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Name of Determination \[see Note 1\]
1 Name of Determination [see Note 1]
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Commonwealth legislation
This Act has been repealed and is no longer in force. It is retained for historical reference.
This Determination created a Medicare dental subsidy (2007–30 Nov 2012) for people whose chronic health conditions had oral‑health impacts. Eligible patients needed specified GP care plans and a GP referral, and could not be hospital inpatients.
Registered Medicare dentists, listed dental specialists, and dental prosthetists (for dentures) provided care from a prescribed list of procedures with set fees. Key limits included a $4,250 Medicare cap per rolling two‑year period, frequency and denture rules, prohibition on cosmetic claims, and required written treatment plans.
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Direct links to the current provisions in Health Insurance (Dental Services) Determination 2007.
1 Name of Determination [see Note 1]
2 Commencement
Section 2A Cessation
3 Definitions
4 Dental services
5 Monetary limit on medicare benefits
6 Patient eligibility
7 Effect of election to claim private health insurance for a dental service
8 Application of items — dental services provided by eligible providers to eligible patients
9 Referral
10 Quotation for dental services and reporting
11 Purpose of service
12 Limitation on items — dentures and denture components
13 Limitation on number of certain services
14 Limitation on provision of certain services
15 Application of item 85433
16 Application of item 85455
17 Limitation on items 85521 and 85531
18 Application of item 85572
19 Application of items 85733, 86733 and 87733
20 Application of item 86433
21 Application of item 86455
22 Limitation on items 86521 and 86531
23 Application of item 86572
Schedule 1 Dental services and fees
Part 1 Services provided by eligible dentists
Part 2 Services provided by eligible dental specialists
Part 3 Services provided by eligible dental prosthetists
Schedule 2 Specialties
Notes
1 Name of Determination [see Note 1]
This Determination is the Health Insurance (Dental Services) Determination 2007.
2 Commencement
This Determination commences on 1 November 2007.
Section 2A Cessation
This Determination ceases at midnight 30 November 2012.
3 Definitions
In this Determination:
Act means the Health Insurance Act 1973.
dental service means a dental service mentioned in Schedule 1.
eligible dental prosthetist means an individual:
(a) who is registered or entitled to practice as a dental prosthetist under a law of a State or Territory; and
(b) whose registration or entitlement to practice as a dental prosthetist entitles the individual to provide services to which any of the items mentioned in Part 3 of Schedule 1 apply; and
(c) whose name is entered in the register, kept by the Chief Executive Medicare, of dental prosthetists who can provide services to which any of the items mentioned in Part 3 of Schedule 1 apply.
eligible dental specialist means a person:
(a) who is registered or licensed to practice under a law of a State or Territory in a specialty mentioned in Schedule 2; and
(b) whose name is entered in the register, kept by the Chief Executive Medicare, of dental specialists who can provide services to which any of the items mentioned in Part 2 of Schedule 1 apply.
eligible dentist means a dental practitioner whose name is entered in the register, kept by the Chief Executive Medicare, of dental practitioners who can provide services to which any of the items mentioned in Part 1 of Schedule 1 apply.
eligible patient has the meaning given by section 6.
GP management plan means a plan to which item 721 of the general medical services table or item 725 of the general medical services table as in force on or before 30 April 2010 applies.
multidisciplinary care plan has the meaning given by clause 2.17.6 of the general medical services table.
relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act.
team care arrangements means team care arrangements to which item 723 of the general medical services table or item 727 of the general medical services table as in force on or before 30 April 2010 applies.
Note Unless a contrary intention appears, an expression used in this Determination has the same meaning as in the Health Insurance Act 1973 — see section 13 of the Legislative Instruments Act 2003.
4 Dental services
A dental service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) specified for the service a fee for each State, being the fee mentioned in the item in Schedule 1 for the service.
Note For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.
5 Monetary limit on medicare benefits
(1) For subsection 3C (2A) of the Act, the total of all amounts of medicare benefit paid or payable for dental services provided to a person in a relevant 2 year period must not exceed $4 250.
(2) In this section:
relevant 2 year period, for a person, has the meaning given by subsections (3) and (4).
(3) If:
(a) a person received a dental service on or after 1 November 2007; and
(b) the service is the first dental service that the person has received on or after 1 November 2007;
the calendar year in which the person received that first dental service and the following calendar year is a relevant 2 year period for the person.
(4) After that relevant 2 year period, each calendar year in which the person receives a dental health service and the following calendar year is a relevant 2 year period for the person unless the first mentioned year is already part of a relevant 2 year period because of a previous application of this subsection.
Example 1
A person who first receives a dental service on 25 November 2007 will be eligible for not more than $4 250 in medicare benefits for all dental services provided to the person in 2007 and 2008.
A 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 2009.
Example 2
A person who first receives a dental service on 15 January 2008 will be eligible for not more than $4 250 in medicare benefits for all dental services provided to the person in 2008 and 2009.
A further relevant 2 year period commences for the person in the calendar year when the patient first receives a dental service on or after 1 January 2010.
6 Patient eligibility
A person is an eligible patient if:
(a) the person either:
(i) has in place a GP management plan and team care arrangements, both of which were received on or before 7 September 2012; or
(ii) has in place a multidisciplinary care plan to which item 731 of the general medical services table applies which was received on or before 7 September 2012; and
(b) his or her oral health is impacting on, or is likely to impact on, his or her general health; and
(c) the person has been referred for a dental service under section 9; and
(d) the person is not an admitted patient of a hospital.
7 Effect of election to claim private health insurance for a dental service
An item in Schedule 1 applies to a dental service only if a private health insurance benefit has not been claimed for that service.
8 Application of items — dental services provided by eligible providers to eligible patients
(1) An item in Part 1 of Schedule 1 applies only to a dental service provided by an eligible dentist to an eligible patient.
(2) An item in Part 2 of Schedule 1 applies only to a dental service provided by an eligible dental specialist to an eligible patient.
(3) An item in Part 3 of Schedule 1 applies only to a dental service provided by an eligible dental prosthetist to an eligible patient.
