Dental fees

Effective 1 July 2023

Dental services can be invoiced online via HICAPS Digital Claims for next business day payments.

For dental services provided on or after 1 July 2023
GeneralSpecialist
Service DescriptionADA NumberMaximum
Payment
Rate
Maximum
Payment
Rate
Diagnostic services
Comprehensive Oral Examination 011 $111.37$111.37
Periodic Oral Examination 012 $70.40 $70.40
Consultation 014 $111.37$111.37
Written report (not elsewhere included) 018 $154.95 $203.97
Intraoral periapical or bitewing radiograph - per exposure 022 $54.86 $54.86
Cone Beam Volumetric Tomography - scan acquisition - per appointment 026 $175.12 $175.12
Cephalometric Radiograph - per exposure 036 $123.80 $123.80
Panoramic radiograph - per exposure 037 $123.80 $123.80
Pulp Testing - per appointment 061 $39.82 $39.82
Diagnostic model - per model 071 $77.04 $77.04
Photographic records - intraoral - per appointment 072 $44.00 $44.00
Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (both arches) 089 $81.73 $81.73
Preventive Services
(Prior approval from TAC required for these services)
Removal Of Calculus - first appointment 114 $ 138.37 $138.37
Bleaching, Internal - per tooth 117 $245.52 $245.52
Topical application of remineralisation and/or cariostatic agents - one treatment 121 $50.49 $50.49
Oral hygiene instruction 141 $55.18$55.18
Desensitising Procedure - per appointment 165 $51.98$51.98
Odontoplasty - per tooth 171 $55.60 $55.60
Periodontal Debridement - per tooth 222 $63.04 $72.49
Periodontal Flap Surgery - per tooth - Limit of 10 per visit, 20 per 12 month period 232 $311.32 $311.32
Surgical treatment of Peri-implant Disease - per implant 233 $375.62 $375.62
Gingival Graft - per tooth, implant or extraction 235 $542.08 $637.75
Guided Tissue Regeneration - per tooth or implant 236 $542.08 $637.75
Guided Tissue Regeneration - membrane removal 237 $629.72 $740.87
Periodontal Surgery for Crown Lengthening - per tooth 238 $544.63 $640.74
Osseous Graft- per tooth or implant 243 $542.08 $637.75
Oral Surgery
Removal of a tooth or part(s) thereof 311 $230.55 $249.32
Sectional removal of tooth or part(s) thereof 314 $303.83 $310.15
Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division 322 $341.81 $357.85
Surgical removal of a tooth or tooth fragment requiring removal of bone 323 $411.58 $440.15
Splinting of displaced tooth/teeth - per tooth 386 $226.65 $283.75
Replantation and splinting of a tooth - per tooth 387 $455.66 $524.01
Endodontics
(These fees include the cost of x-rays where required)    
Direct Pulp Capping 411 $61.38 $64.42
Pulpotomy 414 $151.43 $206.92
Complete chemo-mechanical preparation of root canal - one canal 415 $354.09 $407.19
Complete chemo-mechanical preparation of root canal - each additional canal 416 $174.29 $201.96
Root canal obturation - one canal 417 $347.52 $399.64
Root canal obturation - each additional canal 418 $171.43 $197.14
Extirpation of pulp or debridement of root canal(s) - emergency or palliative 419 $243.17 $243.17
Removal Of Root Filling - Per Canal 451 $165.76 $190.65
Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - per tooth 455 $183.55 $211.08
Restorative Services
Metallic Restoration - One Surface - direct 511 $181.09 $208.25
Metallic Restoration - Two Surfaces - direct 512 $216.42 $248.88
Metallic Restoration - Three Surfaces - direct 513 $253.40 $291.42
Metallic Restoration - Four Surfaces - direct 514 $290.68 $334.28
Metallic Restoration - Five Surfaces - direct 515 $330.09 $379.60
Adhesive Restoration - One Surface - Anterior Tooth - direct 521 $194.71 $223.91
Adhesive Restoration - Two Surfaces - Anterior tooth - direct 522 $228.99 $263.37
Adhesive Restoration - Three Surfaces - Anterior tooth - direct 523 $268.73 $309.05
Adhesive Restoration - Four Surfaces - Anterior tooth - direct 524 $302.35 $347.72
Adhesive Restoration - Five Surfaces - Anterior tooth - direct 525 $355.64 $408.98
Adhesive Restoration - Veneer - Anterior tooth- direct 526 $400.74 $440.10
