54 General Dental Practitioner
62 Specialist Maxillo Facial and Oral Surgeon
64 Specialist Orthodontist
92 Specialist in Oral Medicine and Periodontics
94 Specialist Prosthodontist
98 Specialist Oral Pathologist
95 Dental Therapist
The best ICD-10 code for a dental extraction of a permanent tooth is “ICD-10 code: K08.1 – Extraction of teeth”. This code falls under the category of Diseases of the Oral Cavity, Salivary Glands, and Jaws, and specifically refers to “extraction of teeth, which includes the removal of one or more teeth from the alveolar bone”. It is important to note that the specific tooth or teeth extracted should also be documented in the patient’s chart for accurate record keeping.
For a dental practitioner, having knowledge of the International Classification of Diseases (ICD-10) codes is vital to the dental billing and coding process. ICD-10 codes provide standardised and universal identification for diagnoses and treatments. It is mandatory for precise claiming and reimbursement from medical aid schemes.
Understanding and correctly using these ICD-10 codes will ensure proper reimbursement for dental procedures and treatments. It’s important to stay up-to-date with any changes or updates to these codes to ensure billing and coding compliant dental claims.
January 2023
Dear Healthcare Provider
Momentum Dental Network | 2023 changes and fee structure
Thank you for being part of the Momentum Dental Network in 2022 and partnering with us in our drive to provide quality private healthcare to our members at an affordable price.
Please note the following important information for 2023:
Momentum Health Solutions Primary Care Dental Network merged with Fishmed Dental Network
Please note that the Fishmed Dental Network has been merged with the Momentum Health Solutions Primary Care Dental Network. The Fishmed benefits have been aligned to the Momentum Health Solutions Dental Network benefits and will take effect from 1 January 2023. Please familiarise yourself with the dental benefits in the link below as there have been significant changes to the Fishmed benefits.
The new participating medical scheme and benefit options can be found on the updated Annexure A – Participating schemes and health insurance products for 2023.
Scheme rates
Click here to view the dental network benefits and rates for 2023.
Personal protective equipment (PPE) funding
The dental PPE funding will be discontinued from 1 January 2023 and tariff code 8109 will revert to the original value on the increased amount for R23.70. We kindly request that you do not keep members liable for any costs relating to PPE.
Dental practitioner guide and online resources
For your convenience, we have created a Momentum Dental Network Guide for dental practitioners on our network. It will also be made available on the Momentum Health Solutions provider portal from 1 January 2023.
You also have access to the Momentum provider website where the following information can be found:
• Pay-run dates for 2023 per medical scheme under our administration
• Banking details form and process should you need to change your banking details
• Non-network dental rates for all medical schemes administered by Momentum Health Solutions.
Laboratory claims submission
Please share the network rates and codes with the laboratory you choose to make use of and advise them to make use of these codes should they bill directly.
Should you have any queries, you are welcome to contact us by email at drnet@momentum.co.za.
We would like to express our sincere thanks for your continued commitment and service to our valued members.
Kind regards
Provider Management
Momentum Health Solutions
| DISCOVERY HEALTH | ||
| 2021 DENTAL PRACTITIONER RATES | ||
| Procedure Code | Procedure Description | Scheme Rate |
| 8101 | Oral examination | 257.40 |
| 8102 | Comprehensive oral examination | 386.30 |
| 8103 | Extensive oral examination – condition focused combined consultation for complex treatment planning | 0.00 |
| 8104 | Limited oral examination | 124.80 |
| 8105 | Case presentation – extensive treatment planning | 0.00 |
| 8106 | Special report | 245.50 |
| 8107 | Intraoral radiograph – periapical | 111.60 |
| 8108 | Intraoral radiographs – complete series | 749.50 |
| 8109 | Infection control/barrier techniques | 24.80 |
| 8110 | Sterilized instrumentation | 55.50 |