9 Referral
(1) A general practitioner may refer an eligible patient for a dental service only to:
(a) an eligible dentist; or
(b) an eligible dental prosthetist, if the patient:
(i) has no natural teeth and requires only dental prosthetic services; or
(ii) requires only repairs or maintenance to an existing denture.
(2) A referral by a general practitioner must be made in the form published by the Department and described as ‘Referral Form for Dental Services under Medicare’, as existing on 1 November 2007, or a form that substantially complies with that form.
Note The form is available on the internet — see http://www.health.gov.au.
(3) An eligible dentist who has provided a dental service to an eligible patient referred to the eligible dentist under this subsection or subsection (1), (4) or (5) may refer the patient to an eligible dentist, an eligible dental specialist or an eligible dental prosthetist for an additional dental service.
(4) An eligible dental specialist who has provided a dental service to an eligible patient referred to the eligible dental specialist under this subsection or subsection (3) may refer the patient to an eligible dentist, an eligible dental specialist or an eligible dental prosthetist for an additional dental service.
(5) An eligible dental prosthetist who has provided a dental service to an eligible patient referred to the eligible dental prosthetist under this subsection or subsection (1), (3) or (4) may refer the patient to an eligible dentist or an eligible dental prosthetist for an additional dental service.
10 Quotation for dental services and reporting
(1) This section applies if:
(a) an eligible dentist, an eligible dental specialist or an eligible dental prosthetist performs an initial examination and assessment of an eligible patient, including consideration of any diagnostic tests; and
(b) provides a course of treatment to the patient.
(2) An item in Schedule 1 applies to a dental service included in the course of treatment only if, before beginning the course of treatment, the eligible dentist, eligible dental specialist or eligible dental prosthetist:
(a) gave to the eligible patient, in writing:
(i) a plan of the course of treatment; and
(ii) a quotation for each dental service and each other service (if any) in the plan; and
(b) gave a copy or written summary of the plan to the general practitioner who referred the patient for dental services.
11 Purpose of service
(1) An item in Schedule 1 applies to a dental service only if the primary purpose of the service is to improve the oral health or function of the eligible patient.
(2) An item in Schedule 1 does not apply to a dental service if the primary purpose of the service is to improve the appearance of the eligible patient.
(3) An item in Schedule 1 applies to a dental service if the primary purpose of the service is to improve the oral health or function of the eligible patient and another purpose of the service is to improve the patient’s appearance.
12 Limitation on items — dentures and denture components
(1) For any particular eligible patient, a set of dentures applies not more than:
(a) once in 8 years; or
(b) if exceptional circumstances exist in relation to the patient — twice in 8 years.
(2) In this section:
exceptional circumstances exist in relation to an eligible patient if:
(a) an eligible dentist, an eligible dental specialist or an eligible dental prosthetist is satisfied that there has been a significant change in the clinical condition of the patient that necessitates a new set of dentures for the patient; or
(b) the existing dentures of the patient have been irreparably damaged or lost.
set of dentures means:
(a) complete maxillary and mandibular dentures under item 85719, 86719 or 87719; or
(b) a complete or partial maxillary denture under item 85711, 85721, 85727, 86711, 86721, 86727, 87711, 87721 or 87727; or
(c) a complete or partial mandibular denture under item 85712, 85722, 85728, 86712, 86722, 86728, 87712, 87722 or 87728; or
(d) both:
(i) a complete or partial maxillary denture under any of the items mentioned in paragraph (b); and
(ii) a complete or partial mandibular denture under any of the items mentioned in paragraph (c).
13 Limitation on number of certain services
For any particular eligible patient, an item 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.
| Item | Item of service | Number of times | Period |
|---|---|---|---|
| 1 | 85123, 85311, 85314, 85322, 85323, 85324, 86123, 86311, 86314, 86322, 86323, 86324 | 1 | 1 day |
| 2 | 85927, 86927 | 1 | 3 months |
| 3 | 85111, 85114, 85121, 86111, 86114, 86121 | 1 | 6 months |
| 4 | 85039, 85047, 85131, 85141, 85221, 85225, 85245, 85433, 86036, 86039, 86047, 86131, 86141, 86221, 86225, 86245, 86433 | 1 | 12 months |
| 5 | 85753, 86753, 87753 | 1 | 24 months |
| 6 | 85963, 85964, 86963, 86964 | 1 | 36 months |
| 7 | 85222, 86222 | 2 | 1 day |
| 8 | 85115, 85213, 85234, 85986, 86115, 86213, 86234, 86235, 86986 | 2 | 12 months |
| 9 | 85013, 85572, 86013, 86572 | 3 | 3 months |
| 10 | 85458, 86458 | 3 | 12 months |
| 11 | 85231, 85232, 85233, 85971, 86231, 86232, 86233, 86971 | 4 | 12 months |
| 12 | 85771, 86771, 87771 | 5 | 3 months |
| 13 | 85022, 86022 | 6 | 1 day |
14 Limitation on provision of certain services
For any particular eligible patient, an item mentioned in column 2 of the following table is applicable to a service provided by a particular eligible dentist, eligible dental specialist or eligible dental prosthetist not more than once in the period mentioned in column 3 of the table.
| Item | Item of service | Period |
|---|---|---|
| 1 | 85012, 86012 | 6 months |
| 2 | 86015, 86038, 86082 | 12 months |
| 3 | 85011, 87011 | 24 months |
15 Application of item 85433
For any particular eligible patient, item 85433 does not apply to a service provided to the patient on a day if a service described in item 85431, 85432, 85434, 85436, 85437 or 85438 is provided to the patient on the day.
16 Application of item 85455
For any particular eligible patient, item 85455 does not apply to a service provided to the patient on a day if a service described in item 85415, 85416, 85417 or 85418 is provided to the patient on the day.
17 Limitation on items 85521 and 85531
For any particular eligible patient, any combination of items 85521 and 85531 is applicable to not more than 5 services provided to the patient on a day.
18 Application of item 85572
For any particular eligible patient, item 85572 does not apply to a service provided to the patient on a day if a service described in any of items 85411 to 85418 or items 85431 to 85458 is provided to the patient on the day.
19 Application of items 85733, 86733 and 87733
(1) For any particular eligible patient, item 85733 applies to the addition of no more than 12 teeth to a base provided to the patient under item 85721, 85722, 85727 or 85728.