Adhesive restoration - one surface - posterior tooth - direct 531 $205.28 $236.07
Adhesive restoration - two surfaces - posterior tooth - direct 532 $244.53 $281.22
Adhesive restoration - three surfaces - posterior tooth - direct 533 $286.01 $328.92
Adhesive restoration - four surfaces - posterior tooth - direct 534 $322.20 $370.54
Adhesive restoration - five surfaces - posterior tooth - direct 535 $383.93 $441.52
Adhesive Restoration - Veneer - Posterior tooth - direct 536 $393.41 $440.10
Tooth coloured restoration - one surface - indirect 551 $991.10 $1,139.78
Tooth coloured restoration - two surfaces - indirect 552 $1,098.51 $1,263.29
Tooth coloured restoration - three surfaces - indirect 553 $1,268.95 $1,459.29
Tooth coloured restoration - four surfaces - indirect 554 $1,377.51 $1,584.14
Tooth coloured restoration - five surfaces - indirect 555 $1,510.60 $1,737.18
Tooth - coloured restoration - Veneer - indirect 556 $1,449.90 $1,667.38
Provisional (intermediate/temporary) restoration - per tooth 572 $106.24 $106.24
Pin retention - per pin 575 $48.01 $48.01
Post - Direct 597 $196.83 $221.34
Crown and Bridgework
(If these procedures are to be carried out in a hospital under general anaesthesia, prior approval must be obtained from the TAC)
Full crown - non metallic - indirect 613 $1,706.25 $1,962.20
Full crown - veneered - indirect 615 $1,683.13 $1,935.60
Full crown - metallic indirect 618 $1,693.64 $1,947.68
Post and core for crown - indirect 625 $532.83 $640.74
Preliminary restoration for crown - direct 627 $297.85 $316.49
Provisional bridge pontic - per pontic 632 $337.57 $337.57
Bridge pontic - direct - per pontic 642 $439.50 $505.43
Bridge pontic - indirect - per pontic 643 $1,269.26 $1,713.50
Retainer for bonded fixture - indirect - per tooth 649 $754.02 $867.12
Implant Procedures
Fitting of an implant abutment - per abutment 661 $1,088.55 $1,088.55
Prosthesis with metal frame attached to implants - fixed - per arch 666 $3,922.41 $5,747.07
Removal and reattachment of prosthesis fixed to implant(s) – per implant 669 $188.99 $188.99
Full crown attached to osseointegrated implant - veneered indirect 672 $2,170.17 $2,848.86
Surgical implant guide 679 $257.80 $257.80
Insertion of first stage of two-stage endosseous implant - per implant 684 $2,334.77 $2,334.77
Insertion of one stage endosseous implant - per implant
Includes the cost of hardware
688 $2,817.48 $2,817.48
Second stage surgery of two stage endosseous implant - per implant
Includes the cost of hardware
691 $482.59 $482.59
Prosthodontics
Complete Maxillary Denture 711 $1,564.46 $1,799.12
Complete Mandibular Denture 712 $1,564.46 $1,799.12
Complete Maxillary and Mandibular Denture 719 $2,836.93 $3,262.46
Partial maxillary denture - resin base 721 $1,004.53 $1,004.53
Partial mandibular denture - resin base 722 $1,004.53 $1,004.53
Partial maxillary denture - cast metal framework including rests and retainers 727 $1,742.90 $2,004.35
Partial mandibular denture - cast metal framework including rests and retainers 728 $1,742.90 $2,004.35
Additional items for Acrylic Dentures only
Retainer - Per Tooth 731 $62.95 $62.95
Occlusal Rest - per rest 732 $18.25 $18.25
Tooth/teeth partial denture 733 $61.88 $61.88
Immediate tooth replacement - per tooth 736 $12.28 $12.28
Relining - complete denture - processed 743 $492.64 $492.64
Relining - partial denture - processed 744 $479.52 $479.52
Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth 768 $213.52 $248.11
Splint  - Resin - Indirect772$321.95$455.66
Orthodontics
Active removable appliance therapy - per arch 821 $1,126.63 $1,291.85
Full arch banding - per arch 831 $3,106.41 $4,440.20
Minor tooth guidance - fixed 846 $1,007.40 $1,007.40
Complete course of orthodontic treatment 881 $6,417.11 $8,309.29
General
Travel to provide services 916 FBN* FBN*
Clinical occlusal analysis, including muscle and joint palpation - limit one per three year period 963 $106.24 $148.67
Occlusal splint 965 $707.08 $724.76
Adjustment of pre-existing occlusal splint - per appointment 966 $100.71 $128.82
