Dental fees
Effective 1 July 2022
Dental services can be invoiced online via LanternPay for next business day payments.
| General | Specialist | ||
|---|---|---|---|
| Service Description | ADA Number | Maximum 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 - Indirect | 772 | $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 |
| General | Specialist | ||
|---|---|---|---|
| Service Description | ADA Number | Maximum Payment Rate | Maximum Payment Rate |
| Diagnostic services | |||
| Comprehensive Oral Examination | 011 | $100.59 | $100.59 |
| Periodic Oral Examination | 012 | $63.58 | $63.58 |
| Consultation | 014 | $100.59 | $100.59 |
| Written report (not elsewhere included) | 018 | $139.95 | $184.22 |
| Intraoral periapical or bitewing radiograph - per exposure | 022 | $49.55 | $49.55 |
| Cone Beam Volumetric Tomography - scan acquisition - per appointment | 026 | $158.16 | $158.16 |
| Cephalometric Radiograph - per exposure | 036 | $111.81 | $111.81 |
| Panoramic radiograph - per exposure | 037 | $111.81 | $111.81 |
| Pulp Testing - per appointment | 061 | $35.96 | $35.96 |
| Diagnostic model - per model | 071 | $69.58 | $69.58 |
| Photographic records - intraoral - per appointment | 072 | $39.73 | $39.73 |
| Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (both arches) | 089 | $73.81 | $73.81 |
| Preventive Services | |||
| (Prior approval from TAC required for these services) | |||
| Removal Of Calculus - first appointment | 114 | $124.97 | $124.97 |
| Bleaching, Internal - per tooth | 117 | $221.74 | $221.74 |
| Topical application of remineralisation and/or cariostatic agents - one treatment | 121 | $45.60 | $45.60 |
| Oral hygiene instruction | 141 | $49.84 | $49.84 |
| Desensitising Procedure - per appointment | 165 | $46.94 | $46.94 |
| Odontoplasty - per tooth | 171 | $50.22 | $50.22 |
| Periodontal Debridement - per tooth | 222 | $56.94 | $65.47 |
| Periodontal Flap Surgery - per tooth - Limit of 10 per visit, 20 per 12 month period | 232 | $281.18 | $281.18 |
| Surgical treatment of Peri-implant Disease - per implant | 233 | $339.25 | $339.25 |
| Gingival Graft - per tooth, implant or extraction | 235 | $489.58 | $575.99 |
| Guided Tissue Regeneration - per tooth or implant | 236 | $489.58 | $575.99 |
| Guided Tissue Regeneration - membrane removal | 237 | $568.74 | $669.12 |
| Periodontal Surgery for Crown Lengthening - per tooth | 238 | $491.89 | $578.69 |
| Osseous Graft- per tooth or implant | 243 | $489.58 | $575.99 |
| Oral Surgery | |||
| Removal of a tooth or part(s) thereof | 311 | $208.22 | $225.17 |
| Sectional removal of tooth or part(s) thereof | 314 | $274.41 | $280.11 |
| Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division | 322 | $308.71 | $323.19 |
| Surgical removal of a tooth or tooth fragment requiring removal of bone | 323 | $371.73 | $397.52 |
| Splinting of displaced tooth/teeth - per tooth | 386 | $204.70 | $256.28 |
| Replantation and splinting of a tooth - per tooth | 387 | $411.54 | $473.27 |
| Endodontics | |||
| (These fees include the cost of x-rays where required) | |||
| Direct Pulp Capping | 411 | $55.44 | $58.18 |
| Pulpotomy | 414 | $136.77 | $186.88 |
| Complete chemo-mechanical preparation of root canal - one canal | 415 | $319.80 | $367.76 |
| Complete chemo-mechanical preparation of root canal - each additional canal | 416 | $157.41 | $182.41 |
| Root canal obturation - one canal | 417 | $313.87 | $360.94 |
| Root canal obturation - each additional canal | 418 | $154.83 | $178.05 |
| Extirpation of pulp or debridement of root canal(s) - emergency or palliative | 419 | $219.62 | $219.62 |
| Removal Of Root Filling - Per Canal | 451 | $149.71 | $172.18 |
| Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - per tooth | 455 | $165.78 | $190.64 |
| Restorative Services | |||
| Metallic Restoration - One Surface - direct | 511 | $163.55 | $188.08 |
| Metallic Restoration - Two Surfaces - direct | 512 | $195.46 | $224.78 |
| Metallic Restoration - Three Surfaces - direct | 513 | $228.86 | $263.20 |
| Metallic Restoration - Four Surfaces - direct | 514 | $262.53 | $301.91 |
| Metallic Restoration - Five Surfaces - direct | 515 | $298.13 | $342.84 |
| Adhesive Restoration - One Surface - Anterior Tooth - direct | 521 | $175.85 | $202.22 |
| Adhesive Restoration - Two Surfaces - Anterior tooth - direct | 522 | $206.82 | $237.86 |
| Adhesive Restoration - Three Surfaces - Anterior tooth - direct | 523 | $242.71 | $279.12 |
| Adhesive Restoration - Four Surfaces - Anterior tooth - direct | 524 | $273.07 | $314.04 |
| Adhesive Restoration - Five Surfaces - Anterior tooth - direct | 525 | $321.20 | $369.37 |
| Adhesive Restoration - Veneer - Anterior tooth- direct | 526 | $361.93 | $397.48 |
| Adhesive restoration - one surface - posterior tooth - direct | 531 | $185.40 | $213.21 |
| Adhesive restoration - two surfaces - posterior tooth - direct | 532 | $220.85 | $253.98 |
| Adhesive restoration - three surfaces - posterior tooth - direct | 533 | $258.31 | $297.06 |
| Adhesive restoration - four surfaces - posterior tooth - direct | 534 | $291.00 | $334.65 |
| Adhesive restoration - five surfaces - posterior tooth - direct | 535 | $346.75 | $398.76 |
| Adhesive Restoration - Veneer - Posterior tooth - direct | 536 | $355.31 | $397.48 |
| Tooth coloured restoration - one surface - indirect | 551 | $895.12 | $1,029.41 |
| Tooth coloured restoration - two surfaces - indirect | 552 | $992.13 | $1,140.95 |
| Tooth coloured restoration - three surfaces - indirect | 553 | $1,146.06 | $1,317.98 |
| Tooth coloured restoration - four surfaces - indirect | 554 | $1,244.11 | $1,430.73 |
| Tooth coloured restoration - five surfaces - indirect | 555 | $1,364.31 | $1,568.96 |
| Tooth - coloured restoration - Veneer - indirect | 556 | $1,309.49 | $1,505.91 |
| Provisional (intermediate/temporary) restoration - per tooth | 572 | $95.95 | $95.95 |
| Pin retention - per pin | 575 | $43.36 | $43.36 |
| Post - Direct | 597 | $177.77 | $199.90 |
| 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 | $1,541.02 | $1,772.18 |
| Full crown - veneered - indirect | 615 | $1,520.14 | $1,748.16 |
| Full crown - metallic indirect | 618 | $1,529.63 | $1,759.07 |
| Post and core for crown - indirect | 625 | $481.23 | $578.69 |
| Preliminary restoration for crown - direct | 627 | $269.00 | $285.84 |
| Provisional bridge pontic - per pontic | 632 | $304.88 | $304.88 |
| Bridge pontic - direct - per pontic | 642 | $396.94 | $456.48 |
| Bridge pontic - indirect - per pontic | 643 | $1,146.35 | $1,547.57 |
| Retainer for bonded fixture - indirect - per tooth | 649 | $681.00 | $783.15 |
| Implant Procedures | |||
| Fitting of an implant abutment - per abutment | 661 | $983.14 | $983.14 |
| Prosthesis with metal frame attached to implants - fixed - per arch | 666 | $3,542.57 | $5,190.53 |
| Removal and reattachment of prosthesis fixed to implant(s) – per implant | 669 | $170.69 | $170.69 |
| Full crown attached to osseointegrated implant - veneered indirect | 672 | $1,960.01 | $2,572.98 |
| Surgical implant guide | 679 | $232.84 | $232.84 |
| Insertion of first stage of two-stage endosseous implant - per implant | 684 | $2,108.67 | $2,108.67 |
|
Insertion of one stage endosseous implant - per implant Includes the cost of hardware | 688 | $2,544.64 | $2,544.64 |
|