(2) For any particular eligible patient, item 86733 applies to the addition of no more than 12 teeth to a base provided to the patient under item 86721, 86722, 86727 or 86728.
(3) For any particular eligible patient, item 87733 applies to the addition of no more than 12 teeth to a base provided to the patient under item 87721, 87722, 87727 or 87728.
20 Application of item 86433
For any particular eligible patient, item 86433 does not apply to a service provided to the patient on a day if a service described in item 86431, 86432, 86434, 86436, 86437 or 86438 is provided to the patient on the day.
21 Application of item 86455
For any particular eligible patient, item 86455 does not apply to a service provided to the patient on a day if a service described in item 86415, 86416, 86417 or 86418 is provided to the patient on the day.
22 Limitation on items 86521 and 86531
For any particular eligible patient, any combination of items 86521 and 86531 is applicable to not more than 5 services provided to the patient on a day.
23 Application of item 86572
For any particular eligible patient, item 86572 does not apply to a service provided to the patient on a day if a service described in any of items 86411 to 86418 or items 86431 to 86458 is provided to the patient on the day.
Schedule 1 Dental services and fees
(section 3)
Part 1 Services provided by eligible dentists
<table cellspacing="0" cellpadding="0" style="width:419.4pt; border-collapse:collapse"><thead><tr><td style="width:36.6pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Item</span></p></td><td style="width:301.2pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Service</span></p></td><td style="width:49.2pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Fee ($)</span></p></td></tr></thead><tbody><tr><td colspan="3" style="width:408.6pt; border-top:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group A1</span><span> </span><span>— Diagnostic services</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="ColHead2"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Examinations</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85011</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Comprehensive oral examination, including:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>evaluation of all teeth, their supporting tissues and the oral tissues to record the condition of these structures; and</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>recording an appropriate medical history and any other relevant information</span></p><p class="TableText"><span>(Item is subject to section 14)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>47.60</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85012</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Periodic oral examination and evaluation performed on a patient of record to determine any changes in the patient’s dental and medical health since a previous comprehensive or periodic examination</span></p><p class="TableText"><span>(Item is subject to section 14)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>39.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85013</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Oral examination, limited to a problem</span><span>‑</span><span>focused oral evaluation carried out immediately before required treatment, including recording an appropriate medical history and any other relevant information</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>24.85</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Radiological examination and interpretation</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85022</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Intraoral periapical or bitewing radiograph</span><span> </span><span>— each exposure</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>31.15</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85025</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Intraoral radiograph (occlusal, maxillary or mandibular)</span><span> </span><span>— each exposure</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>55.55</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85031</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Extraoral radiograph (maxillary or mandibular)</span><span> </span><span>— each exposure</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>63.35</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85037</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Panoramic radiograph</span><span> </span><span>— each exposure</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>85.10</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85039</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Tomography of the skull or parts of the skull</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>134.25</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 3</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Other diagnostic services</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85047</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Caries activity screening test</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>36.55</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85051</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Biopsy of tissue</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>111.85</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85071</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Diagnostic model</span><span> </span><span>— each model</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>54.55</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group A2</span><span> </span><span>— Preventive services</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Dental prophylaxis</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85111</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal of plaque, stain or plaque and stain</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>48.60</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85113</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Recontouring pre</span><span>‑</span><span>existing restoration or restorations</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>18.35</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85114</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal of calculus</span><span> </span><span>— first visit</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>81.00</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85115</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal of calculus</span><span> </span><span>— each subsequent visit</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>52.70</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85117</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Bleaching, internal, for non</span><span>‑</span><span>vital discoloured tooth</span><span> </span><span>— each tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>189.80</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Remineralising agents</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85121</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Topical application of remineralising agent</span><span> </span><span>— 1 treatment</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>31.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85123</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Application of concentrated remineralising agent</span><span> </span><span>— single tooth</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>24.45</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 3</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Other preventive services</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85131</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Dietary advice</span><span> </span><span>— consultation of at least 15 minutes</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>32.90</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85141</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Oral hygiene instruction</span><span> </span><span>— consultation of at least 15 minutes</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>44.65</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85161</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Fissure sealing</span><span> </span><span>— each tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>41.55</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85165</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Desensitizing procedure</span><span> </span><span>— each visit</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>24.45</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85171</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Odontoplasty</span><span> </span><span>— each tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>45.85</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group A3</span><span> </span><span>— Periodontics</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85213</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Treatment of acute periodontal infection</span><span> </span><span>— each visit</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>62.90</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85221</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Clinical periodontal analysis and recording</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>47.80</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85222</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Root planing and subgingival curettage</span><span> </span><span>— no more than 8 teeth</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>117.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85225</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Non</span><span>‑</span><span>surgical periodontal treatment where not described in another item</span><span> </span><span>— each visit</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>95.45</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85231</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Gingivectomy</span><span> </span><span>— no more than 8 teeth</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>153.05</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85232</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Periodontal flap surgery</span><span> </span><span>— no more than 8 teeth</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>232.65</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85233</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Osseous surgery</span><span> </span><span>— no more than 8 teeth</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>392.10</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85234</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Osseous graft</span><span> </span><span>— each tooth or implant</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>448.65</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85238</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Periodontal flap surgery for crown lengthening</span><span> </span><span>— each tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>216.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85241</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Root resection</span><span> </span><span>— each root</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>180.40</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85245</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Periodontal surgery involving a tooth or an implant</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>71.65</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group A4</span><span> </span><span>— Oral surgery</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Extractions</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85311</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal of a tooth or part or parts of a tooth, including local anaesthesia and routine and post</span><span>‑</span><span>operative care</span><span> </span><span>— first tooth extracted on a day</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>118.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85314</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Sectional removal of a tooth, including local anaesthesia and routine post</span><span>‑</span><span>operative care</span><span> </span><span>— first sectional removal on a day</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>151.