainers should be indicated. 51.05\n- 88733 Tooth/teeth (partial denture)An item to describe each tooth added to the base of a new partial denture. The number of teeth should be indicated. 41.90\n- 88736 Immediate tooth replacement—per toothProvision within a denture to allow immediate replacement of an extracted tooth. The number of teeth so replaced should be indicated. 10.55\n\n\n18 Item in Subgroup 4 of Group U7\n\n This clause sets out items in Subgroup 4 of Group U7.\n\n \n\n- Group U7: Prosthodontics\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 4 of Group U7—Denture maintenance\n- 88741 Adjustment of a dentureAdjustment 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. 60.80\n\n\n19 Items in Subgroup 6 of Group U7\n\n This clause sets out items in Subgroup 6 of Group U7.\n\n \n\n- Group U7: Prosthodontics\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 6 of Group U7—Denture repairs\n- 88761 Reattaching pre‑existing clasp to dentureRepair, insertion and adjustment of a denture involving re‑attachment of a pre‑existing clasp. 166.95\n- 88762 Replacing/adding clasp to denture—per claspRepair, insertion and adjustment of a denture involving replacement or addition of a new clasp or clasps. 174.45\n- 88764 Repairing broken base of a partial dentureRepair, insertion and adjustment of a broken resin partial denture base. 166.95\n- 88765 Replacing/adding new tooth on denture—per toothRepair, insertion and adjustment of a denture involving replacement with or addition of a new tooth or teeth to a previously existing denture. 174.45\n- 88766 Reattaching existing tooth on denture—per toothRepair, insertion and adjustment of a denture involving reattachment of a pre‑existing denture tooth or teeth. 166.95\n- 88768 Adding tooth to partial denture to replace an extracted or decoronated tooth—per toothModification, insertion and adjustment of a partial denture involving an addition to accommodate the loss of a natural tooth or its coronal section. 176.65\n\n\n20 Item in Subgroup 7 of Group U7\n\n This clause sets out items in Subgroup 7 of Group U7.\n\n \n\n- Group U7: Prosthodontics\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 7 of Group U7—Other prosthodontic services\n- 88776 Impression—dental appliance repair/modificationTaking an impression where required for the repair or modification of a dental appliance. 53.35\n\n\nDivision 8—Group U9: General services\n\n21 Item in Subgroup 1 of Group U9\n\n This clause sets out items in Subgroup 1 of Group U9.\n\n \n\n- Group U9: General services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 1 of Group U9—Emergencies\n- 88911 Palliative careInterim care to relieve pain, infection, bleeding or other problems not associated with other treatment. 79.20\n\n\n22 Items in Subgroup 4 of Group U9\n\n This clause sets out items in Subgroup 4 of Group U9.\n\n \n\n- Group U9: General services\n- Column 1Item Column 2Dental service Column 3Amount of dental benefit ($)\n- Subgroup 4 of Group U9—Sedation\n- 88942 Sedation—intravenousSedative drug(s) administered intravenously, usually in increments. The incremental administration may continue while dental treatment is being rendered. 155.25\n- 88943 Sedation—inhalationNitrous oxide gas mixed with oxygen is inhaled by the patient while dental treatment is being rendered. 77.60\n\nSchedule 2—Dental cap\n\nNote: See section 15.\n\n \n\n1 Dental cap\n\nThe dental cap for the 2 year period beginning on the day specified in an item in column 1 of the following table, and ending on the day specified in column 2 of the item, is the amount specified in column 3 of the item.\n\n \n\n| Item | Column 1
For the 2 year period beginning on… | Column 2
and ending on… | Column 3
the dental cap is… |\n| --- | --- | --- | --- |\n| 1 | 1 January 2026 | 31 December 2027 | $1,158 |\n\n\n \n\nSchedule 3—Repeals\n\n \n\nDental Benefits Rules 2014\n\n1 The whole of the instrument\n\nRepeal the instrument.\n\n \n","sortOrder":0}],"analysis":{"flash_summary":{"complexity_score":8,"scope_assessment":{"changed":true,"description":"This instrument repeals the Dental Benefits Rules 2014 (Schedule 3) and replaces them with an updated schedule and detailed operational rules. It narrows and specifies eligibility by age and receipt of named payments (s 6), tightens provider‑type and provider‑number requirements (ss 7–8, s 10), imposes a defined 2‑year per‑patient cap with a stated dollar amount for 2026–27 (s 15; Schedule 2), and adds precise consent, record‑keeping and frequency exclusions (ss 9, 11, 16–26). Transitional provisions preserve existing 2‑year periods and validate things done under the old rules (ss 30–31)."