| 8111 | Dental testimony | 0.00 |
| 8112 | Intraoral radiograph – bitewing | 111.60 |
| 8113 | Intraoral radiograph – occlusal | 166.80 |
| 8114 | Extraoral radiograph – hand-wrist | 387.20 |
| 8115 | Extraoral radiograph – panoramic | 387.20 |
| 8116 | Extraoral radiograph – cephalometric | 387.20 |
| 8117 | Diagnostic models | 103.80 |
| 8118 | Extraoral radiograph – skull/facial bone | 387.20 |
| 8119 | Diagnostic models mounted | 261.50 |
| 8120 | Treatment plan completed | 0.00 |
| 8121 | Oral and/or facial image (digital/conventional) | 103.80 |
| 8122 | Microbiological studies | 0.00 |
| 8123 | Caries susceptibility tests (By Arrangement) | 0.00 |
| 8124 | Pulp tests | 28.60 |
| 8125 | Pulp tests –more than 3 teeth | 0.00 |
| 8126 | Digital Diagnostic Models | 103.80 |
| 8129 | Office/hospital visit after regularly scheduled hours | 360.20 |
| 8130 | Rebond veneer | 0.00 |
| 8131 | Emergency dental treatment | 146.80 |
| 8132 | Pulp removal (pulpectomy) | 276.60 |
| 8133 | Recement inlay, onlay, crown or veneer | 146.80 |
| 8134 | Recement cast core or post | 146.80 |
| 8135 | Remove inlay, onlay or crown | 292.40 |
| 8136 | Access through a prosthetic crown or inlay to facilitate root canal treatment | 131.00 |
| 8137 | Emergency crown (chair-side) | 503.80 |
| 8138 | Remove retention post (prefabricated or cast) | 191.80 |
| 8139 | Appointment not kept /30min | 0.00 |
| 8140 | House/extended care facility/hospital call | 238.50 |
| 8141 | Inhalation sedation – first 15 minutes or part thereof | 107.50 |
| 8142 | Recement inlay/onlay/veneer | 146.80 |
| 8143 | Inhalation sedation – each addnl 15 minutes | 55.80 |
| 8144 | Intravenous sedation | 64.50 |
| 8145 | Local anaesthetic – per visit | 100.60 |
| 8146 | Resin bonding for restorations | 0.00 |
| 8147 | Monitoring equipment for intravenous sedation | 229.40 |
| 8148 | Use of dental operating microscope | 0.00 |
| 8149 | Nutritional counselling | 0.00 |
| 8150 | Tobacco counselling | 0.00 |
| 8151 | Oral hygiene instruction | 146.80 |
| 8153 | Oral hygiene instruction – each additional visit | 107.50 |
| 8155 | Polishing – complete dentition | 146.80 |
| 8156 | Removal of inlay/onlay/Veneer | 292.40 |
| 8157 | Re-burnishing and polishing of restorations – complete dentition | 146.80 |
| 8158 | Enamel microabrasion | 134.50 |
| 8159 | Prophylaxis – complete dentition | 288.70 |
| 8160 | Removal of gross calculus | 0.00 |
| 8161 | Topical application of fluoride – child | 146.80 |
| 8162 | Topical application of fluoride – adult | 146.80 |
| 8163 | Dental sealant | 97.00 |
| 8165 | Sedative filling | 146.80 |
| 8166 | Application of desensitising resin, per tooth | 97.00 |
| 8167 | Application of desensitising medicament, per visit | 113.00 |
| 8168 | Behavior management | 0.00 |
| 8169 | Occlusal guard | 564.30 |
| 8170 | Cost of Mouth Protector | 0.00 |
| 8171 | Mouth guard | 0.00 |
| 8172 | Cost of orthotic appliance | Blank |
| 8173 | Space maintainer – fixed, per abutment | 272.70 |
| 8174 | Recementation of space maintainer | 146.80 |
| 8175 | Space maintainer – removable | 351.50 |
| 8176 | Periodontal screening | 201.20 |
| 8177 | Oral hygiene instruction (periodontally compromised patient) | 222.00 |
| 8178 | Oral hygiene instruction – each additional visit (periodontally compromised patient) | 120.00 |
| 8179 | Polishing – complete dentition (periodontally compromised patient) | 168.30 |
| 8180 | Prophylaxis – complete dentition (periodontally compromised patient) | 313.60 |
| 8183 | Therapeutic drug injection | 64.50 |
| 8189 | Re-examination – existing condition | 115.70 |
| 8190 | Consultation – second opinion or advice | 239.30 |
| 8192 | Suture – minor | 724.40 |
| 8193 | Three-dimensional reconstruction of cone beam volumetric image using existing data (includes multiple images) | 0.00 |
| 8194 | CBCT capture and interpretation with limited field of view – less than one whole jaw | 961.40 |
| 8195 | CBCT capture and interpretation with limited field of view of one full dental arch -mandible | 1074.00 |
| 8196 | CBCT capture and interpretation with limited field of view of one full dental arch – maxilla | 1074.00 |
| 8197 | CBCT capture and interpretation with limited field of view of both dental arches without orbits and/or cranium | 1125.20 |
| 8198 | CBCT capture and interpretation for TMJ series including two or more exposures. | 1125.20 |