For dental services provided between 1 July 2022 and 30 June 2023
GeneralSpecialist
Service DescriptionADA NumberMaximum
Payment
Rate
Maximum
Payment
Rate
Diagnostic services
Comprehensive Oral Examination 011 $103.13 $103.13
Periodic Oral Examination 012 $65.19 $65.19
Consultation 014 $103.13 $103.13
Written report (not elsewhere included) 018 $143.49 $188.88
Intraoral periapical or bitewing radiograph - per exposure 022 $50.80 $50.80
Cone Beam Volumetric Tomography - scan acquisition - per appointment 026 $162.16 $162.16
Cephalometric Radiograph - per exposure 036 $114.64 $114.64
Panoramic radiograph - per exposure 037 $114.64 $114.64
Pulp Testing - per appointment 061 $36.87 $36.87
Diagnostic model - per model 071 $71.34 $71.34
Photographic records - intraoral - per appointment 072 $40.74 $40.74
Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (both arches) 089 $75.68 $75.68
Preventive Services
(Prior approval from TAC required for these services)
Removal Of Calculus - first appointment 114 $128.13          $128.13
Bleaching, Internal - per tooth 117 $227.35 $227.35
Topical application of remineralisation and/or cariostatic agents - one treatment 121 $46.75 $46.75
Oral hygiene instruction 141 $51.10 $51.10
Desensitising Procedure - per appointment 165 $48.13 $48.13
Odontoplasty - per tooth 171 $51.49 $51.49
Periodontal Debridement - per tooth 222 $58.38 $67.13         
Periodontal Flap Surgery - per tooth - Limit of 10 per visit, 20 per 12 month period 232 $288.29           $288.29          
Surgical treatment of Peri-implant Disease - per implant 233 $347.83 $347.83
Gingival Graft - per tooth, implant or extraction 235 $501.97 $590.56
Guided Tissue Regeneration - per tooth or implant 236 $501.97 $590.56          
Guided Tissue Regeneration - membrane removal 237 $583.13          $686.05
Periodontal Surgery for Crown Lengthening - per tooth 238 $504.33 $593.33
Osseous Graft- per tooth or implant 243 $501.97 $590.56
Oral Surgery
Removal of a tooth or part(s) thereof 311 $213.49 $230.87
Sectional removal of tooth or part(s) thereof 314 $281.35 $287.20
Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division 322 $316.52 $331.37
Surgical removal of a tooth or tooth fragment requiring removal of bone 323 $381.13 $407.58
Splinting of displaced tooth/teeth - per tooth 386 $209.88 $262.76
Replantation and splinting of a tooth - per tooth 387 $421.95 $485.24
Endodontics
(These fees include the cost of x-rays where required)    
Direct Pulp Capping 411 $56.84 $59.65
Pulpotomy 414 $140.23 $191.61
Complete chemo-mechanical preparation of root canal - one canal 415 $327.89 $377.06
Complete chemo-mechanical preparation of root canal - each additional canal 416 $161.39 $187.02
Root canal obturation - one canal 417 $321.81 $370.07
Root canal obturation - each additional canal 418 $158.75 $182.55
Extirpation of pulp or debridement of root canal(s) - emergency or palliative 419 $225.18 $225.18
Removal Of Root Filling - Per Canal 451 $153.50 $176.54
Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - per tooth 455 $169.97 $195.46
Restorative Services   
Metallic Restoration - One Surface - direct 511 $167.69 $192.84
Metallic Restoration - Two Surfaces - direct 512 $200.41 $230.47
Metallic Restoration - Three Surfaces - direct 513 $234.65 $269.86
Metallic Restoration - Four Surfaces - direct 514 $269.17 $309.55
Metallic Restoration - Five Surfaces - direct 515 $305.67 $351.51
Adhesive Restoration - One Surface - Anterior Tooth - direct 521 $180.30 $207.34
Adhesive Restoration - Two Surfaces - Anterior tooth - direct 522 $212.05 $243.88
Adhesive Restoration - Three Surfaces - Anterior tooth - direct 523 $248.85 $286.18
Adhesive Restoration - Four Surfaces - Anterior tooth - direct 524 $279.98 $321.99
Adhesive Restoration - Five Surfaces - Anterior tooth - direct 525 $329.33 $378.72
Adhesive Restoration - Veneer - Anterior tooth- direct 526 $371.09 $407.54
Adhesive restoration - one surface - posterior tooth - direct 531 $190.09 $218.60
