Effective 1 July 2020
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 | $99.32 | $99.32 |
| Periodic Oral Examination | 012 | $62.78 | $62.78 |
| Consultation | 014 | $99.32 | $99.32 |
| Written report (not elsewhere included) | 018 | $138.18 | $181.89 |
| Intraoral periapical or bitewing radiograph - per exposure | 022 | $48.92 | $48.92 |
| Cone Beam Volumetric Tomography - scan acquisition - per appointment | 026 | $156.16 | $156.16 |
| Cephalometric Radiograph - per exposure | 036 | $110.40 | $110.40 |
| Panoramic radiograph - per exposure | 037 | $110.40 | $110.40 |
| Pulp Testing - per appointment | 061 | $35.51 | $35.51 |
| Diagnostic model - per model | 071 | $68.70 | $68.70 |
| Photographic records - intraoral - per appointment | 072 | $39.23 | $39.23 |
| Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (both arches) | 089 | $72.88 | $72.88 |
| Preventive Services | |||
| (Prior approval from TAC required for these services) | |||
| Removal Of Calculus - first appointment | 114 | $123.39 | $123.39 |
| Bleaching, Internal - per tooth | 117 | $218.94 | $218.94 |
| Topical application of remineralisation and/or cariostatic agents - one treatment | 121 | $45.02 | $45.02 |
| Oral hygiene instruction | 141 | $49.21 | $49.21 |
| Desensitising Procedure - per appointment | 165 | $46.35 | $46.35 |
| Odontoplasty - per tooth | 171 | $49.59 | $49.59 |
| Periodontal Debridement - per tooth | 222 | $56.22 | $64.64 |
| Periodontal Flap Surgery - per tooth - Limit of 10 per visit, 20 per 12 month period | 232 | $277.63 | $277.63 |
| Surgical treatment of Peri-implant Disease - per implant | 233 | $334.96 | $334.96 |
| Gingival Graft - per tooth, implant or extraction | 235 | $483.39 | $568.71 |
| Guided Tissue Regeneration - per tooth or implant | 236 | $483.39 | $568.71 |
| Guided Tissue Regeneration - membrane removal | 237 | $561.55 | $660.66 |
| Periodontal Surgery for Crown Lengthening - per tooth | 238 | $485.67 | $571.38 |
| Osseous Graft- per tooth or implant | 243 | $483.39 | $568.71 |
| Oral Surgery | |||
| Removal of a tooth or part(s) thereof | 311 | $205.59 | $222.32 |
| Sectional removal of tooth or part(s) thereof | 314 | $270.94 | $276.57 |
| Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division | 322 | $304.81 | $319.11 |
| Surgical removal of a tooth or tooth fragment requiring removal of bone | 323 | $367.03 | $392.50 |
| Splinting of displaced tooth/teeth - per tooth | 386 | $202.11 | $253.04 |
| Replantation and splinting of a tooth - per tooth | 387 | $406.34 | $467.29 |
| Endodontics | |||
| (These fees include the cost of x-rays where required) | |||
| Direct Pulp Capping | 411 | $54.74 | $57.44 |
| Pulpotomy | 414 | $135.04 | $184.52 |
| Complete chemo-mechanical preparation of root canal - one canal | 415 | $315.76 | $363.11 |
| Complete chemo-mechanical preparation of root canal - each additional canal | 416 | $155.42 | $180.10 |
| Root canal obturation - one canal | 417 | $309.90 | $356.38 |
| Root canal obturation - each additional canal | 418 | $152.87 | $175.80 |
| Extirpation of pulp or debridement of root canal(s) - emergency or palliative | 419 | $216.84 | $216.84 |
| Removal Of Root Filling - Per Canal | 451 | $147.82 | $170.00 |
| Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - per tooth | 455 | $163.68 | $188.23 |
| Restorative Services | |||
| Metallic Restoration - One Surface - direct | 511 | $161.48 | $185.70 |
| Metallic Restoration - Two Surfaces - direct | 512 | $192.99 | $221.94 |
| Metallic Restoration - Three Surfaces - direct | 513 | $225.97 | $259.87 |
| Metallic Restoration - Four Surfaces - direct | 514 | $259.21 | $298.09 |
| Metallic Restoration - Five Surfaces - direct | 515 | $294.36 | $338.51 |
| Adhesive Restoration - One Surface - Anterior Tooth - direct | 521 | $173.63 | $199.66 |
| Adhesive Restoration - Two Surfaces - Anterior tooth - direct | 522 | $204.21 | $234.85 |
| Adhesive Restoration - Three Surfaces - Anterior tooth - direct | 523 | $239.64 | $275.59 |
| Adhesive Restoration - Four Surfaces - Anterior tooth - direct | 524 | $269.62 | $310.07 |
| Adhesive Restoration - Five Surfaces - Anterior tooth - direct | 525 | $317.14 | $364.70 |
| Adhesive Restoration - Veneer - Anterior tooth- direct | 526 | $357.36 | $392.49 |
| Adhesive restoration - one surface - posterior tooth - direct | 531 | $183.06 | $210.52 |