Second stage surgery of two stage endosseous implant - per implant Includes the cost of hardware | 691 | $435.85 | $435.85 |
| Prosthodontics | |||
| Complete Maxillary Denture | 711 | $1,412.96 | $1,624.90 |
| Complete Mandibular Denture | 712 | $1,412.96 | $1,624.90 |
| Complete Maxillary and Mandibular Denture | 719 | $2,562.21 | $2,946.53 |
| Partial maxillary denture - resin base | 721 | $907.26 | $907.26 |
| Partial mandibular denture - resin base | 722 | $907.26 | $907.26 |
| Partial maxillary denture - cast metal framework including rests and retainers | 727 | $1,574.12 | $1,810.25 |
| Partial mandibular denture - cast metal framework including rests and retainers | 728 | $1,574.12 | $1,810.25 |
| Additional items for Acrylic Dentures only | |||
| Retainer - Per Tooth | 731 | $56.85 | $56.85 |
| Occlusal Rest - per rest | 732 | $16.48 | $16.48 |
| Tooth/teeth partial denture | 733 | $55.89 | $55.89 |
| Immediate tooth replacement - per tooth | 736 | $11.09 | $11.09 |
| Relining - complete denture - processed | 743 | $444.93 | $444.93 |
| Relining - partial denture - processed | 744 | $433.08 | $433.08 |
| Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth | 768 | $192.84 | $224.08 |
| Orthodontics | |||
| Active removable appliance therapy - per arch | 821 | $1,017.53 | $1,166.75 |
| Full arch banding - per arch | 831 | $2,805.59 | $4,010.22 |
| Minor tooth guidance - fixed | 846 | $909.84 | $909.84 |
| Complete course of orthodontic treatment | 881 | $5,795.69 | $7,504.63 |
| General | |||
| Travel to provide services | 916 | FBN* | FBN* |
| Clinical occlusal analysis, including muscle and joint palpation - limit one per three year period | 963 | $95.95 | $134.27 |
| Occlusal splint | 965 | $638.60 | $654.58 |
| Adjustment of pre-existing occlusal splint - per appointment | 966 | $90.96 | $116.35 |
| General | Specialist | ||
|---|---|---|---|
| Service Description | ADA Number | Maximum 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 - Indirect | 772 | $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 |
| General | Specialist | ||
|---|---|---|---|
| Service Description | ADA Number | Maximum Payment Rate | Maximum Payment Rate |
| Diagnostic services | |||
| Comprehensive Oral Examination | 011 | $100.59 | $100.59 |
| Periodic Oral Examination | 012 | $63.58 | $63.58 |
| Consultation | 014 | $100.59 | $100.59 |
| Written report (not elsewhere included) | 018 | $139.95 | $184.22 |
| Intraoral periapical or bitewing radiograph - per exposure | 022 | $49.55 | $49.55 |
| Cone Beam Volumetric Tomography - scan acquisition - per appointment | 026 | $158.16 | $158.16 |
| Cephalometric Radiograph - per exposure | 036 | $111.81 | $111.81 |
| Panoramic radiograph - per exposure | 037 | $111.81 | $111.81 |
| Pulp Testing - per appointment | 061 | $35.96 | $35.96 |
| Diagnostic model - per model | 071 | $69.58 | $69.58 |
| Photographic records - intraoral - per appointment | 072 | $39.73 | $39.73 |
| Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (both arches) | 089 | $73.81 | $73.81 |
| Preventive Services | |||
| (Prior approval from TAC required for these services) | |||
| Removal Of Calculus - first appointment | 114 | $124.97 | $124.97 |
| Bleaching, Internal - per tooth | 117 | $221.74 | $221.74 |
| Topical application of remineralisation and/or cariostatic agents - one treatment | 121 | $45.60 | $45.60 |
| Oral hygiene instruction | 141 | $49.84 | $49.84 |
| Desensitising Procedure - per appointment | 165 | $46.94 | $46.94 |
| Odontoplasty - per tooth | 171 | $50.22 | $50.22 |
| Periodontal Debridement - per tooth | 222 | $56.94 | $65.47 |
| Periodontal Flap Surgery - per tooth - Limit of 10 per visit, 20 per 12 month period | 232 | $281.18 | $281.18 |