| 8199 | CBCT capture and interpretation with limited field of view of one full dental arch – maxilla with orbits and/or cranium | 0.00 |
| 8200 | CBCT capture and interpretation with field of view of both dental arches – with orbits and/or cranium | 0.00 |
| 8201 | Extraction – tooth or exposed tooth roots (first per quadrant) | 168.90 |
| 8202 | Extraction – each additional tooth or exposed tooth roots | 68.40 |
| 8203 | Interpretation of diagnostic image by a practitioner not associated with capture of the image, including the report | 409.10 |
| 8204 | Minimally traumatic tooth/root removal (aimed at direct / immediate implant placement) | 0.00 |
| 8205 | CBCT image capture with limited field of view – less than one whole jaw | 577.00 |
| 8206 | CBCT image capture with limited field of view of one full dental arch -mandible | 644.60 |
| 8207 | CBCT image capture with limited field of view of one full dental arch – maxilla without orbits and/or cranium | 644.60 |
| 8208 | CBCT capture with limited field of view of both dental arches – without orbits and/or cranium | 675.10 |
| 8209 | CBCT capture for TMJ series including two or more exposures. | 675.10 |
| 8210 | CBCT capture with limited field of view of one full dental arch – maxilla with orbits and/or cranium | 0.00 |
| 8211 | CBCT capture with field of view of both dental arches – with orbits and/or cranium | 0.00 |
| 8212 | Interpretation of diagnostic image by a practitioner associated with capture of the image, including the report | 0.00 |
| 8213 | Surgical removal of residual roots, first tooth – per tooth | 635.00 |
| 8214 | Surgical removal of residual roots, second and subsequent teeth’s roots | 489.40 |
| 8215 | Impressions for the purpose of establishing virtual models for use in planning software (this code may be reported with the appropriate code for impression material 9753) |
0.00 |
| 8216 | CBCT of plaster models or impressions for the purpose of creating virtual models for use in planning software | 0.00 |
| 8217 | CBCT capture and interpretation for the visualisation of sinuses | 0.00 |
| 8218 | CBCT capture for the visualisation of sinuses | 0.00 |
| 8219 | Report by a third party on pathology, implant measurements, endodontics, orthodontic measurements, nerve proximities etc | 0.00 |
| 8220 | Cost of suture material | Blank |
| 8231 | Complete dentures – maxillary and mandibular | 2369.80 |
| 8232 | Complete denture – maxillary or mandibular | 1461.20 |
| 8233 | Partial denture – resin base – one tooth | 679.30 |
| 8234 | Partial denture – resin base – two teeth | 679.30 |
| 8235 | Partial denture – resin base – three teeth | 1016.50 |
| 8236 | Partial denture – resin base – four teeth | 1016.50 |
| 8237 | Partial denture – resin base – five teeth | 1016.50 |
| 8238 | Partial denture – resin base – six teeth | 1348.00 |
| 8239 | Partial denture – resin base – seven teeth | 1348.00 |
| 8240 | Partial denture – resin base – eight teeth | 1348.00 |
| 8241 | Partial denture – resin base – nine or more teeth | 1348.00 |
| 8244 | Immediate denture – maxillary | 1461.20 |
| 8245 | Immediate denture – mandibular | 1461.20 |
| 8246 | Immediate denture – Partial (report in addition to partial denture codes) | 0.00 |
| 8251 | Clasp or rest – cast gold | 134.50 |
| 8253 | Clasp or rest – wrought gold | 134.50 |
| 8255 | Clasp or rest – stainless steel | 141.50 |
| 8257 | Bar – lingual or palatal | 166.80 |
| 8259 | Rebase complete or partial denture (laboratory) | 554.10 |
| 8261 | Remodel complete or partial denture | 889.00 |
| 8263 | Reline complete or partial denture (chair-side) | 351.50 |
| 8265 | Tissues conditioning per arch (including soft self-cure reline) | 229.40 |
| 8267 | Reline complete or partial denture (laboratory) | 808.40 |
| 8269 | Repair denture or other intra-oral appliance | 214.70 |
| 8270 | Add clasp to existing partial denture | 134.50 |
| 8271 | Add tooth to existing partial denture | 134.50 |
| 8273 | Impression to repair or modify a denture or other intra-oral appliance | 107.50 |
| 8275 | Adjust complete or partial denture | 107.50 |
| 8277 | Inlay in denture | 0.00 |
| 8281 | Partial denture – cast metal framework only | 1584.90 |
| 8283 | Partial denture – Flexidenture framework | 0.00 |
| 8284 | Full denture –Flexidenture framework | 0.00 |
| 8301 | Pulp cap – direct | 195.30 |
| 8303 | Pulp cap – indirect | 195.30 |
