Effective 1 July 2017
| GP | SP | ||||
|---|---|---|---|---|---|
| Service Description | ADA Number | 2017/2018 Maximum Payment Rate | 2016/2017 Maximum Payment Rate | 2017/2018 Maximum Payment Rate | 2016/17 Maximum Payment Rate |
| Diagnostic services | |||||
| Periodic oral examination | 012 | $47.92 | $47.22 | $69.83 | $68.81 |
| Initial examination and completion of TAC report form "DTF 1" | 011, 018 | $93.63 | $92.26 | $115.71 | $114.02 |
| Consultation arranged by the TAC for a second opinion, including a written report | 014, 018 | $158.44 | $156.13 | $221.68 | $218.45 |
| Single intraoral radiograph | 022 | $39.05 | $38.48 | $39.05 | $38.48 |
| Cephalometric radiograph | 036 | $103.79 | $102.28 | $103.79 | $102.28 |
| Panoramic radiograph (eg OPG) | 037 | $103.79 | $102.28 | $103.79 | $102.28 |
| Pulp vitality testing - per visit (maximum 3 visits per year) | 061 | $17.76 | $17.50 | $17.76 | $17.50 |
| Diagnostic model | 071 | $47.75 | $47.05 | $47.75 | $47.05 |
| Photographic records (for the TAC) | 072 | $26.41 | $26.02 | $26.41 | $26.02 |
| Preventive Services | |||||
| (Prior approval from TAC required for these services) | |||||
| Removal of plaque and stain | 114 | $84.86 | $83.62 | $84.86 | $83.62 |
|
Non-vital bleaching (if separate appointments are made) | 117 | $164.63 | $162.23 | $205.83 | $202.83 |
| Topical fluoride treatment | 121 | $51.01 | $50.27 | $51.01 | $50.27 |
|
Oral hygiene instruction where appropriate time is allocated | 141 | $30.49 | $30.05 | $38.10 | $37.54 |
| Adjunctive General Services | |||||
| Desensitisation of dentine (per visit) | 165 | $32.74 | $32.26 | $32.74 | $32.26 |
| Odontoplasty for fractured teeth (per tooth) | 171 | $32.74 | $32.26 | $32.74 | $32.26 |
| Periodontics | |||||
| Root planing and subgingival curettage (per segment) | 222 | FBN* | FBN* | $261.88 | $258.06 |
| Periodontal flap surgery (per segment) | 232 | FBN* | FBN* | $698.19 | $688.01 |
| Osseous surgery (per segment) | 233 | FBN* | FBN* | $314.90 | $310.31 |
| Osseous graft | |||||
| Small amount (eg alveolar bone) | 234A | $287.43 | $283.24 | ||
| Large amount (eg rib graft) | 234B | $476.43 | $469.48 | ||
| Gingival connective tissue graft | 235 | FBN* | FBN* | $698.19 | $688.01 |
| Guided tissue regeneration (per tooth or implant) | 236/237 | FBN* | FBN* | $698.19 | $688.01 |
| Expendable GTR material | 236A | ||||
| Crown lengthening - including alveolar bone removal (per tooth). NB: Multiple operation rule applies | 238 | FBN* | FBN* | $537.16 | $529.33 |
| Oral Surgery | |||||
| Extraction of a single tooth | 311 | $121.75 | $119.97 | $152.13 | $149.91 |
| Sectional removal of tooth | 314 | $179.08 | $176.47 | $188.49 | $185.74 |
| Surgical extraction without bone removal | 322 | $179.08 | $176.47 | $188.49 | $185.74 |
| Surgical extraction requiring bone removal | 323 | $229.64 | $226.29 | $281.06 | $276.96 |
| Removal of soft tissue | 377 | $46.22 | $45.55 | $46.22 | $45.55 |
| Repositioning and splinting of displaced tooth | 386 | $190.01 | $187.24 | $237.88 | $234.41 |
| Replanting avulsed tooth and splinting | 387, 772 | $269.91 | $265.97 | $382.00 | $376.43 |
| Endodontics | |||||
| Pulp capping | 411 | $32.49 | $32.02 | $40.62 | $40.03 |
| Cvek pulpotomy | 414 | $118.64 | $116.91 | $173.47 | $170.94 |
| Extirpation of pulp or debridement of root canal - 1 canal | 415†| $216.13 | $212.98 | $316.29 | $311.68 |
| Extirpation of pulp or debridement of root canal - each additional canal | 416 | $96.37 | $94.96 | $129.98 | $128.08 |
| Root canal obturation - 1 canal | 417†| $224.79 | $221.51 | $323.60 | $318.88 |
| Root canal obturation - each additional canal | 418 | $96.37 | $94.96 | $129.98 | $128.08 |
| Emergency endodontic procedure not exceeding 15 minutes | 419 | $121.75 | $119.97 | $152.13 | $149.91 |
| Apicectomy and apical seal | 432, 434 | $235.06 | $231.63 | $312.50 | $307.94 |