| Surgical treatment of Peri-implant Disease - per implant | 233 | $339.25 | $339.25 |
| Gingival Graft - per tooth, implant or extraction | 235 | $489.58 | $575.99 |
| Guided Tissue Regeneration - per tooth or implant | 236 | $489.58 | $575.99 |
| Guided Tissue Regeneration - membrane removal | 237 | $568.74 | $669.12 |
| Periodontal Surgery for Crown Lengthening - per tooth | 238 | $491.89 | $578.69 |
| Osseous Graft- per tooth or implant | 243 | $489.58 | $575.99 |
| Oral Surgery | |||
| Removal of a tooth or part(s) thereof | 311 | $208.22 | $225.17 |
| Sectional removal of tooth or part(s) thereof | 314 | $274.41 | $280.11 |
| Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division | 322 | $308.71 | $323.19 |
| Surgical removal of a tooth or tooth fragment requiring removal of bone | 323 | $371.73 | $397.52 |
| Splinting of displaced tooth/teeth - per tooth | 386 | $204.70 | $256.28 |
| Replantation and splinting of a tooth - per tooth | 387 | $411.54 | $473.27 |
| Endodontics | |||
| (These fees include the cost of x-rays where required) | |||
| Direct Pulp Capping | 411 | $55.44 | $58.18 |
| Pulpotomy | 414 | $136.77 | $186.88 |
| Complete chemo-mechanical preparation of root canal - one canal | 415 | $319.80 | $367.76 |
| Complete chemo-mechanical preparation of root canal - each additional canal | 416 | $157.41 | $182.41 |
| Root canal obturation - one canal | 417 | $313.87 | $360.94 |
| Root canal obturation - each additional canal | 418 | $154.83 | $178.05 |
| Extirpation of pulp or debridement of root canal(s) - emergency or palliative | 419 | $219.62 | $219.62 |
| Removal Of Root Filling - Per Canal | 451 | $149.71 | $172.18 |
| Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - per tooth | 455 | $165.78 | $190.64 |
| Restorative Services | |||
| Metallic Restoration - One Surface - direct | 511 | $163.55 | $188.08 |
| Metallic Restoration - Two Surfaces - direct | 512 | $195.46 | $224.78 |
| Metallic Restoration - Three Surfaces - direct | 513 | $228.86 | $263.20 |
| Metallic Restoration - Four Surfaces - direct | 514 | $262.53 | $301.91 |
| Metallic Restoration - Five Surfaces - direct | 515 | $298.13 | $342.84 |
| Adhesive Restoration - One Surface - Anterior Tooth - direct | 521 | $175.85 | $202.22 |
| Adhesive Restoration - Two Surfaces - Anterior tooth - direct | 522 | $206.82 | $237.86 |
| Adhesive Restoration - Three Surfaces - Anterior tooth - direct | 523 | $242.71 | $279.12 |
| Adhesive Restoration - Four Surfaces - Anterior tooth - direct | 524 | $273.07 | $314.04 |
| Adhesive Restoration - Five Surfaces - Anterior tooth - direct | 525 | $321.20 | $369.37 |
| Adhesive Restoration - Veneer - Anterior tooth- direct | 526 | $361.93 | $397.48 |
| Adhesive restoration - one surface - posterior tooth - direct | 531 | $185.40 | $213.21 |
| Adhesive restoration - two surfaces - posterior tooth - direct | 532 | $220.85 | $253.98 |
| Adhesive restoration - three surfaces - posterior tooth - direct | 533 | $258.31 | $297.06 |
| Adhesive restoration - four surfaces - posterior tooth - direct | 534 | $291.00 | $334.65 |
| Adhesive restoration - five surfaces - posterior tooth - direct | 535 | $346.75 | $398.76 |
| Adhesive Restoration - Veneer - Posterior tooth - direct | 536 | $355.31 | $397.48 |
| Tooth coloured restoration - one surface - indirect | 551 | $895.12 | $1,029.41 |
| Tooth coloured restoration - two surfaces - indirect | 552 | $992.13 | $1,140.95 |
| Tooth coloured restoration - three surfaces - indirect | 553 | $1,146.06 | $1,317.98 |
| Tooth coloured restoration - four surfaces - indirect | 554 | $1,244.11 | $1,430.73 |