| 8304 | Rubber dam per arch | 115.00 |
| 8306 | Cost of MTA | Blank |
| 8307 | Pulp amputation (pulpotomy) | 191.80 |
| 8308 | External bleaching – per arch | 0.00 |
| 8309 | Home bleaching – instructions and applicator | 0.00 |
| 8310 | Supply of bleaching materials | 0.00 |
| 8311 | Home bleaching – subsequent visit | 0.00 |
| 8312 | Root canal therapy – anterior primary tooth Anterior primary teeth include incisors and canines. Prep and obturation | 0.00 |
| 8313 | Root canal therapy – posterior primary tooth | 0.00 |
| 8317 | Root canal preparation, each additional canal – molar Preparation of the canal. May require further appointments to prepare the canal. Obturation is done in a subsequent appointment. | 0.00 |
| 8318 | Irrigation and medication per tooth at a separate visit | 146.80 |
| 8323 | Retreatment of previously completed root canal therapy, each additional canal – anterior or premolar | 0.00 |
| 8324 | Retreatment of previously completed root canal therapy, each additional canal – molar | 0.00 |
| 8325 | Internal bleaching – per tooth | 0.00 |
| 8327 | Internal bleaching – each additional visit | 0.00 |
| 8328 | Root canal obturation – anteriors and premolars – each additional canal | 272.70 |
| 8329 | Root canal therapy – anteriors and premolars – each additional canal | 340.20 |
| 8330 | Removal of root canal obstruction | 191.80 |
| 8331 | Repair of perforation defects | 0.00 |
| 8332 | Root canal preparatory visit – single canal tooth | 146.80 |
| 8333 | Root canal preparatory visit – multi canal tooth | 206.50 |
| 8334 | Re-preparation of previously obturated root canal | 217.10 |
| 8335 | Root canal obturation – anteriors and premolars – first canal | 666.80 |
| 8336 | Root canal obturation – posteriors – first canal | 917.90 |
| 8337 | Root canal obturation – posteriors – each additional canal | 272.70 |
| 8338 | Root canal therapy – anteriors and premolars – first canal | 1020.00 |
| 8339 | Root canal therapy – posteriors – first canal | 1402.00 |
| 8340 | Root canal therapy – posteriors – each additional canal | 340.20 |
| 8341 | Amalgam – one surface | 336.40 |
| 8342 | Amalgam – two surfaces | 414.10 |
| 8343 | Amalgam – three surfaces | 504.90 |
| 8344 | Amalgam – four or more surfaces | 563.00 |
| 8345 | Prefabricated post retention, per post (in addition to restoration) | 288.70 |
| 8346 | Restorative Material Factor | 0.00 |
| 8347 | Pin retention – first pin (in addition to restoration) | 145.30 |
| 8348 | Pin retention – each additional pin (in addition to restoration) | 134.50 |
| 8349 | Carve restoration to accommodate existing removable prosthesis | 59.50 |
| 8350 | Resin crown – anterior primary tooth (direct) | 637.60 |
| 8351 | Resin – one surface, anterior | 368.90 |
| 8352 | Resin – two surfaces, anterior | 464.20 |
| 8353 | Resin – three surfaces, anterior | 554.40 |
| 8354 | Resin – four or more surfaces, anterior | 618.60 |
| 8355 | Veneer – resin (chair-side) | 509.50 |
| 8357 | Prefabricated metal crown | 299.50 |
| 8360 | Interim (temporary) inlay/onlay | 0.00 |
| 8361 | Inlay – metal – one surface | 446.00 |
| 8362 | Inlay/onlay – metal – two surfaces | 652.50 |
| 8363 | Inlay/onlay – metal – three surfaces | 1088.40 |
| 8364 | Inlay/onlay – metal – four or more surfaces | 1316.20 |
| 8366 | Pin retention as part of cast restoration (any number of pins) | 217.10 |
| 8367 | Resin – one surface, posterior | 400.00 |
| 8368 | Resin – two surfaces, posterior | 494.60 |
| 8369 | Resin – three surfaces, posterior | 597.70 |
| 8370 | Resin – four or more surfaces, posterior | 642.90 |
| 8371 | Inlay – porcelain – one surface | 537.70 |
| 8372 | Inlay/onlay – porcelain – two surfaces | 794.00 |
| 8373 | Inlay/onlay – porcelain – three surfaces | 1308.50 |
| 8374 | Inlay/onlay – porcelain – four or more surfaces | 1584.90 |
| 8375 | Prefabricated resin crown | 299.50 |
| 8376 | Core build-up with prefabricated posts | 799.60 |
| 8379 | Cost of prefabricated posts | Blank |
| 8381 | Inlay – resin – one surface | 537.70 |
| 8382 | Inlay/onlay – resin – two surfaces | 794.00 |
| 8383 | Inlay/onlay – resin – three surfaces | 1308.50 |
| 8384 | Inlay/onlay – resin – four or more surfaces | 1584.90 |
| 8385 | Fabrication of Indirect resin inlay/onlay restoration | 0.00 |
| 8391 | Cast core with single post | 337.00 |
| 8392 | Cast post (each additional) | 200.60 |