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85316</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Additional extraction requiring:</span></p><p class="TableP1a" style="margin-top:3pt"><span style="width:8.19pt; text-indent:0pt; display:inline-block"></span><span>(a)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>removal of a tooth or part or parts of a tooth; or</span></p><p class="TableP1a" style="margin-top:3pt; margin-bottom:6pt"><span style="width:7.57pt; text-indent:0pt; display:inline-block"></span><span>(b)</span><span style="width:6.25pt; text-indent:0pt; display:inline-block"> </span><span>sectional removal of a tooth;</span></p><p class="TableText" style="margin-top:6pt"><span>on the same day as a service described in item 85311 or 85314 is provided to the patient</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>87.95</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Surgical extractions</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85322</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Surgical removal of a tooth or tooth fragment, not requiring removal of bone or tooth division, including local anaesthesia and routine post</span><span>‑</span><span>operative care</span><span> </span><span>— first tooth extracted on a day</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>192.40</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85323</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Surgical removal of a tooth or tooth fragment, requiring removal of bone, including local anaesthesia and routine post</span><span>‑</span><span>operative care</span><span> </span><span>— first tooth extracted on a day</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>219.75</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85324</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Surgical removal of a tooth or tooth fragment, requiring removal of bone and tooth division, including local anaesthesia and routine post</span><span>‑</span><span>operative care</span><span> </span><span>— first tooth extracted on a day</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>295.65</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85326</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Additional extraction requiring surgical removal of a tooth or tooth fragment, on the same day as a service described in item 85322, 85323 or 85324 is provided to the patient</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>185.30</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 3</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Surgery for prostheses</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85331</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Alveolectomy, including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span><span> </span><span>— each segment</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>119.95</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85337</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Reduction of fibrous tuberosity, including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>168.60</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85338</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Reduction of flabby ridge, including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span><span> </span><span>— each segment</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>78.90</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85341</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal of hyperplastic tissue, including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>182.80</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 4</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— General surgical</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85377</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal or repair of soft tissue (not described in another item), including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>182.95</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85378</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Surgical removal of foreign body, including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>103.55</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 5</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Other surgical procedures</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85381</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Surgical exposure of unerupted tooth, including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>259.35</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85384</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Repositioning of displaced tooth, including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span><span> </span><span>— each tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>172.40</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85386</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Splinting of displaced tooth, including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span><span> </span><span>— each tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>177.80</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85387</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Replantation and splinting of tooth, including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>348.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85391</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Frenectomy, including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>159.75</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85392</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Incision and drainage of abscess or cyst, including insertion of sutures, normal post</span><span>‑</span><span>operative care and suture removal</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>87.50</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group A5</span><span> </span><span>— Endodontics</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Pulp and root canal treatments</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85411</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Direct pulp capping</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>31.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85412</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Incomplete endodontic therapy</span><span> </span><span>— inoperable or fractured</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>107.75</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85414</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Pulpotomy</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>68.70</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85415</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Complete chemo</span><span>‑</span><span>mechanical preparation of root canal</span><span> </span><span>— first canal on a tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>193.40</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85416</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Complete chemo</span><span>‑</span><span>mechanical preparation of root canal</span><span> </span><span>— each additional canal on a tooth for which the service described in item</span><span> </span><span>85415 has been performed</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>92.15</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85417</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Root canal obturation</span><span> </span><span>— first canal on a tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>188.35</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85418</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Root canal obturation</span><span> </span><span>— each additional canal on a tooth for which the service described in item 85417 has been performed</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>88.10</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85419</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Extirpation of pulp or debridement of root canal or canals</span><span> </span><span>— emergency or palliative</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>124.55</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Periradicular surgery</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85431</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Periapical curettage</span><span> </span><span>— each root</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>225.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85432</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Apicectomy, including curettage</span><span> </span><span>— each root</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>279.95</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85433</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-bottom:6pt"><span>Exploratory periradicular surgery</span></p><p class="TableText" style="margin-top:6pt"><span>(Item is subject to sections 13 and 15)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>114.90</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85434</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Apical seal, including apicectomy and periapical curettage</span><span> </span><span>— each canal</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>347.00</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85436</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Sealing of perforation</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>214.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85437</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Surgical treatment and repair of an external root resorption</span><span> </span><span>— each tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>349.60</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85438</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Hemisection</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>259.35</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 3</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Other endodontic services</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85445</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Exploration for a calcified root canal</span><span> </span><span>— each canal</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>95.45</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85451</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal of root filling</span><span> </span><span>— each canal</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>95.45</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85452</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal of cemented root canal post or post crown</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>95.45</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85453</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal of or bypassing fractured endodontic instrument</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>79.60</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85455</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Additional visit for irrigation or dressing, or irrigation and dressing, of the root canal system</span><span> </span><span>— each tooth</span></p><p class="TableText"><span>(Item is subject to section 16)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>95.45</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85457</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Obturation of resorption defect or perforation</span><span> </span><span>— non</span><span>‑</span><span>surgical</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>95.45</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85458</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Interim therapeutic root filling</span><span> </span><span>— each tooth</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>127.25</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group A6</span><span> </span><span>— Restorative services</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Metallic restorations</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— direct</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85511</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metallic restoration, 1 surface</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>94.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85512</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metallic restoration, 2 surfaces</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>115.45</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85513</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metallic restoration, 3 surfaces</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>137.70</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85514</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metallic restoration, 4 surfaces</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>157.00</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85515</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metallic restoration, 5 surfaces</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>179.25</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Adhesive restorations</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— anterior teeth</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— direct</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85521</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adhesive restoration, 1 surface, anterior tooth</span><span> </span><span>— direct</span></p><p class="TableText"><span>(Item is subject to section 17)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>104.30</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85522</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adhesive restoration, 2 surfaces, anterior tooth</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>126.55</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85523</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adhesive restoration, 3 surfaces, anterior tooth</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>149.85</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85524</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adhesive restoration, 4 surfaces, anterior tooth</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>173.15</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85525</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adhesive restoration, 5 surfaces, anterior tooth</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>203.55</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 3</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Adhesive Restorations</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— posterior teeth</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— direct</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85531</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adhesive restoration, 1 surface, posterior tooth</span><span> </span><span>— direct</span></p><p class="TableText"><span>(Item is subject to section 17)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>111.40</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85532</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adhesive restoration, 2 surfaces, posterior tooth</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>139.75</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85533</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adhesive restoration, 3 surfaces, posterior tooth</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>168.10</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85534</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adhesive restoration, 4 surfaces, posterior tooth</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>189.40</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85535</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adhesive restoration, 5 surfaces, posterior tooth</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>218.75</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 4</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Metallic