Adhesive restoration - two surfaces - posterior tooth - direct 532 $226.44 $260.41
Adhesive restoration - three surfaces - posterior tooth - direct 533 $264.85 $304.58
Adhesive restoration - four surfaces - posterior tooth - direct 534 $298.36 $343.12
Adhesive restoration - five surfaces - posterior tooth - direct 535 $355.52 $408.85
Adhesive Restoration - Veneer - Posterior tooth - direct 536 $364.30 $407.54
Tooth coloured restoration - one surface - indirect 551 $917.77 $1,055.45
Tooth coloured restoration - two surfaces - indirect 552 $1,017.23 $1,169.82
Tooth coloured restoration - three surfaces - indirect 553 $1,175.06 $1,351.32
Tooth coloured restoration - four surfaces - indirect 554 $1,275.59 $1,466.93
Tooth coloured restoration - five surfaces - indirect 555 $1,398.83 $1,608.65
Tooth - coloured restoration - Veneer - indirect 556 $1,342.62 $1,544.01
Provisional (intermediate/temporary) restoration - per tooth 572 $98.38 $98.38
Pin retention - per pin 575 $44.46 $44.46
Post - Direct 597 $182.27 $204.96
Crown and Bridgework
(If these procedures are to be carried out in a hospital under general anaesthesia, prior approval must be obtained from the TAC)
Full crown - non metallic - indirect 613 $1,580.01 $1,817.02
Full crown - veneered - indirect 615 $1,558.60 $1,792.39
Full crown - metallic indirect 618 $1,568.33 $1,803.57
Post and core for crown - indirect 625 $493.41 $593.33
Preliminary restoration for crown - direct 627 $275.81 $293.07
Provisional bridge pontic - per pontic 632 $312.59 $312.59
Bridge pontic - direct - per pontic 642 $406.98 $468.03
Bridge pontic - indirect - per pontic 643 $1,175.35 $1,586.72
Retainer for bonded fixture - indirect - per tooth 649 $698.23 $802.96
Implant Procedures
Fitting of an implant abutment - per abutment 661 $1,008.01 $1,008.01
Prosthesis with metal frame attached to implants - fixed - per arch 666 $3,632.20 $5,321.85
Removal and reattachment of prosthesis fixed to implant(s) – per implant 669 $175.01 $175.01
Full crown attached to osseointegrated implant - veneered indirect 672 $2,009.60 $2,638.08
Surgical implant guide 679 $238.83 $238.73
Insertion of first stage of two-stage endosseous implant - per implant 684 $2,162.02 $2,162.02
Insertion of one stage endosseous implant - per implant
Includes the cost of hardware
688 $2,609.02 $2,609.02
Second stage surgery of two stage endosseous implant - per implant
Includes the cost of hardware
691 $446.88 $446.88
Prosthodontics
Complete Maxillary Denture 711 $1,448.71 $1,666.01
Complete Mandibular Denture 712 $1,448.71 $1,666.01
Complete Maxillary and Mandibular Denture 719 $2,627.03 $3,021.08
Partial maxillary denture - resin base 721 $930.21 $930.21
Partial mandibular denture - resin base 722 $930.21 $930.21
Partial maxillary denture - cast metal framework including rests and retainers 727 $1,613.95 $1,856.05
Partial mandibular denture - cast metal framework including rests and retainers 728 $1,613.95 $1,856.05
Additional items for Acrylic Dentures only
Retainer - Per Tooth 731 $58.29 $58.29
Occlusal Rest - per rest 732 $16.90 $16.90
Tooth/teeth partial denture 733 $57.30 $57.30
Immediate tooth replacement - per tooth 736 $11.37 $11.37
Relining - complete denture - processed 743 $456.19 $456.19
Relining - partial denture - processed 744 $444.04 $444.04
Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth 768 $197.72 $229.75
Splint  - Resin - Indirect772$298.13$421.95
Orthodontics
Active removable appliance therapy - per arch 821 $1,043.27 $1,196.27
Full arch banding - per arch 831 $2,876.57 $4,111.68
Minor tooth guidance - fixed 846 $932.86 $932.86
Complete course of orthodontic treatment 881 $5,942.32 $7,694.50
General
Travel to provide services 916 FBN* FBN*
Clinical occlusal analysis, including muscle and joint palpation - limit one per three year period 963 $98.38 $137.67
Occlusal splint 965 $654.76 $671.14
Adjustment of pre-existing occlusal splint - per appointment 966 $93.26 $119.29