| Adhesive restoration - two surfaces - posterior tooth - direct | 532 | $218.06 | $250.77 |
| Adhesive restoration - three surfaces - posterior tooth - direct | 533 | $255.05 | $293.31 |
| Adhesive restoration - four surfaces - posterior tooth - direct | 534 | $287.32 | $330.42 |
| Adhesive restoration - five surfaces - posterior tooth - direct | 535 | $342.37 | $393.72 |
| Adhesive Restoration - Veneer - Posterior tooth - direct | 536 | $350.82 | $392.46 |
| Tooth coloured restoration - one surface - indirect | 551 | $883.81 | $1,016.40 |
| Tooth coloured restoration - two surfaces - indirect | 552 | $979.59 | $1,126.53 |
| Tooth coloured restoration - three surfaces - indirect | 553 | $1,131.58 | $1,301.32 |
| Tooth coloured restoration - four surfaces - indirect | 554 | $1,228.39 | $1,412.65 |
| Tooth coloured restoration - five surfaces - indirect | 555 | $1,347.07 | $1,549.13 |
| Tooth - coloured restoration - Veneer - indirect | 556 | $1,292.94 | $1,486.88 |
| Provisional (intermediate/temporary) restoration - per tooth | 572 | $94.74 | $94.74 |
| Pin retention - per pin | 575 | $42.81 | $42.81 |
| Post - Direct | 597 | $175.52 | $197.37 |
| 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 | $1,521.54 | $1,749.78 |
| Full crown - veneered - indirect | 615 | $1,500.93 | $1,726.07 |
| Full crown - metallic indirect | 618 | $1,510.30 | $1,736.84 |
| Post and core for crown - indirect | 625 | $475.15 | $571.38 |
| Preliminary restoration for crown - direct | 627 | $265.60 | $282.23 |
| Provisional bridge pontic - per pontic | 632 | $301.03 | $301.03 |
| Bridge pontic - direct - per pontic | 642 | $391.92 | $450.71 |
| Bridge pontic - indirect - per pontic | 643 | $1,131.86 | $1,528.01 |
| Retainer for bonded fixture - indirect - per tooth | 649 | $672.39 | $773.25 |
| Implant Procedures | |||
| Fitting of an implant abutment - per abutment | 661 | $970.71 | $970.71 |
| Prosthesis with metal frame attached to implants - fixed - per arch | 666 | $3.497.80 | $5,124.93 |
| Removal and reattachment of prosthesis fixed to implant(s) – per implant | 669 | $168.53 | $168.53 |
| Full crown attached to osseointegrated implant - veneered indirect | 672 | $1,935.24 | $2,540.46 |
| Surgical implant guide | 679 | $229.90 | $229.90 |
| Insertion of first stage of two-stage endosseous implant - per implant | 684 | $2,082.02 | $2,082.02 |
|
Insertion of one stage endosseous implant - per implant Includes the cost of hardware | 688 | $2,512.48 | $2,512.48 |
|
Second stage surgery of two stage endosseous implant - per implant Includes the cost of hardware | 691 | $430.34 | $430.34 |
| Prosthodontics | |||
| Complete Maxillary Denture | 711 | $1,395.10 | $1,604.36 |
| Complete Mandibular Denture | 712 | $1,395.10 | $1,604.36 |
| Complete Maxillary and Mandibular Denture | 719 | $2,529.83 | $2,909.29 |
| Partial maxillary denture - resin base | 721 | $895.79 | $895.79 |
| Partial mandibular denture - resin base | 722 | $895.79 | $895.79 |
| Partial maxillary denture - cast metal framework | 727 | $1,554.23 | $1,787.37 |
| Partial mandibular denture - cast metal framework | 728 | $1,554.23 | $1,787.37 |
| Acrylic Dentures (Additional items) | |||
| Retainer - Per Tooth | 731 | $56.13 | $56.13 |
| Occlusal Rest - per rest | 732 | $16.27 | $16.27 |
| Tooth/teeth partial denture | 733 | $55.18 | $55.18 |
| Immediate tooth replacement - per tooth | 736 | $10.95 | $10.95 |
| Relining - complete denture - processed | 743 | $439.31 | $439.31 |
| Relining - partial denture - processed | 744 | $427.61 | $427.61 |
| Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth | 768 | $190.40 | $221.25 |
| Orthodontics | |||
| Active removable appliance therapy - per arch | 821 | $1,004.67 | $1,152.00 |
| Full arch banding - per arch | 831 | $2,770.13 | $3,959.54 |
| Minor tooth guidance - fixed | 846 | $898.34 | $898.34 |
| Complete course of orthodontic treatment | 881 | $5,722.44 | $7,409.78 |
| General | |||
| Travel to provide services | 916 | FBN* | FBN* |
| Clinical occlusal analysis, including muscle and joint palpation - limit one per three year period | 963 | $94.74 | $132.57 |
| Occlusal splint | 965 | $630.53 | $646.31 |
| Adjustment of pre-existing occlusal splint - per appointment | 966 | $89.81 | $114.88 |
| General | Specialist | ||
|---|---|---|---|
| Service Description | ADA Number | Maximum Payment Rate | Maximum Payment Rate |
| Diagnostic services | |||