restorations</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— indirect</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85541</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metallic restoration, 1 surface</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>405.95</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85542</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metallic restoration, 2 surfaces</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>536.45</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85543</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metallic restoration, 3 surfaces</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>701.10</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85544</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metallic restoration, 4 surfaces</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>819.15</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85545</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metallic restoration, 5 surfaces</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>871.75</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 5</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Tooth coloured restorations</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— indirect</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85551</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Tooth</span><span>‑</span><span>coloured restoration, 1 surface</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>496.90</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85552</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Tooth</span><span>‑</span><span>coloured restoration, 2 surfaces</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>678.95</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85553</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Tooth</span><span>‑</span><span>coloured restoration, 3 surfaces</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>785.00</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85554</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Tooth</span><span>‑</span><span>coloured restoration, 4 surfaces</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>888.00</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85555</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Tooth</span><span>‑</span><span>coloured restoration 5 surfaces</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>849.40</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 6</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Other restorative services</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85572</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Provisional restoration</span><span> </span><span>— intermediate or temporary</span></p><p class="TableText"><span>(Item is subject to sections 13 and 18)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>44.00</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85574</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metal band</span><span> </span><span>— the cementation of a metal band for diagnostic purposes, protective purposes or for the placement of a provisional (intermediate) restoration</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>37.10</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85575</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Pin retention</span><span> </span><span>— each pin</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>25.30</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85576</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Stainless steel crown</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>191.75</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85577</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Cusp capping</span><span> </span><span>— each cusp</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>27.35</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85578</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Restoration of an incisal corner</span><span> </span><span>— each corner</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>27.35</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85595</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal of inlay or onlay</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>87.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85596</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Recementing of inlay or onlay</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>71.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85597</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Post, direct</span><span> </span><span>— insertion of a post into a prepared root canal to provide an anchor for an artificial crown or other restoration</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>133.20</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group A7</span><span> </span><span>— Crown and Bridge</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Crowns</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85613</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Full crown, non metallic</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>1</span><span> </span><span>096.35</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85615</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Full crown, veneered</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>1</span><span> </span><span>035.30</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85618</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Full crown, metallic</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>974.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85625</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Core for crown including post</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>288.65</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85627</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Preliminary restoration for crown</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>119.30</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85629</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Post and root cap</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>302.40</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="page-break-after:avoid"><span style="font-family:Arial, sans-serif; font-size:9pt; font-style:italic">Subgroup 2</span><span style="font-family:Arial, sans-serif; font-size:9pt; font-style:italic"> </span><span style="font-family:Arial, sans-serif; font-size:9pt; font-style:italic">— Temporary (provisional ) crown and bridge</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableP1a"><span>85631</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableP1a"><span>Provisional crown</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>137.60</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableP1a"><span>85632</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableP1a"><span>Provisional bridge</span><span> </span><span>— each pontic</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>198.55</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="page-break-after:avoid"><span style="font-family:Arial, sans-serif; font-size:9pt; font-style:italic">Subgroup 3</span><span style="font-family:Arial, sans-serif; font-size:9pt; font-style:italic"> </span><span style="font-family:Arial, sans-serif; font-size:9pt; font-style:italic">— Bridges</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85642</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Bridge pontic, direct</span><span> </span><span>— each pontic</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>532.40</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85643</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Bridge pontic, indirect</span><span> </span><span>— each pontic</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>810.25</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85644</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Semi</span><span>‑</span><span>fixed attachment</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>258.35</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85645</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Precision or magnetic attachment</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>297.40</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85649</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Retainer for bonded fixture, indirect</span><span> </span><span>— each tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>288.95</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="page-break-after:avoid"><span style="font-family:Arial, sans-serif; font-size:9pt; font-style:italic">Subgroup 4</span><span style="font-family:Arial, sans-serif; font-size:9pt; font-style:italic"> </span><span style="font-family:Arial, sans-serif; font-size:9pt; font-style:italic">— Crown and bridge repairs and other services</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85651</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Recementing crown or veneer</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>93.15</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85652</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Recementing bridge or splint</span><span> </span><span>— each abutment</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>90.90</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85653</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Rebonding of bridge or splint if retreatment of bridge surface is required</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>82.75</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85655</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal of crown</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>55.65</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85656</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal of bridge or splint</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>167.05</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85658</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Repair of crown, bridge or splint, including labour and laboratory costs</span><span> </span><span>— indirect.</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>345.05</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85659</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Repair of crown, bridge or splint</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>227.45</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 5</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Implant Prostheses</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85661</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Fitting of implant abutment</span><span> </span><span>— each abutment</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>520.10</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85669</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Removal and reattachment of prosthesis fixed to implant or implants</span><span> </span><span>— each implant</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>146.60</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85671</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Full crown attached to osseointegrated implant, non metallic</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>1</span><span> </span><span>096.35</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85672</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Full crown attached to osseointegrated implant, veneered</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>1</span><span> </span><span>233.30</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85673</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Full crown attached to osseointegrated implant, metallic – indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>975.45</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group A8</span><span> </span><span>— Prosthodontics</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Dentures and denture components</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85711</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Complete maxillary denture</span></p><p class="TableText"><span>(Item is subject to section 12)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>797.70</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85712</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Complete mandibular denture</span></p><p class="TableText"><span>(Item is subject to section 12)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>797.70</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85716</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metal palate or plate</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>285.