CTHRepealedLegislation
Health Insurance (Dental Services) Determination 2007
Part 1Services provided by eligible dentists
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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> ```