| 8397 | Cast core with pins (any number of pins) | 537.70 |
| 8398 | Core build-up with or without pins | 652.50 |
| 8400 | Temporary crown | 0.00 |
| 8401 | Crown – full cast metal | 1929.20 |
| 8403 | Crown – 3/4 cast metal | 1929.20 |
| 8404 | Crown – 3/4 porcelain/ceramic | 1584.50 |
| 8405 | Crown – resin laboratory | 1584.50 |
| 8406 | Crown – three-quarter resin (indirect) | 1584.50 |
| 8407 | Crown – resin with metal | 1929.20 |
| 8409 | Crown – porcelain/ceramic | 1929.20 |
| 8410 | Provisional crown | 325.60 |
| 8411 | Crown – porcelain with metal | 1929.20 |
| 8413 | Repair crown (permanent or provisional) | 325.60 |
| 8414 | Additional fee for provision of crown within an existing clasp or rest | 97.00 |
| 8415 | Pontic – porcelain/ceramic | 1574.80 |
| 8416 | Pontic – cast metal | 1088.40 |
| 8417 | Pontic – resin with metal | 1574.80 |
| 8418 | Pontic – porcelain fused to metal | 1574.80 |
| 8419 | Provisional pontic | 325.60 |
| 8420 | Pontic – resin based composite (indirect) | 1574.80 |
| 8421 | Temporary pontic | 0.00 |
| 8423 | Ovate pontic design | 0.00 |
| 8431 | Temporary inlay/onlay retainer | 0.00 |
| 8432 | Inlay/onlay retainer – metal – two surfaces | 652.50 |
| 8433 | Inlay/onlay retainer – metal – three surfaces | 1088.40 |
| 8434 | Inlay/onlay retainer – metal – four or more surfaces | 1316.20 |
| 8436 | Inlay/onlay retainer – porcelain – two surfaces | 794.00 |
| 8437 | Inlay/onlay retainer – porcelain – three surfaces | 1308.50 |
| 8438 | Inlay/onlay retainer – porcelain – four or more surfaces | 1584.90 |
| 8440 | Temporary crown retainer | 0.00 |
| 8441 | Crown retainer – full cast metal | 1929.20 |
| 8442 | Crown retainer – 3/4 cast metal | 1929.20 |
| 8443 | Crown retainer – porcelain/ceramic | 1929.20 |
| 8444 | Crown retainer – 3/4 porcelain/ceramic | 1929.20 |
| 8445 | Crown retainer – porcelain with metal | 1929.20 |
| 8446 | Crown retainer – resin with metal | 1929.20 |
| 8447 | Provisional crown retainer | 325.60 |
| 8448 | Crown retainer – resin based composite (indirect) | 1929.20 |
| 8471 | Procedural Sedation or General anaesthesia – assessment | 0.00 |
| 8472 | Procedural Sedation first 30 min | 0.00 |
| 8473 | Procedural Sedation each additional 15 min or part thereof | 0.00 |
| 8474 | Procedure room for sedation | 0.00 |
| 8480 | Cost of Prefabricated metal restoration | 0.00 |
| 8481 | Cost of prefabricated resin crown | 0.00 |
| 8482 | Cost of orthodontic attachment | 0.00 |
| 8483 | Cost of CT Scan DICOM conversion | 0.00 |
| 8485 | Cost of the production of a computer generated surgical guide using rapid prototyping. Systems using computer generated laboratory techniques (e.g. Med 3-D) can use laboratory technician codes.(8099) | 0.00 |
| 8499 | General anaesthetic | 0.00 |
| 8501 | Consultation – Prosthodontis | 0.00 |
| 8503 | Occlusion analysis mounted | 325.60 |
| 8505 | Pantographic recording | 473.00 |
| 8506 | Detailed consultation – Prosthodontist | 0.00 |
| 8507 | Comprehensive consultation – Prosthodontist | 0.00 |
| 8508 | Electrognathographic recording | 506.60 |
| 8509 | Electrognathographic recording with computer analysis | 841.20 |
| 8514 | Recement bridge | 146.80 |
| 8515 | Sectioning of a bridge | 0.00 |
| 8516 | Remove bridge | 292.40 |
| 8517 | Reimplantation of avulsed tooth (include stabilisation) | 339.30 |
| 8518 | Repair bridge | 325.60 |
| 8519 | Fabrication of computer generated 1-3 surface resin or ceramic inlay or onlay | 0.00 |
| 8520 | Fabrication of computer generated 4 or more surface resin or ceramic inlay or onlay | 0.00 |
| 8521 | Fabrication of computer generated resin or ceramic crown | 0.00 |
| 8522 | Fabrication of computer generated resin or ceramic crown retainer, per unit as part of bridge framework | 0.00 |
| 8523 | Fabrication of computer generated resin or ceramic pontic, per unit as part of bridge framework | 0.00 |
| 8524 | Fabrication of computer generated resin or ceramic veneer for bridge framework, per unit | 0.00 |
| 8525 | Fabrication of computer generated ceramic implant supported restoration, per unit | 0.00 |
| 8526 | Fabrication of a computer generated ceramic implant abutment, per unit | 0.00 |
| 8527 | Direct Cost of material in the fabrication of computer generated resin restoration. See Rule 002 and Appendix A for the cost of direct materials | 0.00 |