| Comprehensive Oral Examination | 011 | $97.36 | $97.36 |
| Periodic Oral Examination | 012 | $61.54 | $61.54 |
| Consultation | 014 | $97.36 | $97.36 |
| Written report (not elsewhere included) | 018 | $135.46 | $178.31 |
| Intraoral periapical or bitewing radiograph - per exposure | 022 | $47.96 | $47.96 |
| Cone Beam Volumetric Tomography - scan acquisition - per appointment | 026 | $153.08 | $153.08 |
| Cephalometric Radiograph - per exposure | 036 | $108.22 | $108.22 |
| Panoramic radiograph - per exposure | 037 | $108.22 | $108.22 |
| Pulp Testing - per appointment | 061 | $34.81 | $34.81 |
| Diagnostic model - per model | 071 | $67.35 | $67.35 |
| Photographic records - intraoral - per appointment | 072 | $38.46 | $38.46 |
| Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (both arches) | 089 | $71.44 | $71.44 |
| Preventive Services | |||
| (Prior approval from TAC required for these services) | |||
| Removal Of Calculus - first appointment | 114 | $120.96 | $120.96 |
| Bleaching, Internal - per tooth | 117 | $214.63 | $214.63 |
| Topical application of remineralisation and/or cariostatic agents - one treatment | 121 | $44.13 | $44.13 |
| Oral hygiene instruction | 141 | $48.24 | $48.24 |
| Desensitising Procedure - per appointment | 165 | $45.44 | $45.44 |
| Odontoplasty - per tooth | 171 | $48.61 | $48.61 |
| Periodontal Debridement - per tooth | 222 | $55.11 | $63.37 |
| Periodontal Flap Surgery - per tooth - Limit of 10 per visit, 20 per 12 month period | 232 | $272.16 | $272.16 |
| Surgical treatment of Peri-implant Disease - per implant | 233 | $328.36 | $328.36 |
| Gingival Graft - per tooth, implant or extraction | 235 | $473.87 | $557.50 |
| Guided Tissue Regeneration - per tooth or implant | 236 | $473.87 | $557.50 |
| Guided Tissue Regeneration - membrane removal | 237 | $550.49 | $647.64 |
| Periodontal Surgery for Crown Lengthening - per tooth | 238 | $476.10 | $560.12 |
| Osseous Graft- per tooth or implant | 243 | $473.87 | $557.50 |
| Oral Surgery | |||
| Removal of a tooth or part(s) thereof | 311 | $201.54 | $217.94 |
| Sectional removal of tooth or part(s) thereof | 314 | $265.60 | $271.12 |
| Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division | 322 | $298.80 | $312.82 |
| Surgical removal of a tooth or tooth fragment requiring removal of bone | 323 | $359.80 | $384.77 |
| Splinting of displaced tooth/teeth - per tooth | 386 | $198.13 | $248.05 |
| Replantation and splinting of a tooth - per tooth | 387 | $398.33 | $458.08 |
| Endodontics | |||
| (These fees include the cost of x-rays where required) | |||
| Direct Pulp Capping | 411 | $53.66 | $56.31 |
| Pulpotomy | 414 | $132.38 | $180.88 |
| Complete chemo-mechanical preparation of root canal - one canal | 415 | $309.54 | $355.96 |
| Complete chemo-mechanical preparation of root canal - each additional canal | 416 | $152.36 | $176.55 |
| Root canal obturation - one canal | 417 | $303.79 | $349.36 |
| Root canal obturation - each additional canal | 418 | $149.86 | $172.34 |
| Extirpation of pulp or debridement of root canal(s) - emergency or palliative | 419 | $212.57 | $212.57 |
| Removal Of Root Filling - Per Canal | 451 | $144.91 | $166.65 |
| Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - per tooth | 455 | $160.45 | $184.52 |
| Restorative Services | |||
| Metallic Restoration - One Surface - direct | 511 | $158.30 | $182.04 |
| Metallic Restoration - Two Surfaces - direct | 512 | $189.19 | $217.57 |
| Metallic Restoration - Three Surfaces - direct | 513 | $221.52 | $254.75 |
| Metallic Restoration - Four Surfaces - direct | 514 | $254.10 | $292.22 |
| Metallic Restoration - Five Surfaces - direct | 515 | $288.56 | $331.84 |
| Adhesive Restoration - One Surface - Anterior Tooth - direct | 521 | $170.21 | $195.73 |
| Adhesive Restoration - Two Surfaces - Anterior tooth - direct | 522 | $200.19 | $230.22 |
| Adhesive Restoration - Three Surfaces - Anterior tooth - direct | 523 | $234.92 | $270.16 |
| Adhesive Restoration - Four Surfaces - Anterior tooth - direct | 524 | $264.31 | $303.96 |
| Adhesive Restoration - Five Surfaces - Anterior tooth - direct | 525 | $310.89 | $357.51 |
| Adhesive Restoration - Veneer - Anterior tooth- direct | 526 | $343.91 | $384.73 |
| Adhesive restoration - one surface - posterior tooth - direct | 531 | $179.45 | $206.37 |
| Adhesive restoration - two surfaces - posterior tooth - direct | 532 | $213.76 | $245.83 |