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85719</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Complete maxillary and mandibular dentures</span></p><p class="TableText"><span>(Item is subject to section 12)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>1</span><span> </span><span>364.10</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85721</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Partial maxillary denture</span><span> </span><span>— resin, base only</span></p><p class="TableText"><span>(Item is subject to section 12)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>383.80</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85722</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Partial mandibular denture</span><span> </span><span>— resin, base only</span></p><p class="TableText"><span>(Item is subject to section 12)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>383.80</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85727</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Partial maxillary denture, base only, consisting of cast metal framework and including provision of casting, clasps, retainers and occlusal rests</span></p><p class="TableText"><span>(Item is subject to section 12)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>1</span><span> </span><span>145.90</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85728</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Partial mandibular denture, base only, consisting of cast metal framework and including provision of casting, clasps, retainers and occlusal rests</span></p><p class="TableText"><span>(Item is subject to section 12)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>1</span><span> </span><span>145.90</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85731</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Retainer</span><span> </span><span>— each tooth, if a service described in item 85721 or</span><span> </span><span>85722 has been provided to the patient</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>39.80</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85732</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Occlusal rest</span><span> </span><span>— each rest, if a service described in item 85721 or</span><span> </span><span>85722 has been provided to the patient</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>19.35</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85733</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Addition of tooth to the base of a new partial denture</span><span> </span><span>— each tooth</span></p><p class="TableText"><span>(Item is subject to section 19)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>41.10</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85735</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Precision or magnetic attachment</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>230.15</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85736</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Immediate tooth replacement</span><span> </span><span>— each tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>8.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85737</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Resilient lining</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>170.80</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85738</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Wrought bar</span><span> </span><span>— joining sections of a partial prosthesis</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>159.15</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85739</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Metal backing</span><span> </span><span>— an extension of the casting of a cast metal partial denture to provide a backing for the denture tooth</span><span> </span><span>— each backing</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>71.90</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; margin-right:1.7pt; margin-bottom:3pt; page-break-after:avoid; font-size:9pt"><span style="font-family:Arial, sans-serif; font-style:italic">Subgroup 2</span><span style="font-family:Arial, sans-serif; font-style:italic"> </span><span style="font-family:Arial, sans-serif; font-style:italic">— Denture maintenance</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85741</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adjustment of a denture to improve comfort and function</span><span> </span><span>— not including a routine adjustment following the insertion of a new denture or maintenance or repair of an existing denture</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>47.15</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85743</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Relining, complete denture</span><span> </span><span>— processed</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>300.80</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85744</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Relining, partial denture</span><span> </span><span>— processed</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>256.30</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85745</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Remodelling, complete denture</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>472.65</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85746</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Remodelling, partial denture</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>404.10</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85751</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Relining, complete denture, chair</span><span>‑</span><span>side only, hard or soft material</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>164.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85752</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Relining, partial denture</span><span> </span><span>— direct</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>138.70</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85753</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Cleaning and polishing of pre</span><span>‑</span><span>existing denture</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>38.25</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 3</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Denture repairs</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85761</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Reattaching pre</span><span>‑</span><span>existing tooth or clasp to denture, including labour and laboratory costs</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>130.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85762</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Replacing clasp on denture</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>136.05</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85763</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Repairing broken base of a complete denture, including labour and laboratory costs</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>117.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85764</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Repairing broken base of a partial denture, including labour and laboratory costs</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>130.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85765</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Replacing first tooth on denture</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>136.05</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85767</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Any repair or tooth replacement in addition to other repairs, alterations or other modifications for the same denture on the same day, including labour and laboratory costs</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>53.80</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85768</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adding tooth to partial denture to replace an extracted or decoronated tooth</span><span> </span><span>— each tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>137.70</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85769</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Repair or addition to metal casting</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>164.70</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 4</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Other prosthodontic services</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85771</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Tissue conditioning treatment before impressions</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>62.50</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85772</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Splint, resin</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>244.75</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85773</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Splint, metal</span><span> </span><span>— indirect</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>259.35</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85776</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Impression if required for denture repair or modification</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>41.55</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85777</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Identification</span><span> </span><span>— marking a dental appliance with the name of a patient or other form of enduring patient identification</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>33.25</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group A9</span><span> </span><span>— Orthodontics</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Removable appliances</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85811</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Passive removable appliance</span><span> </span><span>— each arch</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>293.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85821</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Active removable appliance</span><span> </span><span>— each arch</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>503.85</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85823</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Functional orthopaedic appliance</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>439.05</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Fixed appliances</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85829</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Partial banding</span><span> </span><span>— each arch</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>525.30</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85831</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Full arch banding</span><span> </span><span>— each arch</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>1</span><span> </span><span>329.90</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span>Group A10</span><span> </span><span>— General services</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 1</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Emergencies</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85911</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Palliative care</span><span> </span><span>— interim care to relieve pain, infection, bleeding or other problems not associated with other services</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>61.80</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 2</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Drug therapy</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85926</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Individually made tray for the application of medicaments to teeth or supporting tissues, other than for bleaching</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>143.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85927</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Supply, prescription or administration of medications and medicaments required for a service</span></p><p class="TableText"><span>(Item subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>24.85</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 3</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Anaesthesia and sedation</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85949</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Treatment under general anaesthesia, if the anaesthetic is administered by a specialist anaesthetist</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>150.20</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 4</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Occlusal therapy</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85963</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Clinical occlusal analysis including muscle and joint palpation</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>79.60</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85964</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Registration and mounting of casts for occlusal analysis</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>68.20</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85965</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Occlusal splint</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>474.15</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85966</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adjustment of pre</span><span>‑</span><span>existing occlusal splint</span><span> </span><span>— each visit</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>66.70</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85968</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Occlusal adjustment following occlusal analysis</span><span> </span><span>— each visit</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>96.85</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85971</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Adjunctive physical therapy for temporomandibular joint and associated structures</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>56.40</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85972</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Repair or addition of occlusal splint</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>199.20</span></p></td></tr><tr><td colspan="3" style="width:408.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableColHead"><span style="font-weight:normal; font-style:italic">Subgroup 5</span><span style="font-weight:normal; font-style:italic"> </span><span style="font-weight:normal; font-style:italic">— Miscellaneous</span></p></td></tr><tr><td style="width:36.6pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85981</span></p></td><td style="width:301.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Splinting and stabilisation, direct</span><span> </span><span>— each tooth</span></p></td><td style="width:49.2pt; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>87.50</span></p></td></tr><tr><td style="width:36.6pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>85986</span></p></td><td style="width:301.2pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText"><span>Post</span><span>‑</span><span>operative care if not provided for in another item</span></p><p class="TableText"><span>(Item is subject to section 13)</span></p></td><td style="width:49.2pt; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p class="TableText" style="margin-right:11.35pt; text-align:right"><span>63.70</span></p></td></tr></tbody></table> ```Sourced from the Federal Register of Legislation (legislation.gov.au), CC BY 4.0.