| Tooth coloured restoration - five surfaces - indirect | 555 | $1,364.31 | $1,568.96 |
| Tooth - coloured restoration - Veneer - indirect | 556 | $1,309.49 | $1,505.91 |
| Provisional (intermediate/temporary) restoration - per tooth | 572 | $95.95 | $95.95 |
| Pin retention - per pin | 575 | $43.36 | $43.36 |
| Post - Direct | 597 | $177.77 | $199.90 |
| 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 | $1,541.02 | $1,772.18 |
| Full crown - veneered - indirect | 615 | $1,520.14 | $1,748.16 |
| Full crown - metallic indirect | 618 | $1,529.63 | $1,759.07 |
| Post and core for crown - indirect | 625 | $481.23 | $578.69 |
| Preliminary restoration for crown - direct | 627 | $269.00 | $285.84 |
| Provisional bridge pontic - per pontic | 632 | $304.88 | $304.88 |
| Bridge pontic - direct - per pontic | 642 | $396.94 | $456.48 |
| Bridge pontic - indirect - per pontic | 643 | $1,146.35 | $1,547.57 |
| Retainer for bonded fixture - indirect - per tooth | 649 | $681.00 | $783.15 |
| Implant Procedures | |||
| Fitting of an implant abutment - per abutment | 661 | $983.14 | $983.14 |
| Prosthesis with metal frame attached to implants - fixed - per arch | 666 | $3,542.57 | $5,190.53 |
| Removal and reattachment of prosthesis fixed to implant(s) – per implant | 669 | $170.69 | $170.69 |
| Full crown attached to osseointegrated implant - veneered indirect | 672 | $1,960.01 | $2,572.98 |
| Surgical implant guide | 679 | $232.84 | $232.84 |
| Insertion of first stage of two-stage endosseous implant - per implant | 684 | $2,108.67 | $2,108.67 |
|
Insertion of one stage endosseous implant - per implant Includes the cost of hardware | 688 | $2,544.64 | $2,544.64 |
|
Second stage surgery of two stage endosseous implant - per implant Includes the cost of hardware | 691 | $435.85 | $435.85 |
| Prosthodontics | |||
| Complete Maxillary Denture | 711 | $1,412.96 | $1,624.90 |
| Complete Mandibular Denture | 712 | $1,412.96 | $1,624.90 |
| Complete Maxillary and Mandibular Denture | 719 | $2,562.21 | $2,946.53 |
| Partial maxillary denture - resin base | 721 | $907.26 | $907.26 |
| Partial mandibular denture - resin base | 722 | $907.26 | $907.26 |
| Partial maxillary denture - cast metal framework including rests and retainers | 727 | $1,574.12 | $1,810.25 |
| Partial mandibular denture - cast metal framework including rests and retainers | 728 | $1,574.12 | $1,810.25 |
| Additional items for Acrylic Dentures only | |||
| Retainer - Per Tooth | 731 | $56.85 | $56.85 |
| Occlusal Rest - per rest | 732 | $16.48 | $16.48 |
| Tooth/teeth partial denture | 733 | $55.89 | $55.89 |
| Immediate tooth replacement - per tooth | 736 | $11.09 | $11.09 |
| Relining - complete denture - processed | 743 | $444.93 | $444.93 |
| Relining - partial denture - processed | 744 | $433.08 | $433.08 |
| Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth | 768 | $192.84 | $224.08 |
| Orthodontics | |||
| Active removable appliance therapy - per arch | 821 | $1,017.53 | $1,166.75 |
| Full arch banding - per arch | 831 | $2,805.59 | $4,010.22 |
| Minor tooth guidance - fixed | 846 | $909.84 | $909.84 |
| Complete course of orthodontic treatment | 881 | $5,795.69 | $7,504.63 |
| General | |||
| Travel to provide services | 916 | FBN* | FBN* |
| Clinical occlusal analysis, including muscle and joint palpation - limit one per three year period | 963 | $95.95 | $134.27 |
| Occlusal splint | 965 | $638.60 | $654.58 |
| Adjustment of pre-existing occlusal splint - per appointment | 966 | $90.96 | $116.35 |
* Note: Where the terminology FBN appears in this schedule, the fee must be negotiated with the TAC before any dental treatment is commenced.