| Adhesive restoration - three surfaces - posterior tooth - direct | 533 | $250.02 | $287.53 |
| Adhesive restoration - four surfaces - posterior tooth - direct | 534 | $281.66 | $323.91 |
| Adhesive restoration - five surfaces - posterior tooth - direct | 535 | $335.62 | $385.96 |
| Adhesive Restoration - Veneer - Posterior tooth - direct | 536 | $343.91 | $384.73 |
| Tooth coloured restoration - one surface - indirect | 551 | $866.40 | $996.37 |
| Tooth coloured restoration - two surfaces - indirect | 552 | $960.29 | $1,104.33 |
| Tooth coloured restoration - three surfaces - indirect | 553 | $1,109.28 | $1,275.68 |
| Tooth coloured restoration - four surfaces - indirect | 554 | $1,204.19 | $1,384.82 |
| Tooth coloured restoration - five surfaces - indirect | 555 | $1,320.53 | $1,518.61 |
| Tooth - coloured restoration - Veneer - indirect | 556 | $1,267.46 | $1,457.58 |
| Provisional (intermediate/temporary) restoration - per tooth | 572 | $92.87 | $92.87 |
| Pin retention - per pin | 575 | $41.97 | $41.97 |
| Post - Direct | 597 | $172.06 | $193.48 |
| 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 | $1,491.56 | $1,715.30 |
| Full crown - veneered - indirect | 615 | $1,471.36 | $1,692.06 |
| Full crown - metallic indirect | 618 | $1,480.54 | $1,702.62 |
| Post and core for crown - indirect | 625 | $465.79 | $560.12 |
| Preliminary restoration for crown - direct | 627 | $260.37 | $276.67 |
| Provisional bridge pontic - per pontic | 632 | $295.10 | $295.10 |
| Bridge pontic - direct - per pontic | 642 | $384.20 | $441.83 |
| Bridge pontic - indirect - per pontic | 643 | $1,109.56 | $1,497.90 |
| Retainer for bonded fixture - indirect - per tooth | 649 | $659.14 | $758.01 |
| Implant Procedures | |||
| Fitting of an implant abutment - per abutment | 661 | $951.58 | $951.58 |
| Prosthesis with metal frame attached to implants - fixed - per arch | 666 | $3.428.88 | $5,023.95 |
| Removal and reattachment of prosthesis fixed to implant(s) – per implant | 669 | $165.21 | $165.21 |
| Full crown attached to osseointegrated implant - veneered indirect | 672 | $1,897.11 | $2,490.40 |
| Surgical implant guide | 679 | $225.37 | $225.37 |
| Insertion of first stage of two-stage endosseous implant - per implant | 684 | $2,041.00 | $2,041.00 |
|
Insertion of one stage endosseous implant - per implant Includes the cost of hardware | 688 | $2,462.97 | $2,462.97 |
|
Second stage surgery of two stage endosseous implant - per implant Includes the cost of hardware | 691 | $421.86 | $421.86 |
| Prosthodontics | |||
| Complete Maxillary Denture | 711 | $1,367.61 | $1,572.75 |
| Complete Mandibular Denture | 712 | $1,367.61 | $1,572.75 |
| Complete Maxillary and Mandibular Denture | 719 | $2,479.98 | $2,851.97 |
| Partial maxillary denture - resin base | 721 | $878.14 | $878.14 |
| Partial mandibular denture - resin base | 722 | $878.14 | $878.14 |
| Partial maxillary denture - cast metal framework | 727 | $1,523.61 | $1,752.15 |
| Partial mandibular denture - cast metal framework | 728 | $1,523.61 | $1,752.15 |
| Acrylic Dentures (Additional items) | |||
| Retainer - Per Tooth | 731 | $55.02 | $55.02 |
| Occlusal Rest - per rest | 732 | $15.95 | $15.95 |
| Tooth/teeth partial denture | 733 | $54.09 | $54.09 |
| Immediate tooth replacement - per tooth | 736 | $10.73 | $10.73 |
| Relining - complete denture - processed | 743 | $430.65 | $430.65 |
| Relining - partial denture - processed | 744 | $419.18 | $419.18 |
| Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth | 768 | $186.65 | $216.89 |
| Orthodontics | |||
| Active removable appliance therapy - per arch | 821 | $984.87 | $1,129.30 |
| Full arch banding - per arch | 831 | $2,715.55 | $3,881.52 |
| Minor tooth guidance - fixed | 846 | $880.64 | $880.64 |
| Complete course of orthodontic treatment | 881 | $5,609.69 | $7,263.78 |
| General | |||
| Travel to provide services | 916 | FBN* | FBN* |
| Clinical occlusal analysis, including muscle and joint palpation - limit one per three year period | 963 | $92.87 | $129.96 |
| Occlusal splint | 965 | $618.11 | $633.58 |
| Adjustment of pre-existing occlusal splint - per appointment | 966 | $88.04 | $112.62 |
| General | Specialist | ||
|---|---|---|---|
| Service Description | ADA Number | Maximum Payment Rate | Maximum Payment Rate |
| Diagnostic services | |||
| Periodic oral examination | 012 | $61.54 | $72.81 |
| Comprehensive Oral Examination | 011 | $97.36 | $120.65 |