| Apexification - fee additional to routine endodontic treatment | 458 | $134.01 | $132.06 | $210.62 | $207.55 |
| Removal of root filling (per canal) | 451 | $88.96 | $87.66 | $126.82 | $124.97 |
| Additional visit for irrigation and/or dressing of the root canal system | 455 | $85.73 | $84.48 | $103.79 | $102.28 |
| †These fees include the cost of x-rays where required | |||||
| Restorative Services | |||||
| Metallic restoration - 1 surface | 511 | $101.79 | $100.31 | $128.39 | $126.52 |
| Metallic restoration - 2 surfaces | 512 | $121.74 | $119.96 | $166.33 | $163.90 |
| Metallic restoration - 3 surfaces | 513 | $144.35 | $142.24 | $210.62 | $207.55 |
| Adhesive resin restoration: anterior tooth - 1 surface | 521 | $111.63 | $110.00 | $141.20 | $139.14 |
| Adhesive resin restoration: anterior tooth - 2 surfaces | 522 | $131.85 | $129.93 | $178.37 | $175.77 |
| Adhesive resin restoration: anterior tooth - 3 surfaces | 523 | $152.13 | $149.91 | $216.13 | $212.98 |
| Adhesive resin restoration: anterior tooth - 4 surfaces | 524 | $183.85 | $181.17 | $252.83 | $249.14 |
| Adhesive resin restoration: posterior tooth - 1 surface | 531 | $117.70 | $115.98 | $147.03 | $144.89 |
| Adhesive resin restoration: posterior tooth - 2 surfaces | 532 | $141.95 | $139.88 | $177.50 | $174.91 |
| Adhesive resin restoration: posterior tooth - 3 surfaces | 533 | $170.37 | $167.89 | $223.97 | $220.70 |
| Metallic inlay or onlay - 2 surface cavity | 542 | $612.85 | $603.91 | $739.45 | $728.67 |
| Metallic inlay or onlay - 3 surface cavity | 543 | $720.39 | $709.88 | $889.67 | $876.69 |
| In the administration of the TAC's dental service the term "gold" shall be restricted to alloys with a gold content of not less than 40% and with total precious metal content in excess of 60%. Any other dental alloy will be classified as "non precious metal". | |||||
| Complex coronal metallic reconstruction in amalgam | 515 | $189.30 | $186.54 | $265.34 | $261.47 |
| Complex coronal reconstruction in tooth coloured adhesive resin - direct | 525/535 | $281.06 | $276.96 | $360.08 | $354.83 |
| Temporary restoration emergency or interim treatment only | 572 | $95.15 | $93.76 | $118.87 | $117.14 |
| Pin retention (per unit pin) | 575 | $27.99 | $27.58 | $27.99 | $27.58 |
| Enamel bonded adhesive resin facing | 582 | $253.53 | $249.83 | $316.83 | $312.21 |
| Indirect bonded facing | 583 | $840.45 | $828.19 | $1,065.86 | $1,050.32 |
| Post - direct preformed | 597 | $95.15 | $93.76 | $118.87 | $117.14 |
| Temporary composite bridge when not part of definitive treatment (per pontic) | 632 | $198.01 | $195.12 | $243.00 | $239.46 |
| Crown and Bridgework | |||||
| Bridges should be described in terms of the Australian Dental Association's Schedule of Dental Services. However, in addition to the number of units, the number of abutment teeth and pontics should be stated [eg 3 units (2+1). The fee which the TAC will consider reasonable may be calculated by adding the fees listed for the restoration of the abutment teeth to the fees listed for the pontic or pontics as hereunder specified. | |||||
| Indirect non-metallic full crown | 613 | $1,226.00 | $1,208.12 | $1,602.57 | $1,579.20 |
| Indirect veneered full crown | 615 | $1,314.72 | $1,295.55 | $1,686.44 | $1,661.84 |
| Full crown - metallic | 618 | $1,226.00 | $1,208.12 | $1,602.57 | $1,579.20 |
| Cast core for crown including post | 625 | $307.07 | $302.59 | $537.16 | $529.33 |
| Preliminary restoration for crown | 627 | $189.30 | $186.54 | $265.33 | $261.46 |
| Pontics - direct | 642 | $230.44 | $227.08 | $307.05 | $302.57 |
| Pontics - indirect | 643 | $1,016.53 | $1,001.70 | $1,270.54 | $1,252.01 |
| Bridge - indirect bonded (Maryland) | |||||
| 1 pontic | 643/ 649 | $1,314.72 | $1,295.55 | $1,583.58 | $1,560.48 |
| 2 pontics | 643/ 649 | $1,891.87 | $1,864.28 | $2,358.85 | $2,324.45 |