| 8528 | Direct Cost of material in the fabrication of computer generated ceramic restoration. See Rule 002 and Appendix A for the cost of direct materials | 0.00 |
| 8533 | Implant supported removable complete overdenture | 2634.50 |
| 8534 | Implant supported removable partial overdenture | 2107.20 |
| 8536 | Crown – implant/abutment supported – porcelain/ceramic | 2504.70 |
| 8537 | Crown – implant/abutment supported – porcelain with metal | 2504.70 |
| 8538 | Crown – implant/abutment supported – cast metal | 2504.70 |
| 8539 | Crown-Implant / abutment supported crown – resin veneered to metal | 2504.70 |
| 8541 | Implant supported interim (temporary) crown – cemented A temporary implant supported crown is a short term acrylic or resin restoration that is made to maintain function and an appropriate transmucosal tissue aperture until the permanent prosthesis has be | 0.00 |
| 8542 | Implant supported interim (temporary) crown – screw retained | 0.00 |
| 8543 | Implant supported provisional crown – cemented | 325.60 |
| 8544 | Implant supported provisional crown – screw retained | 325.60 |
| 8546 | Crown retainer – implant/abutment supported – porcelain/ceramic | 2504.70 |
| 8547 | Crown retainer – implant/abutment supported – porcelain with metal | 2504.70 |
| 8548 | Crown retainer – implant/abutment supported – cast metal | 2504.70 |
| 8549 | Implant supported crown retainer – resin veneered to metal | 1929.20 |
| 8550 | Retainer-Implant/Abutment Supported | 1929.20 |
| 8551 | Occlusal adjustment – major | 929.80 |
| 8552 | Veneer – porcelain (laboratory) | 1127.10 |
| 8553 | Occlusal adjustment – minor | 324.50 |
| 8554 | Veneer – resin (laboratory) | 1127.10 |
| 8560 | Cost of ceramic block | Blank |
| 8561 | Gold foil class I or IV | 851.00 |
| 8563 | Gold foil class V | 995.50 |
| 8565 | Gold foil class III | 1252.50 |
| 8570 | Fabrication of computer generated ceramic restoration | 1680.90 |
| 8571 | Implant supported interim (temporary) retainer – cemented | 0.00 |
| 8572 | Implant supported interim (temporary)crown retainer – screw retained | 0.00 |
| 8573 | Implant supported provisional crown retainer – cemented | 325.60 |
| 8574 | Implant supported provisional crown retainer – screw retained | 325.60 |
| 8578 | Prefabricated abutment | 272.70 |
| 8579 | Custom abutment | 1243.00 |
| 8580 | Modification of prefabricated abutment | 0.00 |
| 8581 | Cast core with single post | 0.00 |
| 8582 | Cast core with double post | 0.00 |
| 8583 | Cast core with triple post | 0.00 |
| 8584 | Connector bar – implant supported | 2634.50 |
| 8585 | Connector bar | 2634.50 |
| 8586 | Stress breaker | 982.40 |
| 8587 | Coping metal | 218.90 |
| 8590 | Implant maintenance procedures – per implant | 120.80 |
| 8591 | Removal of implant supported prosthesis | 292.40 |
| 8592 | Crown – implant/abutment supported | 0.00 |
| 8593 | Repair of implant supported resin prosthesis | 133.50 |
| 8594 | Repair of implant supported prosthesis | 133.50 |
| 8595 | Repair of implant abutment | 133.50 |
| 8596 | Repair of implant supported ceramic or ceramometal crown, retainer or pontic | 133.50 |
| 8597 | Locks and milled rests | 133.50 |
| 8598 | Repair of implant supported Provisional Prosthesis | 133.50 |
| 8599 | Precision attachment (removable denture) | 325.60 |
| 8600 | Cost of implant components | Blank |
| 8601 | Computerised implant planning | 0.00 |
| 8602 | Computer Generated Surgical Guide A computer generated surgical guide for implant positioning after computerised planning code 8601. See Rule 002 Code 8483 followed by 8092 | 0.00 |
| 8606 | Placement of implant fixtures outside the oral cavity | 1362.50 |
| 8607 | Skeletal anchorage – screw, plate or implant | 0.00 |
| 8608 | Removal of non-integrated implant | 724.40 |
| 8609 | Flap operation with modification of the implant surface,including bone surgery-one to three implants per quadrant | 0.00 |
| 8610 | Flap operation with modification of the implant surface,including bone surgery-four or more implants per quadrant | 0.00 |
| 8611 | Pontic – sanitary | 895.90 |
| 8612 | Skeletal anchorage – removal | 0.00 |
| 8613 | Pontic – posterior | 0.00 |
| 8615 | Pontic – anterior/premolar | 0.00 |
| 8617 | Retainer cast metal (Maryland type retainer) | 652.50 |
| 8618 | Retainer – ceramic for resin bonded bridge | 0.00 |
| 8621 | Metal base for implant supported denture – Partial | 0.00 |
