12Limitation on items — dentures and denture components

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).