Health Insurance (Dental Services) Determination 2007
as amended
made under subsection 3C (1) of the
Health Insurance Act 1973
This compilation was prepared on 8 September 2012
taking into account amendments up to Health Insurance (Dental Services) Amendment Determination 2012 (No. 1)
Prepared by the Office of Legislative Drafting and Publishing,
Attorney‑General’s Department, Canberra
Contents
1 Name of Determination [see Note 1]
2 Commencement
Section 2A Cessation
3 Definitions
4 Dental services
5 Monetary limit on medicare benefits
6 Patient eligibility
7 Effect of election to claim private health insurance for a dental service
8 Application of items — dental services provided by eligible providers to eligible patients
9 Referral
10 Quotation for dental services and reporting
11 Purpose of service
12 Limitation on items — dentures and denture components
13 Limitation on number of certain services
14 Limitation on provision of certain services
15 Application of item 85433
16 Application of item 85455
17 Limitation on items 85521 and 85531
18 Application of item 85572
19 Application of items 85733, 86733 and 87733
20 Application of item 86433
21 Application of item 86455
22 Limitation on items 86521 and 86531
23 Application of item 86572
Schedule 1 Dental services and fees
Part 1 Services provided by eligible dentists
Part 2 Services provided by eligible dental specialists
Part 3 Services provided by eligible dental prosthetists
Schedule 2 Specialties
Notes
1 Name of Determination [see Note 1]
This Determination is the Health Insurance (Dental Services) Determination 2007.
2 Commencement
This Determination commences on 1 November 2007.
Section 2A Cessation
This Determination ceases at midnight 30 November 2012.
3 Definitions
In this Determination:
Act means the Health Insurance Act 1973.
dental service means a dental service mentioned in Schedule 1.
eligible dental prosthetist means an individual:
(a) who is registered or entitled to practice as a dental prosthetist under a law of a State or Territory; and
(b) whose registration or entitlement to practice as a dental prosthetist entitles the individual to provide services to which any of the items mentioned in Part 3 of Schedule 1 apply; and
(c) whose name is entered in the register, kept by the Chief Executive Medicare, of dental prosthetists who can provide services to which any of the items mentioned in Part 3 of Schedule 1 apply.
eligible dental specialist means a person:
(a) who is registered or licensed to practice under a law of a State or Territory in a specialty mentioned in Schedule 2; and
(b) whose name is entered in the register, kept by the Chief Executive Medicare, of dental specialists who can provide services to which any of the items mentioned in Part 2 of Schedule 1 apply.
eligible dentist means a dental practitioner whose name is entered in the register, kept by the Chief Executive Medicare, of dental practitioners who can provide services to which any of the items mentioned in Part 1 of Schedule 1 apply.
eligible patient has the meaning given by section 6.
GP management plan means a plan to which item 721 of the general medical services table or item 725 of the general medical services table as in force on or before 30 April 2010 applies.
multidisciplinary care plan has the meaning given by clause 2.17.6 of the general medical services table.
relevant provisions means all provisions, relating to professional services or to medical services, of the Act and regulations made under the Act, and the National Health Act 1953 and regulations made under that Act.
team care arrangements means team care arrangements to which item 723 of the general medical services table or item 727 of the general medical services table as in force on or before 30 April 2010 applies.
Note Unless a contrary intention appears, an expression used in this Determination has the same meaning as in the Health Insurance Act 1973 — see section 13 of the Legislative Instruments Act 2003.
4 Dental services
A dental service provided in accordance with this Determination is to be treated, for the relevant provisions, as if:
(a) it were both a professional service and a medical service; and
(b) there were an item in the general medical services table that:
(i) related to the service; and
(ii) specified for the service a fee for each State, being the fee mentioned in the item in Schedule 1 for the service.
Note For this Determination, an internal Territory is deemed to form part of the State of New South Wales — see subsection 3C (7) of the Act.
5 Monetary limit on medicare benefits
(1) For subsection 3C (2A) of the Act, the total of all amounts of medicare benefit paid or payable for dental services provided to a person in a relevant 2 year period must not exceed $4 250.
(2) In this section:
relevant 2 year period, for a person, has the meaning given by subsections (3) and (4).
(3) If:
(a) a person received a dental service on or after 1 November 2007; and
(b) the service is the first dental service that the person has received on or after 1 November 2007;
the calendar year in which the person received that first dental service and the following calendar year is a relevant 2 year period for the person.
(4) After that relevant 2 year period, each calendar year in which the person receives a dental health service and the following calendar year is a relevant 2 year period for the person unless the first mentioned year is already part of a relevant 2 year period because of a previous application of this subsection.
Example 1
A person who first receives a dental service on 25 November 2007 will be eligible for not more than $4 250 in medicare benefits for all dental services provided to the person in 2007 and 2008.
A 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 2009.
Example 2
A person who first receives a dental service on 15 January 2008 will be eligible for not more than $4 250 in medicare benefits for all dental services provided to the person in 2008 and 2009.
A further relevant 2 year period commences for the person in the calendar year when the patient first receives a dental service on or after 1 January 2010.
6 Patient eligibility
A person is an eligible patient if:
(a) the person either:
(i) has in place a GP management plan and team care arrangements, both of which were received on or before 7 September 2012; or
(ii) has in place a multidisciplinary care plan to which item 731 of the general medical services table applies which was received on or before 7 September 2012; and
(b) his or her oral health is impacting on, or is likely to impact on, his or her general health; and
(c) the person has been referred for a dental service under section 9; and
(d) the person is not an admitted patient of a hospital.
7 Effect of election to claim private health insurance for a dental service
An item in Schedule 1 applies to a dental service only if a private health insurance benefit has not been claimed for that service.
8 Application of items — dental services provided by eligible providers to eligible patients
(1) An item in Part 1 of Schedule 1 applies only to a dental service provided by an eligible dentist to an eligible patient.