For dental services provided on or after 1 July 2023
GeneralSpecialist
Service DescriptionADA NumberMaximum
Payment
Rate
Maximum
Payment
Rate
Diagnostic services
Comprehensive Oral Examination 011 $111.37$111.37
Periodic Oral Examination 012 $70.40 $70.40
Consultation 014 $111.37$111.37
Written report (not elsewhere included) 018 $154.95 $203.97
Intraoral periapical or bitewing radiograph - per exposure 022 $54.86 $54.86
Cone Beam Volumetric Tomography - scan acquisition - per appointment 026 $175.12 $175.12
Cephalometric Radiograph - per exposure 036 $123.80 $123.80
Panoramic radiograph - per exposure 037 $123.80 $123.80
Pulp Testing - per appointment 061 $39.82 $39.82
Diagnostic model - per model 071 $77.04 $77.04
Photographic records - intraoral - per appointment 072 $44.00 $44.00
Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (both arches) 089 $81.73 $81.73
Preventive Services
(Prior approval from TAC required for these services)
Removal Of Calculus - first appointment 114 $ 138.37 $138.37
Bleaching, Internal - per tooth 117 $245.52 $245.52
Topical application of remineralisation and/or cariostatic agents - one treatment 121 $50.49 $50.49
Oral hygiene instruction 141 $55.18$55.18
Desensitising Procedure - per appointment 165 $51.98$51.98
Odontoplasty - per tooth 171 $55.60 $55.60
Periodontal Debridement - per tooth 222 $63.04 $72.49
Periodontal Flap Surgery - per tooth - Limit of 10 per visit, 20 per 12 month period 232 $311.32 $311.32
Surgical treatment of Peri-implant Disease - per implant 233 $375.62 $375.62
Gingival Graft - per tooth, implant or extraction 235 $542.08 $637.75
Guided Tissue Regeneration - per tooth or implant 236 $542.08 $637.75
Guided Tissue Regeneration - membrane removal 237 $629.72 $740.87
Periodontal Surgery for Crown Lengthening - per tooth 238 $544.63 $640.74
Osseous Graft- per tooth or implant 243 $542.08 $637.75
Oral Surgery
Removal of a tooth or part(s) thereof 311 $230.55 $249.32
Sectional removal of tooth or part(s) thereof 314 $303.83 $310.15
Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division 322 $341.81 $357.85
Surgical removal of a tooth or tooth fragment requiring removal of bone 323 $411.58 $440.15
Splinting of displaced tooth/teeth - per tooth 386 $226.65 $283.75
Replantation and splinting of a tooth - per tooth 387 $455.66 $524.01
Endodontics
(These fees include the cost of x-rays where required)    
Direct Pulp Capping 411 $61.38 $64.42
Pulpotomy 414 $151.43 $206.92
Complete chemo-mechanical preparation of root canal - one canal 415 $354.09 $407.19
Complete chemo-mechanical preparation of root canal - each additional canal 416 $174.29 $201.96
Root canal obturation - one canal 417 $347.52 $399.64
Root canal obturation - each additional canal 418 $171.43 $197.14
Extirpation of pulp or debridement of root canal(s) - emergency or palliative 419 $243.17 $243.17
Removal Of Root Filling - Per Canal 451 $165.76 $190.65
Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - per tooth 455 $183.55 $211.08
Restorative Services
Metallic Restoration - One Surface - direct 511 $181.09 $208.25
Metallic Restoration - Two Surfaces - direct 512 $216.42 $248.88
Metallic Restoration - Three Surfaces - direct 513 $253.40 $291.42
Metallic Restoration - Four Surfaces - direct 514 $290.68 $334.28
Metallic Restoration - Five Surfaces - direct 515 $330.09 $379.60
Adhesive Restoration - One Surface - Anterior Tooth - direct 521 $194.71 $223.91
Adhesive Restoration - Two Surfaces - Anterior tooth - direct 522 $228.99 $263.37
Adhesive Restoration - Three Surfaces - Anterior tooth - direct 523 $268.73 $309.05
Adhesive Restoration - Four Surfaces - Anterior tooth - direct 524 $302.35 $347.72
Adhesive Restoration - Five Surfaces - Anterior tooth - direct 525 $355.64 $408.98
Adhesive Restoration - Veneer - Anterior tooth- direct 526 $400.74 $440.10
Adhesive restoration - one surface - posterior tooth - direct 531 $205.28 $236.07
Adhesive restoration - two surfaces - posterior tooth - direct 532 $244.53 $281.22