| Implant based veneered - full crown | 661, 672 | $2,000.18 | $1,971.01 | $2,440.38 | $2,404.79 |
| Surgical Procedures For Implant Prostheses | |||||
| Hardware for implant procedures | 661A | ||||
| Prosthesis with metal frame for bridgework (per implant) | 666 | $1,559.77 | $1,537.02 | ||
| Removal and reattachment of implant prosthesis for repair or cleaning | 669 | $158.44 | $156.13 | ||
| Surgical implant guide | 679 | $216.13 | $212.98 | $216.13 | $212.98 |
| Osseo-integration procedure - intraoral implantation of titanium fixture | 684 | FBN* | FBN* | $960.55 | $946.54 |
| Osseo-integration procedure - one-stage | 688 | FBN* | FBN* | $1,074.23 | $1,058.56 |
| Osseo-integration procedure - fixation of transcutaneous abutment | 691 | FBN* | FBN* | $363.46 | $358.16 |
|
If these procedures are to be carried out in a hospital under general anaesthesia, prior approval must be obtained from TAC. For the second and subsequent fixtures inserted at the same appointment, the multiple operation rule applies. In addition, the surgeon is entitled to reimbursement for the retail cost of any expendable implant hardware supplied directly. | |||||
| Prosthodontics - Full Dentures | |||||
| Full upper or full lower dentures | 711, 712 | $861.95 | $849.38 | $1,283.98 | $1,265.25 |
| Full upper and full lower dentures | 719 | $1,520.64 | $1,498.46 | $2,391.48 | $2,356.60 |
| Prosthodontics - Partial Dentures | |||||
| Partial denture - acrylic base: | |||||
| One tooth | 721A/722A | $380.24 | $374.69 | $475.27 | $468.34 |
| Two teeth | 721B/722B | $424.60 | $418.41 | $530.68 | $522.94 |
| Three teeth | 721C/722C | $468.91 | $462.07 | $587.67 | $579.10 |
| Four teeth | 721D/722D | $557.62 | $549.49 | $697.01 | $686.84 |
| Five to nine teeth | 721E/722E | $646.35 | $636.92 | $807.89 | $796.11 |
| Ten teeth or more | 721F/722F | $823.72 | $811.71 | $1,029.69 | $1,014.67 |
| Partial denture - chrome cobalt including cost of casting: | |||||
| One or two teeth | 727A/728A | $1,317.89 | $1,298.67 | $1,647.35 | $1,623.32 |
| Three or four teeth | 727B/728B | $1,406.61 | $1,386.10 | $1,758.20 | $1,732.56 |
| Five to nine teeth | 727C/728C | $1,520.64 | $1,498.46 | $1,900.75 | $1,873.03 |
| Ten teeth or more | 727D/728D | $1,609.34 | $1,585.87 | $2,011.64 | $1,982.30 |
| Additional items for Acrylic Dentures only | |||||
| Each retainer | 731 | $44.42 | $43.77 | $44.42 | $43.77 |
| Occlusal rest (not part of retainer) | 732 | $15.30 | $15.08 | $15.30 | $15.08 |
| Immediate tooth replacement | 736 | $10.29 | $10.14 | $10.29 | $10.14 |
| Full denture relining | 743 | $301.10 | $296.71 | $376.45 | $370.96 |
| Partial denture relining | 744 | $264.63 | $260.77 | $329.57 | $324.76 |
| Denture base modification | 754 | $153.58 | $151.34 | $153.58 | $151.34 |
| Adding tooth to partial denture to replace extracted tooth | 768 | $148.92 | $146.75 | $148.92 | $146.75 |
| Orthodontics | |||||
| Active removable appliance therapy - one arch | 821 | $711.75 | $701.37 | $1,028.35 | $1,013.35 |
| Full arch banding - one arch | 831 | N/A | N/A | $3,722.40 | $3,668.11 |
| Full course of fixed appliance orthodontic treatment | 881 | N/A | N/A | $5,805.32 | $5,720.65 |
| Orthodontic extrusion of tooth | 846 | N/A | N/A | $844.54 | $832.22 |
| Temporomandibular Joint Therapy | |||||
| Full clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report to the TAC. | 963, 964 | $227.11 | $223.80 | $278.60 | $274.54 |
| Occlusal splint including initial programming | 965 | $515.42 | $507.90 | $607.60 | $598.74 |
| Routine adjustment of splint - per visit (maximum of 6 visits) | 966 | $85.68 | $84.43 | $108.01 | $106.43 |
| Travel - Treatment outside of rooms | FBN* | FBN* | |||
* Note: Where the terminology FBN appears in this schedule, the fee must be negotiated with the TAC before any dental treatment is commenced.