| Consultation | 014 | $97.36 | $231.15 |
| Consultation - extended (30 minutes or over) | 015 | $123.48 | $103.57 |
| Written report (not elsewhere included) | 018 | $135.46 | $178.31 |
| Intraoral periapical or bitewing radiograph - per exposure | 022 | $48.65 | $47.96 |
| Cephalometric Radiograph - per exposure | 036 | $108.22 | $108.22 |
| Panoramic radiograph - per exposure | 037 | $105.11 | $110.53 |
| Pulp Testing - per appointment | 061 | $34.81 | $35.45 |
| Diagnostic model - per model | 071 | $67.35 | $63.61 |
| Photographic records - intraoral - per appointment | 072 | $38.46 | $38.46 |
| Preventive Services | |||
| (Prior approval from TAC required for these services) | |||
| Removal of calculus - first appointment | 114 | $130.93 | $120.96 |
| Bleaching, internal - Per Tooth | 117 | $171.67 | $214.63 |
| Topical application of remineralisation and/or cariostatic agents - one treatment | 121 | $44.13 | $53.19 |
| Oral hygiene instruction | 141 | $45.29 | $45.88 |
| Adjunctive General Services | |||
| Desensitising Procedure - per appointment | 165 | $45.44 | $42.75 |
| Odontoplasty - per tooth | 171 | $34.14 | $34.14 |
| Periodontics | |||
| Periodontal debridement - per tooth | 222 | $288.09 | $273.08 |
| Periodontal flap surgery - per tooth | 232 | FBN* | $272.16 |
| Surgical treatment of peri-implant disease - per implant | 233 | FBN* | $328.36 |
| Application of biologically active material | 234 | FBN* | |
| Gingival graft - per tooth, implant or extraction | 235 | FBN* | $728.03 |
| Guided Tissue Regeneration - per tooth or implant) | 236 | $728.03 | |
| Periodontal surgery for crown lengthening - per tooth | 238 | $560.12 | |
| Osseous graft | 243 | FBN* | FBN* |
| Oral Surgery | |||
| Removal of a tooth or part(s) thereof | 311 | $201.54 | $217.94 |
| Sectional removal of tooth or part(s) thereof | 314 | $265.60 | $271.12 |
| Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division | 322 | $298.80 | $312.82 |
| Surgical removal of a tooth or tooth fragment requiring removal of bone | 323 | $359.80 | $384.77 |
| Removal or repair of soft tissue (not elsewhere defined) | 377 | $48.20 | $48.20 |
| Splinting of displaced tooth/teeth - per tooth | 386 | $198.13 | $248.05 |
| Replantation and splinting of a tooth - per tooth | 387 | $281.44 | $398.33 |
| Endodontics | |||
| Direct Pulp Capping | 411 | $53.66 | $56.31 |
| Pulpotomy | 414 | $132.38 | $180.88 |
| Complete chemo-mechanical preparation of root canal - one canal | 415†| $309.54 | $329.82 |
| Complete chemo-mechanical preparation of root canal - each additional canal | 416 | $152.36 | $160.59 |
| Root canal obturation - one canal | 417†| $303.79 | $337.43 |
| Root canal obturation - each additional canal | 418 | $149.86 | $157.45 |
| Extirpation of pulp or debridement of root canal(s) - emergency or palliative | 419 | $212.57 | $212.72 |
| Apicectomy - per root | 432 | $245.10 | $325.86 |
| Apical seal - per canal | 434 | $245.10 | $325.86 |
| Removal Of Root Filling - Per Canal | 451 | $158.51 | $141.81 |
| Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - Per Tooth | 455 | $160.45 | $152.24 |
| Interim therapeutic root filling - per tooth | 458 | $139.74 | $219.62 |
| †These fees include the cost of x-rays where required | |||
| Restorative Services | |||
| Metallic restoration - one surface - direct | 511 | $158.30 | $178.31 |
| Metallic restoration - two surfaces - direct | 512 | $189.19 | $190.82 |
| Metallic restoration - three surfaces - direct | 513 | $221.52 | $235.66 |
| Metallic restoration - four surfaces - direct | 514 | $254.10 | $254.10 |
| Metallic restoration - five surfaces - direct | 515 | $288.56 | $296.14 |
| Adhesive restoration - one surface - anterior tooth - direct | 521 | $170.21 | $172.06 |
| Adhesive restoration - two surfaces - anterior tooth - direct | 522 | $200.19 | $204.38 |
| Adhesive restoration - three surfaces - anterior tooth - direct | 523 | $234.92 | $232.53 |
| Adhesive restoration - four surfaces - anterior tooth - direct | 524 | $266.80 | $264.86 |
| Adhesive restoration - five surfaces - anterior tooth - direct | 525 | $310.89 | $375.47 |
| Adhesive restoration - one surface - posterior tooth - direct | 531 | $179.45 | $179.35 |
| Adhesive restoration - two surfaces - posterior tooth - direct | 532 | $222.57 | $213.76 |
| Adhesive restoration - three surfaces - posterior tooth - direct | 533 | $258.07 | $259.65 |