Adhesive restoration - three surfaces - posterior tooth - direct 533 $286.01 $328.92
Adhesive restoration - four surfaces - posterior tooth - direct 534 $322.20 $370.54
Adhesive restoration - five surfaces - posterior tooth - direct 535 $383.93 $441.52
Adhesive Restoration - Veneer - Posterior tooth - direct 536 $393.41 $440.10
Tooth coloured restoration - one surface - indirect 551 $991.10 $1,139.78
Tooth coloured restoration - two surfaces - indirect 552 $1,098.51 $1,263.29
Tooth coloured restoration - three surfaces - indirect 553 $1,268.95 $1,459.29
Tooth coloured restoration - four surfaces - indirect 554 $1,377.51 $1,584.14
Tooth coloured restoration - five surfaces - indirect 555 $1,510.60 $1,737.18
Tooth - coloured restoration - Veneer - indirect 556 $1,449.90 $1,667.38
Provisional (intermediate/temporary) restoration - per tooth 572 $106.24 $106.24
Pin retention - per pin 575 $48.01 $48.01
Post - Direct 597 $196.83 $221.34
Crown and Bridgework
(If these procedures are to be carried out in a hospital under general anaesthesia, prior approval must be obtained from the TAC)
Full crown - non metallic - indirect 613 $1,706.25 $1,962.20
Full crown - veneered - indirect 615 $1,683.13 $1,935.60
Full crown - metallic indirect 618 $1,693.64 $1,947.68
Post and core for crown - indirect 625 $532.83 $640.74
Preliminary restoration for crown - direct 627 $297.85 $316.49
Provisional bridge pontic - per pontic 632 $337.57 $337.57
Bridge pontic - direct - per pontic 642 $439.50 $505.43
Bridge pontic - indirect - per pontic 643 $1,269.26 $1,713.50
Retainer for bonded fixture - indirect - per tooth 649 $754.02 $867.12
Implant Procedures
Fitting of an implant abutment - per abutment 661 $1,088.55 $1,088.55
Prosthesis with metal frame attached to implants - fixed - per arch 666 $3,922.41 $5,747.07
Removal and reattachment of prosthesis fixed to implant(s) – per implant 669 $188.99 $188.99
Full crown attached to osseointegrated implant - veneered indirect 672 $2,170.17 $2,848.86
Surgical implant guide 679 $257.80 $257.80
Insertion of first stage of two-stage endosseous implant - per implant 684 $2,334.77 $2,334.77
Insertion of one stage endosseous implant - per implant
Includes the cost of hardware
688 $2,817.48 $2,817.48
Second stage surgery of two stage endosseous implant - per implant
Includes the cost of hardware
691 $482.59 $482.59
Prosthodontics
Complete Maxillary Denture 711 $1,564.46 $1,799.12
Complete Mandibular Denture 712 $1,564.46 $1,799.12
Complete Maxillary and Mandibular Denture 719 $2,836.93 $3,262.46
Partial maxillary denture - resin base 721 $1,004.53 $1,004.53
Partial mandibular denture - resin base 722 $1,004.53 $1,004.53
Partial maxillary denture - cast metal framework including rests and retainers 727 $1,742.90 $2,004.35
Partial mandibular denture - cast metal framework including rests and retainers 728 $1,742.90 $2,004.35
Additional items for Acrylic Dentures only
Retainer - Per Tooth 731 $62.95 $62.95
Occlusal Rest - per rest 732 $18.25 $18.25
Tooth/teeth partial denture 733 $61.88 $61.88
Immediate tooth replacement - per tooth 736 $12.28 $12.28
Relining - complete denture - processed 743 $492.64 $492.64
Relining - partial denture - processed 744 $479.52 $479.52
Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth 768 $213.52 $248.11
Splint  - Resin - Indirect772$321.95$455.66
Orthodontics
Active removable appliance therapy - per arch 821 $1,126.63 $1,291.85
Full arch banding - per arch 831 $3,106.41 $4,440.20
Minor tooth guidance - fixed 846 $1,007.40 $1,007.40
Complete course of orthodontic treatment 881 $6,417.11 $8,309.29
General
Travel to provide services 916 FBN* FBN*
Clinical occlusal analysis, including muscle and joint palpation - limit one per three year period 963 $106.24 $148.67
Occlusal splint 965 $707.08 $724.76
Adjustment of pre-existing occlusal splint - per appointment 966 $100.71 $128.82
For dental services provided between 1 July 2022 and 30 June 2023
GeneralSpecialist
Service DescriptionADA NumberMaximum