(2) An item in Part 2 of Schedule 1 applies only to a dental service provided by an eligible dental specialist to an eligible patient.
(3) An item in Part 3 of Schedule 1 applies only to a dental service provided by an eligible dental prosthetist to an eligible patient.
9 Referral
(1) A general practitioner may refer an eligible patient for a dental service only to:
(a) an eligible dentist; or
(b) an eligible dental prosthetist, if the patient:
(i) has no natural teeth and requires only dental prosthetic services; or
(ii) requires only repairs or maintenance to an existing denture.
(2) A referral by a general practitioner must be made in the form published by the Department and described as ‘Referral Form for Dental Services under Medicare’, as existing on 1 November 2007, or a form that substantially complies with that form.
Note The form is available on the internet — see http://www.health.gov.au.
(3) An eligible dentist who has provided a dental service to an eligible patient referred to the eligible dentist under this subsection or subsection (1), (4) or (5) may refer the patient to an eligible dentist, an eligible dental specialist or an eligible dental prosthetist for an additional dental service.
(4) An eligible dental specialist who has provided a dental service to an eligible patient referred to the eligible dental specialist under this subsection or subsection (3) may refer the patient to an eligible dentist, an eligible dental specialist or an eligible dental prosthetist for an additional dental service.
(5) An eligible dental prosthetist who has provided a dental service to an eligible patient referred to the eligible dental prosthetist under this subsection or subsection (1), (3) or (4) may refer the patient to an eligible dentist or an eligible dental prosthetist for an additional dental service.
10 Quotation for dental services and reporting
(1) This section applies if:
(a) an eligible dentist, an eligible dental specialist or an eligible dental prosthetist performs an initial examination and assessment of an eligible patient, including consideration of any diagnostic tests; and
(b) provides a course of treatment to the patient.
(2) An item in Schedule 1 applies to a dental service included in the course of treatment only if, before beginning the course of treatment, the eligible dentist, eligible dental specialist or eligible dental prosthetist:
(a) gave to the eligible patient, in writing:
(i) a plan of the course of treatment; and
(ii) a quotation for each dental service and each other service (if any) in the plan; and
(b) gave a copy or written summary of the plan to the general practitioner who referred the patient for dental services.
11 Purpose of service
(1) An item in Schedule 1 applies to a dental service only if the primary purpose of the service is to improve the oral health or function of the eligible patient.
(2) An item in Schedule 1 does not apply to a dental service if the primary purpose of the service is to improve the appearance of the eligible patient.
(3) An item in Schedule 1 applies to a dental service if the primary purpose of the service is to improve the oral health or function of the eligible patient and another purpose of the service is to improve the patient’s appearance.
12 Limitation on items — dentures and denture components
(1) For any particular eligible patient, a set of dentures applies not more than:
(a) once in 8 years; or
(b) if exceptional circumstances exist in relation to the patient — twice in 8 years.
(2) In this section:
exceptional circumstances exist in relation to an eligible patient if:
(a) an eligible dentist, an eligible dental specialist or an eligible dental prosthetist is satisfied that there has been a significant change in the clinical condition of the patient that necessitates a new set of dentures for the patient; or
(b) the existing dentures of the patient have been irreparably damaged or lost.
set of dentures means:
(a) complete maxillary and mandibular dentures under item 85719, 86719 or 87719; or
(b) a complete or partial maxillary denture under item 85711, 85721, 85727, 86711, 86721, 86727, 87711, 87721 or 87727; or
(c) a complete or partial mandibular denture under item 85712, 85722, 85728, 86712, 86722, 86728, 87712, 87722 or 87728; or
(d) both:
(i) a complete or partial maxillary denture under any of the items mentioned in paragraph (b); and
(ii) a complete or partial mandibular denture under any of the items mentioned in paragraph (c).
13 Limitation on number of certain services
For any particular eligible patient, an item 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.
| Item | Item of service | Number of times | Period |
|---|---|---|---|
| 1 | 85123, 85311, 85314, 85322, 85323, 85324, 86123, 86311, 86314, 86322, 86323, 86324 | 1 | 1 day |
| 2 | 85927, 86927 | 1 | 3 months |
| 3 | 85111, 85114, 85121, 86111, 86114, 86121 | 1 | 6 months |
| 4 | 85039, 85047, 85131, 85141, 85221, 85225, 85245, 85433, 86036, 86039, 86047, 86131, 86141, 86221, 86225, 86245, 86433 | 1 | 12 months |
| 5 | 85753, 86753, 87753 | 1 | 24 months |
| 6 | 85963, 85964, 86963, 86964 | 1 | 36 months |
| 7 | 85222, 86222 | 2 | 1 day |
| 8 | 85115, 85213, 85234, 85986, 86115, 86213, 86234, 86235, 86986 | 2 | 12 months |
| 9 | 85013, 85572, 86013, 86572 | 3 | 3 months |
| 10 | 85458, 86458 | 3 | 12 months |
| 11 | 85231, 85232, 85233, 85971, 86231, 86232, 86233, 86971 | 4 | 12 months |
| 12 | 85771, 86771, 87771 | 5 | 3 months |
| 13 | 85022, 86022 | 6 | 1 day |
14 Limitation on provision of certain services
For any particular eligible patient, an item mentioned in column 2 of the following table is applicable to a service provided by a particular eligible dentist, eligible dental specialist or eligible dental prosthetist not more than once in the period mentioned in column 3 of the table.
| Item | Item of service | Period |
|---|---|---|
| 1 | 85012, 86012 | 6 months |
| 2 | 86015, 86038, 86082 | 12 months |
| 3 | 85011, 87011 | 24 months |
15 Application of item 85433
For any particular eligible patient, item 85433 does not apply to a service provided to the patient on a day if a service described in item 85431, 85432, 85434, 85436, 85437 or 85438 is provided to the patient on the day.
16 Application of item 85455
For any particular eligible patient, item 85455 does not apply to a service provided to the patient on a day if a service described in item 85415, 85416, 85417 or 85418 is provided to the patient on the day.
17 Limitation on items 85521 and 85531
For any particular eligible patient, any combination of items 85521 and 85531 is applicable to not more than 5 services provided to the patient on a day.
18 Application of item 85572
For any
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