| Adhesive restoration - four surfaces - posterior tooth - direct | 534 | $281.66 | |
| Adhesive restoration - five surfaces - posterior tooth - direct | 535 | $335.62 | $375.47 |
| Metallic restoration - one surface - indirect | 541 | $616.29 | $616.29 |
| Metallic restoration - two surfaces - indirect | 542 | $629.73 | $771.06 |
| Metallic restoration - three surfaces - indirect | 543 | $740.23 | $927.70 |
| Metallic restoration - four surfaces - indirect | 544 | $724.43 | |
| Metallic restoration - five surfaces - indirect | 545 | $724.43 | |
| Tooth coloured restoration - one surface - indirect | 551 | $907.04 | $843.95 |
| Tooth coloured restoration - two surfaces - indirect | 552 | $1,037.34 | $856.20 |
| Tooth coloured restoration - three surfaces - indirect | 553 | $1,175.49 | $1,109.28 |
| Tooth coloured restoration - four surfaces - indirect | 554 | $1,280.41 | $1,114.39 |
| Tooth coloured restoration - five surfaces - indirect | 555 | $1,195.01 | $1,195.01 |
| Provisional (intermediate/temporary) restoration - per tooth | 572 | $108.75 | $123.95 |
| Pin retention - per pin | 575 | $41.97 | $40.67 |
| Post - Direct | 597 | $193.48 | $172.06 |
| 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. | |||
| Full crown - non metallic - indirect | 613 | $1,707.48 | $1,621.47 |
| Full crown - veneered - indirect | 615 | $1,696.08 | $1,758.53 |
| Full crown - metallic indirect | 618 | $1,688.18 | $1,671.08 |
| Post and core for crown - indirect | 625 | $465.79 | $560.12 |
| Preliminary restoration for crown - direct | 627 | $260.37 | $276.67 |
| Provisional bridge pontic - per pontic | 632 | $291.77 | $295.10 |
| Bridge pontic - direct - per pontic | 642 | $240.29 | $320.17 |
| Bridge pontic - indirect - per pontic | 643 | $1,266.86 | $1,651.27 |
| Retainer for bonded fixture - indirect - per tooth | 649 | $1,370.92 | $2,459.68 |
| Implant Procedures | |||
| Fitting of an implant abutment - per abutment | 661 | $951.58 | $944.73 |
| Prosthesis with metal frame attached to implants - fixed - per arch | 666 | $2,941.87 | $5,023.95 |
| Removal and reattachment of prosthesis fixed to implant(s) – per implant | 669 | $165.21 | |
| Full crown attached to osseointegrated implant - veneered indirect | 672 | $2,036.99 | $2,490.40 |
| Surgical implant guide | 679 | $225.37 | $225.37 |
| Insertion of first stage of two-stage endosseous implant - per implant | 684 | $1,001.61 | |
| Insertion of one stage endosseous implant - per implant | 688 | FBN* | $2,462.97 |
| Second stage surgery of two stage endosseous implant - per implant | 691 | $378.99 | |
|
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 | |||
| Complete Maxillary Denture | 711 | $1,367.61 | $1,372.26 |
| Complete Mandibular Denture | 712 | $1,380.18 | $1,462.98 |
| Complete maxillary and mandibular denture | 719 | $2,479.98 | $2,493.70 |
| Partial maxillary denture - resin base | 721 | $878.14 | $772.67 |
| Partial maxillary denture - cast metal framework | 727 | $1,604.72 | $1,601.65 |
| Acrylic Dentures (Additional items) | |||
| Retainer - Per Tooth | 731 | $55.02 | $55.27 |
| Occlusal Rest - per rest | 732 | $15.73 | $15.95 |
| Tooth/teeth partial denture | 733 | $51.19 | $54.09 |
| Immediate tooth replacement - per tooth | 736 | $10.57 | $10.73 |
| Relining - complete denture - processed | 743 | $427.63 | $430.65 |
| Relining - partial denture - processed | 744 | $403.54 | $419.18 |
| Denture base modification | 754 | $157.81 | $160.15 |
| Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth | 768 | $216.89 | $186.65 |
| Orthodontics | |||
| Active removable appliance therapy - per arch | 821 | $984.87 | $1,129.30 |
| Full arch banding - per arch | 831 | $3,881.52 | |
| Minor tooth guidance - fixed | 846 | $880.64 | |
| Complete course of orthodontic treatment | 881 | $7,263.78 | |
| Travel to provide treatment | 916 | FBN* | FBN* |
| Clinical occlusal analysis, including muscle and joint palpation | 963 | $233.37 | $290.51 |
| Registration and mounting of models for oclusal analysis | 964 | $233.37 | $290.51 |
| Occlusal splint | 965 | $618.11 | $633.58 |
| Adjustment of pre-existing occlusal splint - per appointment | 966 | $88.04 | $112.62 |
| General | Specialist | ||
|---|---|---|---|
| Service Description | ADA Number | Maximum Payment Rate | Maximum Payment Rate |
| Diagnostic services | |||
| Periodic oral examination | 012 | $60.30 | $71.35 |