Payment
Rate
Maximum
Payment
Rate
Diagnostic services
Comprehensive Oral Examination 011 $103.13 $103.13
Periodic Oral Examination 012 $65.19 $65.19
Consultation 014 $103.13 $103.13
Written report (not elsewhere included) 018 $143.49 $188.88
Intraoral periapical or bitewing radiograph - per exposure 022 $50.80 $50.80
Cone Beam Volumetric Tomography - scan acquisition - per appointment 026 $162.16 $162.16
Cephalometric Radiograph - per exposure 036 $114.64 $114.64
Panoramic radiograph - per exposure 037 $114.64 $114.64
Pulp Testing - per appointment 061 $36.87 $36.87
Diagnostic model - per model 071 $71.34 $71.34
Photographic records - intraoral - per appointment 072 $40.74 $40.74
Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (both arches) 089 $75.68 $75.68
Preventive Services
(Prior approval from TAC required for these services)
Removal Of Calculus - first appointment 114 $128.13          $128.13
Bleaching, Internal - per tooth 117 $227.35 $227.35
Topical application of remineralisation and/or cariostatic agents - one treatment 121 $46.75 $46.75
Oral hygiene instruction 141 $51.10 $51.10
Desensitising Procedure - per appointment 165 $48.13 $48.13
Odontoplasty - per tooth 171 $51.49 $51.49
Periodontal Debridement - per tooth 222 $58.38 $67.13         
Periodontal Flap Surgery - per tooth - Limit of 10 per visit, 20 per 12 month period 232 $288.29           $288.29          
Surgical treatment of Peri-implant Disease - per implant 233 $347.83 $347.83
Gingival Graft - per tooth, implant or extraction 235 $501.97 $590.56
Guided Tissue Regeneration - per tooth or implant 236 $501.97 $590.56          
Guided Tissue Regeneration - membrane removal 237 $583.13          $686.05
Periodontal Surgery for Crown Lengthening - per tooth 238 $504.33 $593.33
Osseous Graft- per tooth or implant 243 $501.97 $590.56
Oral Surgery
Removal of a tooth or part(s) thereof 311 $213.49 $230.87
Sectional removal of tooth or part(s) thereof 314 $281.35 $287.20
Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division 322 $316.52 $331.37
Surgical removal of a tooth or tooth fragment requiring removal of bone 323 $381.13 $407.58
Splinting of displaced tooth/teeth - per tooth 386 $209.88 $262.76
Replantation and splinting of a tooth - per tooth 387 $421.95 $485.24
Endodontics
(These fees include the cost of x-rays where required)    
Direct Pulp Capping 411 $56.84 $59.65
Pulpotomy 414 $140.23 $191.61
Complete chemo-mechanical preparation of root canal - one canal 415 $327.89 $377.06
Complete chemo-mechanical preparation of root canal - each additional canal 416 $161.39 $187.02
Root canal obturation - one canal 417 $321.81 $370.07
Root canal obturation - each additional canal 418 $158.75 $182.55
Extirpation of pulp or debridement of root canal(s) - emergency or palliative 419 $225.18 $225.18
Removal Of Root Filling - Per Canal 451 $153.50 $176.54
Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - per tooth 455 $169.97 $195.46
Restorative Services   
Metallic Restoration - One Surface - direct 511 $167.69 $192.84
Metallic Restoration - Two Surfaces - direct 512 $200.41 $230.47
Metallic Restoration - Three Surfaces - direct 513 $234.65 $269.86
Metallic Restoration - Four Surfaces - direct 514 $269.17 $309.55
Metallic Restoration - Five Surfaces - direct 515 $305.67 $351.51
Adhesive Restoration - One Surface - Anterior Tooth - direct 521 $180.30 $207.34
Adhesive Restoration - Two Surfaces - Anterior tooth - direct 522 $212.05 $243.88
Adhesive Restoration - Three Surfaces - Anterior tooth - direct 523 $248.85 $286.18
Adhesive Restoration - Four Surfaces - Anterior tooth - direct 524 $279.98 $321.99
Adhesive Restoration - Five Surfaces - Anterior tooth - direct 525 $329.33 $378.72
Adhesive Restoration - Veneer - Anterior tooth- direct 526 $371.09 $407.54
Adhesive restoration - one surface - posterior tooth - direct 531 $190.09 $218.60
Adhesive restoration - two surfaces - posterior tooth - direct 532 $226.44 $260.41