| 8631 | Root canal therapy – first canal | 0.00 |
| 8633 | Root canal therapy – each additional canal | 0.00 |
| 8634 | Apexification/ apexogenesis /recalcification – initial visit | 0.00 |
| 8635 | Apexification/recalcification per visit | 195.30 |
| 8637 | Apicectomy/ periradicular surgery, first root – premolar | 0.00 |
| 8638 | Apicectomy/ periradicular surgery, each additional root – anteriors and premolars | 0.00 |
| 8639 | Endodontic instruments per patient per completed treatment. | 0.00 |
| 8640 | Removal of fractured post or instrument from root canal | 0.00 |
| 8642 | Apicectomy/ periradicular surgery, each additional root – molars | 0.00 |
| 8643 | Complete dentures – maxillary and mandibular (with complications) | 0.00 |
| 8645 | Complete dentures – maxillary and mandibular (with major complications) | 0.00 |
| 8646 | Immediate denture – maxillary or mandibular Only for Prosthodontist | 0.00 |
| 8647 | Immediate denture – maxillary or mandibular (with major complications) Only for Prosthodontist | 0.00 |
| 8649 | Complete denture – maxillary or mandibular (with complications) | 0.00 |
| 8651 | Complete denture – maxillary or mandibular (with major complications) | 0.00 |
| 8652 | Overdenture – complete | 2634.50 |
| 8653 | Overdenture – partial | 2107.20 |
| 8654 | Implant supported fixed-detachable complete overdenture | 2962.70 |
| 8655 | Implant supported fixed-detachable partial overdenture | 2369.80 |
| 8657 | Replacement of precision attachment | 186.80 |
| 8658 | Interim complete denture | 1461.10 |
| 8659 | Interim partial denture | 1168.60 |
| 8660 | Additional fee to implant supported fixed-detachable denture – per implant | 408.70 |
| 8661 | Diagnostic dentures (including tissue conditioning) | 2370.60 |
| 8662 | Adjust complete or partial dentures (remounting) | 379.90 |
| 8663 | Metal base to complete denture | 793.80 |
| 8664 | Remount crown or bridge for prosthetics | 379.90 |
| 8665 | Mini screw implants | 0.00 |
| 8666 | Immediate loading of implant | 0.00 |
| 8667 | Soft base to denture (heat cured) | 793.80 |
| 8668 | Metal base for implant supported denture – complete | 793.80 |
| 8669 | Crown cemented on a screw-retained implant-supported superstructure |
2504.70 |
| 8670 | Implant screw access closure | 368.90 |
| 8671 | Partial denture – cast metal framework with resin denture base | 0.00 |
| 8672 | Altered cast technique (in addition to partial denture) | 101.90 |
| 8674 | Additive partial denture | 1195.10 |
| 8685 | Modification of obturator prostheses per visit. | 0.00 |
| 8701 | Consultation – periodontist | 0.00 |
| 8703 | Consultation – Periodontist (detailed) | 0.00 |
| 8705 | Re-examination – Periodontist | 0.00 |
| 8707 | Periodontal screening – Periodontist | 0.00 |
| 8711 | The visualisation enhancement adjunct (VEA) | 0.00 |
| 8713 | Blood and Blood Products for Regeneration | 0.00 |
| 8723 | Provisional splinting – extracoronal (wire) – per sextant | 272.70 |
| 8725 | Provisional splinting – extracoronal (wire plus resin) – per sextant | 395.70 |
| 8727 | Provisional splinting – intracoronal – per tooth | 124.30 |
| 8731 | Incision & drainage of abscess – intra-oral | 234.30 |
| 8732 | Topical treatment of diseased soft tissue | 0.00 |
| 8737 | Root planing – four or more teeth per quadrant | 588.40 |
| 8739 | Root planing – one to three teeth per quadrant | 468.10 |
| 8740 | Periodontal maintenance | 0.00 |
| 8741 | Gingivectomy/gingivoplasty – four or more teeth per quadrant | 767.50 |
| 8743 | Gingivectomy or gingivoplasty – one to three teeth per quadrant | 613.10 |
| 8746 | Flap operation with root planing and curettage (open curettage) – four or more teeth per quadrant | 0.00 |
| 8747 | Flap operation with root planing and curettage, including bone surgery – one to three teeth per quadrant | 0.00 |
| 8748 | Flap operation with root planing and curettage, including bone surgery – four or more teeth per quadrant | 0.00 |
| 8749 | Flap procedure, root planing and one to three surgical services – per quadrant | 1593.20 |
| 8751 | Flap procedure, root planing and one to three surgical services – per sextant | 1319.20 |
| 8753 | Flap procedure, root planing and four or more surgical services – per quadrant | 1974.70 |
| 8755 | Flap procedure, root planing and four or more surgical services – per sextant | 1600.30 |
| 8756 | Clinical crown lengthening (isolated procedure) | 970.50 |