| Comprehensive Oral Examination | 011 | $95.40 | $118.23 |
| Consultation | 014 | $95.40 | $226.51 |
| Consultation - extended (30 minutes or over) | 015 | $121.00 | $101.49 |
| Written report (not elsewhere included) | 018 | $132.74 | $174.73 |
| Intraoral periapical or bitewing radiograph - per exposure | 022 | $47.67 | $47.00 |
| Cephalometric Radiograph - per exposure | 036 | $106.05 | $106.05 |
| Panoramic radiograph - per exposure | 037 | $103.00 | $108.31 |
| Pulp Testing - per appointment | 061 | $34.11 | $34.74 |
| Diagnostic model - per model | 071 | $66.00 | $62.33 |
| Photographic records - intraoral - per appointment | 072 | $37.69 | $37.69 |
| Preventive Services | |||
| (Prior approval from TAC required for these services) | |||
| Removal of calculus - first appointment | 114 | $128.30 | $118.53 |
| Bleaching, internal - Per Tooth | 117 | $168.22 | $210.32 |
| Topical application of remineralisation and/or cariostatic agents - one treatment | 121 | $43.24 | $52.12 |
| Oral hygiene instruction | 141 | $44.38 | $44.96 |
| Adjunctive General Services | |||
| Desensitising Procedure - per appointment | 165 | $44.53 | $41.89 |
| Odontoplasty - per tooth | 171 | $33.45 | $33.45 |
| Periodontics | |||
| Periodontal debridement - per tooth | 222 | $282.30 | $267.59 |
| Periodontal flap surgery - per tooth | 232 | FBN* | $266.69 |
| Surgical treatment of peri-implant disease - per implant | 233 | FBN* | $321.76 |
| Application of biologically active material | 234 | FBN* | |
| Gingival graft - per tooth, implant or extraction | 235 | FBN* | $713.41 |
| Guided Tissue Regeneration - per tooth or implant) | 236 | $713.41 | |
| Periodontal surgery for crown lengthening - per tooth | 238 | $548.87 | |
| Osseous graft | 243 | FBN* | FBN* |
| Oral Surgery | |||
| Removal of a tooth or part(s) thereof | 311 | $197.49 | $213.56 |
| Sectional removal of tooth or part(s) thereof | 314 | $260.26 | $265.67 |
| Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division | 322 | $292.80 | $306.54 |
| Surgical removal of a tooth or tooth fragment requiring removal of bone | 323 | $352.57 | $377.04 |
| Removal or repair of soft tissue (not elsewhere defined) | 377 | $47.23 | $47.23 |
| Splinting of displaced tooth/teeth - per tooth | 386 | $194.15 | $243.07 |
| Replantation and splinting of a tooth - per tooth | 387 | $275.79 | $390.33 |
| Endodontics | |||
| Direct Pulp Capping | 411 | $52.58 | $55.18 |
| Pulpotomy | 414 | $129.72 | $177.25 |
| Complete chemo-mechanical preparation of root canal - one canal | 415†| $303.32 | $323.19 |
| Complete chemo-mechanical preparation of root canal - each additional canal | 416 | $149.30 | $157.36 |
| Root canal obturation - one canal | 417†| $297.69 | $330.65 |
| Root canal obturation - each additional canal | 418 | $146.85 | $154.29 |
| Extirpation of pulp or debridement of root canal(s) - emergency or palliative | 419 | $208.30 | $208.45 |
| Apicectomy - per root | 432 | $240.18 | $319.31 |
| Apical seal - per canal | 434 | $240.18 | $319.31 |
| Removal Of Root Filling - Per Canal | 451 | $155.33 | $138.96 |
| Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - Per Tooth | 455 | $157.23 | $149.18 |
| Interim therapeutic root filling - per tooth | 458 | $136.93 | $215.21 |
| †These fees include the cost of x-rays where required | |||
| Restorative Services | |||
| Metallic restoration - one surface - direct | 511 | $155.12 | $174.73 |
| Metallic restoration - two surfaces - direct | 512 | $185.39 | $186.99 |
| Metallic restoration - three surfaces - direct | 513 | $217.07 | $230.93 |
| Metallic restoration - four surfaces - direct | 514 | $249.00 | $249.00 |
| Metallic restoration - five surfaces - direct | 515 | $282.76 | $290.19 |
| Adhesive restoration - one surface - anterior tooth - direct | 521 | $166.79 | $168.60 |
| Adhesive restoration - two surfaces - anterior tooth - direct | 522 | $196.17 | $200.27 |
| Adhesive restoration - three surfaces - anterior tooth - direct | 523 | $230.20 | $227.86 |
| Adhesive restoration - four surfaces - anterior tooth - direct | 524 | $261.44 | $259.54 |
| Adhesive restoration - five surfaces - anterior tooth - direct | 525 | $304.64 | $367.93 |
| Adhesive restoration - one surface - posterior tooth - direct | 531 | $175.85 | $175.75 |
| Adhesive restoration - two surfaces - posterior tooth - direct | 532 | $218.10 | $209.47 |