},"complexity_factors":["Extensive, granular Dental Benefits Schedule listing many discrete item numbers with precise dollar benefits (Schedule 1).","Multiple conditional non‑payment rules tied to timing, tooth‑level and provider‑level repetition, and same‑day conflicts (Part 2 Division 2, ss 16–26).","A rolling 2‑year per‑patient dental cap with defined 2‑year periods and transitional carry‑over rules (s 15; Schedule 2; s 30).","Detailed record‑keeping and billing requirements (patient name, date, item, provider name and provider number, amounts) that create compliance burdens for providers (s 9).","Consent regime with approved forms, same‑day signature rules, emergency and other exceptions, and signature/administrative error exceptions (s 11).","Complex provider eligibility rules and limits based on provider type, provider numbers and whether services are rendered on behalf of dentists or public sector providers (ss 6–8; s 10).","Cross‑references to the Dental Benefits Act 2008 and Social Security and veterans' payment schemes for eligibility definitions, increasing interpretive dependencies (ss 3, 5, 6).","Administrative discretion and interaction with State/Territory arrangements (Minister may direct s 12(b); time‑limited bar on State/Territory services until 1 Jan 2027 in s 12).","Special information consent requirement linking Department of Veterans' Affairs data sharing to benefit entitlement (s 14).","Transitional continuity and savings clauses preserving some acts and active 2‑year periods from the old rules (ss 30–31; Schedule 3 repeals the 2014 Rules)."],"plain_english_summary":"This instrument replaces the 2014 Dental Benefits Rules and sets the mechanics for Commonwealth payment under the Child Dental Benefits Schedule: who counts as an eligible patient (age and receipt of specified payments), which providers and services qualify (listed by item in Schedule 1), documentation and consent requirements, service frequency limits and a two‑year per‑patient cap ($1,158 for 1 Jan 2026–31 Dec 2027). It affects eligible children and youth, dental practitioners and allied providers by defining when the Commonwealth will, or will not, pay for specific dental items."},"kimi_summary":{"content_quality":"ok","complexity_score":7,"scope_assessment":{"changed":false,"description":"This appears to be a straightforward re-enactment and update of the Dental Benefits Rules 2014. The structure mirrors the original (definitions, conditions for non-payment, schedule of services, dental cap, repeals) and maintains the same scope: operational rules for the Child Dental Benefits Schedule. While the specific item numbers and dollar amounts may have been updated, the legislative architecture and policy intent remain consistent with the original scheme established in 2008 and first implemented in 2014."},"complexity_factors":["Extensive cross-referencing between the Act (Dental Benefits Act 2008), the Rules, and the Schedule — services are defined by item numbers (e.g., 88311, 88521) that have no intuitive meaning","47+ defined terms in section 5 alone, many importing definitions from other legislation (Social Security Act 1991, Health Insurance Regulations 2018, Military Rehabilitation and Compensation Act 2004)","Nested conditional logic throughout Part 2 — 15 separate sections detailing when benefits are NOT payable, with multiple exceptions to exceptions (e.g., section 11 has two exception subsections for emergency and other exceptional circumstances)","Complex temporal restrictions — benefits blocked based on previous services rendered in specific rolling periods (3 months, 5 months, 6 months, 12 months, 24 months, or 'same day')","Tooth-specific and provider-specific restrictions — some rules apply per tooth, others per patient, others per provider, creating a three-dimensional matrix of eligibility","Transitional provisions preserving entitlements from the repealed 2014 Rules, requiring readers to understand both instruments simultaneously","Schedule 1 contains 50+ individual service items across 8 major groups (U0-U9) with subgroup divisions, each with specific clinical descriptors and dollar amounts"],"plain_english_summary":"Sets rules for government-paid child dental subsidies under the CDBS, defining covered services, provider eligibility, documentation and a $1,158 per-child two‑year cap. Affects children under 18 from low‑income/benefit‑receiving families and dental providers; aims to prevent duplicate claims and ensure appropriate provider types. Replaces the 2014 rules for services from February 2026 and determines whether vulnerable families receive subsidised dental care or must pay full price."},"flash_summary_failed":{"failed":true,"reason":"A positive credit balance is required for all requests, including BYOK, so fallback providers remain available. Add credits at https://vercel.com/d?to=%2F%5Bteam%5D%2F%7E%2Fai%3Fmodal%3Dtop-up to continue.","source":"analysis-cron"}},"importantCases":[],"_links":{"self":"/api/acts/dental-benefits-rules-2026","history":"/api/acts/dental-benefits-rules-2026/history","analysis":"/api/acts/dental-benefits-rules-2026/analysis","conflicts":"/api/acts/dental-benefits-rules-2026/conflicts","importantCases":"/api/acts/dental-benefits-rules-2026/important-cases","documents":"/api/acts/dental-benefits-rules-2026/documents"}}