Adhesive restoration - three surfaces - posterior tooth - direct 533 $264.85 $304.58
Adhesive restoration - four surfaces - posterior tooth - direct 534 $298.36 $343.12
Adhesive restoration - five surfaces - posterior tooth - direct 535 $355.52 $408.85
Adhesive Restoration - Veneer - Posterior tooth - direct 536 $364.30 $407.54
Tooth coloured restoration - one surface - indirect 551 $917.77 $1,055.45
Tooth coloured restoration - two surfaces - indirect 552 $1,017.23 $1,169.82
Tooth coloured restoration - three surfaces - indirect 553 $1,175.06 $1,351.32
Tooth coloured restoration - four surfaces - indirect 554 $1,275.59 $1,466.93
Tooth coloured restoration - five surfaces - indirect 555 $1,398.83 $1,608.65
Tooth - coloured restoration - Veneer - indirect 556 $1,342.62 $1,544.01
Provisional (intermediate/temporary) restoration - per tooth 572 $98.38 $98.38
Pin retention - per pin 575 $44.46 $44.46
Post - Direct 597 $182.27 $204.96
Crown and Bridgework
(If these procedures are to be carried out in a hospital under general anaesthesia, prior approval must be obtained from the TAC)
Full crown - non metallic - indirect 613 $1,580.01 $1,817.02
Full crown - veneered - indirect 615 $1,558.60 $1,792.39
Full crown - metallic indirect 618 $1,568.33 $1,803.57
Post and core for crown - indirect 625 $493.41 $593.33
Preliminary restoration for crown - direct 627 $275.81 $293.07
Provisional bridge pontic - per pontic 632 $312.59 $312.59
Bridge pontic - direct - per pontic 642 $406.98 $468.03
Bridge pontic - indirect - per pontic 643 $1,175.35 $1,586.72
Retainer for bonded fixture - indirect - per tooth 649 $698.23 $802.96
Implant Procedures
Fitting of an implant abutment - per abutment 661 $1,008.01 $1,008.01
Prosthesis with metal frame attached to implants - fixed - per arch 666 $3,632.20 $5,321.85
Removal and reattachment of prosthesis fixed to implant(s) – per implant 669 $175.01 $175.01
Full crown attached to osseointegrated implant - veneered indirect 672 $2,009.60 $2,638.08
Surgical implant guide 679 $238.83 $238.73
Insertion of first stage of two-stage endosseous implant - per implant 684 $2,162.02 $2,162.02
Insertion of one stage endosseous implant - per implant
Includes the cost of hardware
688 $2,609.02 $2,609.02
Second stage surgery of two stage endosseous implant - per implant
Includes the cost of hardware
691 $446.88 $446.88
Prosthodontics
Complete Maxillary Denture 711 $1,448.71 $1,666.01
Complete Mandibular Denture 712 $1,448.71 $1,666.01
Complete Maxillary and Mandibular Denture 719 $2,627.03 $3,021.08
Partial maxillary denture - resin base 721 $930.21 $930.21
Partial mandibular denture - resin base 722 $930.21 $930.21
Partial maxillary denture - cast metal framework including rests and retainers 727 $1,613.95 $1,856.05
Partial mandibular denture - cast metal framework including rests and retainers 728 $1,613.95 $1,856.05
Additional items for Acrylic Dentures only
Retainer - Per Tooth 731 $58.29 $58.29
Occlusal Rest - per rest 732 $16.90 $16.90
Tooth/teeth partial denture 733 $57.30 $57.30
Immediate tooth replacement - per tooth 736 $11.37 $11.37
Relining - complete denture - processed 743 $456.19 $456.19
Relining - partial denture - processed 744 $444.04 $444.04
Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth 768 $197.72 $229.75
Splint  - Resin - Indirect772$298.13$421.95
Orthodontics
Active removable appliance therapy - per arch 821 $1,043.27 $1,196.27
Full arch banding - per arch 831 $2,876.57 $4,111.68
Minor tooth guidance - fixed 846 $932.86 $932.86
Complete course of orthodontic treatment 881 $5,942.32 $7,694.50
General
Travel to provide services 916 FBN* FBN*
Clinical occlusal analysis, including muscle and joint palpation - limit one per three year period 963 $98.38 $137.67
Occlusal splint 965 $654.76 $671.14
Adjustment of pre-existing occlusal splint - per appointment 966 $93.26 $119.29

* Note: Where the terminology FBN appears in this schedule, the fee must be negotiated with the TAC before any dental treatment is commenced.