| Adhesive restoration - three surfaces - posterior tooth - direct | 533 | $252.89 | $254.43 |
| Adhesive restoration - four surfaces - posterior tooth - direct | 534 | $276.00 | |
| Adhesive restoration - five surfaces - posterior tooth - direct | 535 | $328.88 | $367.93 |
| Metallic restoration - one surface - indirect | 541 | $603.91 | $603.91 |
| Metallic restoration - two surfaces - indirect | 542 | $617.08 | $755.57 |
| Metallic restoration - three surfaces - indirect | 543 | $725.36 | $909.06 |
| Metallic restoration - four surfaces - indirect | 544 | $709.88 | |
| Metallic restoration - five surfaces - indirect | 545 | $709.88 | |
| Tooth coloured restoration - one surface - indirect | 551 | $888.82 | $827.00 |
| Tooth coloured restoration - two surfaces - indirect | 552 | $1,016.50 | $839.00 |
| Tooth coloured restoration - three surfaces - indirect | 553 | $1,151.88 | $1,087.00 |
| Tooth coloured restoration - four surfaces - indirect | 554 | $1,254.69 | $1,092.00 |
| Tooth coloured restoration - five surfaces - indirect | 555 | $1,171.00 | $1,171.00 |
| Provisional (intermediate/temporary) restoration - per tooth | 572 | $106.57 | $121.46 |
| Pin retention - per pin | 575 | $41.13 | $39.85 |
| Post - Direct | 597 | $189.59 | $168.60 |
| 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. | |||
| Full crown - non metallic - indirect | 613 | $1,673.18 | $1,588.90 |
| Full crown - veneered - indirect | 615 | $1,662.01 | $1,723.20 |
| Full crown - metallic indirect | 618 | $1,654.27 | $1,637.51 |
| Post and core for crown - indirect | 625 | $456.43 | $548.87 |
| Preliminary restoration for crown - direct | 627 | $255.14 | $271.11 |
| Provisional bridge pontic - per pontic | 632 | $285.91 | $289.17 |
| Bridge pontic - direct - per pontic | 642 | $235.46 | $313.74 |
| Bridge pontic - indirect - per pontic | 643 | $1,241.41 | $1,618.10 |
| Retainer for bonded fixture - indirect - per tooth | 649 | $1,343.38 | $2,410.27 |
| Implant Procedures | |||
| Fitting of an implant abutment - per abutment | 661 | $932.46 | $925.75 |
| Prosthesis with metal frame attached to implants - fixed - per arch | 666 | $2,882.77 | $4,923.03 |
| Removal and reattachment of prosthesis fixed to implant(s) – per implant | 669 | $161.89 | |
| Full crown attached to osseointegrated implant - veneered indirect | 672 | $1,996.07 | |
| Surgical implant guide | 679 | $220.84 | $220.84 |
| Insertion of first stage of two-stage endosseous implant - per implant | 684 | $981.49 | |
| Insertion of one stage endosseous implant - per implant | 688 | FBN* | $2,413.49 |
| Second stage surgery of two stage endosseous implant - per implant | 691 | $371.38 | |
|
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 | |||
| Complete Maxillary Denture | 711 | $1,340.14 | $1,344.69 |
| Complete Mandibular Denture | 712 | $1,352.45 | $1,433.59 |
| Complete maxillary and mandibular denture | 719 | $2,430.16 | $2,443.61 |
| Partial maxillary denture - resin base | 721 | $860.50 | $757.15 |
| Partial maxillary denture - cast metal framework | 727 | $1,572.48 | $1,569.48 |
| Acrylic Dentures (Additional items) | |||
| Retainer - Per Tooth | 731 | $53.91 | $54.16 |
| Occlusal Rest - per rest | 732 | $15.41 | $15.63 |
| Tooth/teeth partial denture | 733 | $50.16 | $53.00 |
| Immediate tooth replacement - per tooth | 736 | $10.36 | $10.51 |
| Relining - complete denture - processed | 743 | $419.04 | $422.00 |
| Relining - partial denture - processed | 744 | $395.43 | $410.76 |
| Denture base modification | 754 | $154.64 | $156.93 |
| Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth | 768 | $212.53 | $182.90 |
| Orthodontics | |||
| Active removable appliance therapy - per arch | 821 | $965.09 | $1,106.61 |
| Full arch banding - per arch | 831 | $3,803.55 | |
| Minor tooth guidance - fixed | 846 | $862.95 | |
| Complete course of orthodontic treatment | 881 | $7,117.86 | |
| Travel to provide treatment | 916 | FBN* | FBN* |
| Clinical occlusal analysis, including muscle and joint palpation | 963 | $228.68 | $284.67 |
| Registration and mounting of models for oclusal analysis | 964 | $228.68 | $284.67 |
| Occlusal splint | 965 | $605.69 | $620.85 |
| Adjustment of pre-existing occlusal splint - per appointment | 966 | $86.27 | $110.36 |
* Note: Where the terminology FBN appears in this schedule, the fee must be negotiated with the TAC before any dental treatment is commenced.