| 8759 | Pedicle flapped graft (isolated procedure) | 729.10 |
| 8761 | Masticatory mucosal autograft – one to four teeth (isolated procedure) | 792.40 |
| 8762 | Masticatory mucosal autograft – four or more teeth (isolated procedure) | 1189.90 |
| 8763 | Wedge resection (isolated procedure) | 466.40 |
| 8765 | Hemisection of a tooth, resection of a root or tunnel preparation (isolated procedure) | 640.50 |
| 8766 | Bone regeneration/repair procedure – as part of a flap operation | 381.40 |
| 8767 | Bone regeneration/repair procedure – at a single site | 988.70 |
| 8768 | Unlisted periodontal procedure | 466.40 |
| 8769 | Membrane removal (used for guided tissue regeneration) | 466.40 |
| 8770 | Cost of bone regenerative/repair material | Blank |
| 8771 | Insertion of intra-pocket chemotherapeutic agent – per pocket so treated | 0.00 |
| 8772 | Submucosal connective tissue autograft (isolated procedure) | 800.80 |
| 8773 | Cost of intrapocket chemotherapeutic agent | Blank |
| 8774 | Guided tissue regeneration – resorbable barrier, per site | 0.00 |
| 8775 | Guided tissue regeneration – nonresorbable barrier, per site (includes subsequent removal of membrane) | 0.00 |
| 8776 | Submucosal connective tissue autograft – extending across one to three teeth per quadrant | 0.00 |
| 8777 | Submucosal connective tissue autograft – extending across four or more teeth per quadrant | 0.00 |
| 8778 | Submucosal soft tissue allograft – extending across one to three teeth per quadrant | 0.00 |
| 8779 | Submucosal soft tissue allograft – extending across four or more teeth per quadrant | 0.00 |
| 8780 | Alveolar process preservation, per extraction site | 0.00 |
| 8781 | Consultation – Oral medicine (simple) | 162.90 |
| 8782 | Consultation – Oral medicine (complex) | 0.00 |
| 8783 | Consultation – Oral medicine (subsequent) | 121.10 |
| 8785 | Root resection | 640.50 |
| 8786 | Tunnel preparation | 640.50 |
| 8787 | Unlisted oral medicine procedure | 167.20 |
| 8792 | Vestibuloplasty with teeth per sextant | 0.00 |
| 8793 | Vestibuloplasty in an edentulous area per sextant | 0.00 |
| 8794 | Alveoplasty with implant therapy 1-3 teeth | 0.00 |
| 8795 | Alveoplasty with implant therapy 4 or more teeth | 0.00 |
| 8796 | Repair of oronasal opening | 0.00 |
| 8801 | Consultation – Orthodontist | 200.70 |
| 8803 | Consultation – Orthodontis (subsequent, retention and post treatment) | 140.50 |
| 8804 | Placement of Fixed orthodontic retainer | 0.00 |
| 8805 | Repair or Replacement of fixed orthodontic Retainer | 0.00 |
| 8806 | Orthodontic retention visit | 0.00 |
| 8807 | Post orthodontic treatment consultation | 0.00 |
| 8811 | Tracing and analysis of extra-oral film | 45.10 |
| 8837 | Diagnosis and treatment planning – Orthodontist | 93.40 |
| 8839 | Diagnostic setup (orthodontics) | 199.70 |
| 8840 | Treatment planning for orthognathic surgery – ALL | 688.40 |
| 8841 | Ortho Tx – fixed lingual appliance – one arch | 10640.10 |
| 8842 | Ortho Tx – fixed lingual appliance – one arch, modeate | 12504.50 |
| 8843 | Ortho Tx – fixed lingual appliance – one arch, severe | 14247.20 |
| 8845 | Temporary anchorage device per unit | 0.00 |
| 8846 | Repair orthodontic appliance – removable | 134.80 |
| 8847 | Replace orthodontic appliance – removable | 466.40 |
| 8848 | Repair orthodontic appliance – fixed | 199.70 |
| 8849 | Retainer (orthodontic) | 466.40 |
| 8850 | Treatment of MPDS – first visit | 224.60 |
| 8851 | Treatment of MPDS – subsequent visit | 118.20 |
| 8852 | Occlusal orthotic appliance | 564.30 |
| 8855 | Consultation – cleft palate therapy (house or hospital) | 272.70 |
| 8856 | Consultation – cleft palate (subsequent) | 133.50 |
| 8857 | Consultation – cleft palate (maximum) | 931.10 |
| 8858 | Ortho Tx – functional appliance | 2968.90 |
| 8861 | Ortho Tx – partial fixed appliance – minor | 1974.70 |
| 8862 | Ortho Tx – removable appliance | 1648.00 |
| 8863 | Ortho Tx – each additional removable appliance | 828.40 |
| 8865 | Ortho Tx – partial fixed appliance – one arch | 5267.10 |
| 8866 | Ortho Tx – partial fixed appliance – both arches | 7243.90 |
| 8867 | Ortho Tx – fixed appliance – one arch | 5661.40 |
| 8868 | Ortho Tx – fixed appliance – one arch, modeate | 6983.30 |
| 8869 | Ortho Tx – fixed appliance – one arch, severe | 8167.50 |
| 8870 | Therapy to control harmful habits – removable appliance | 0.00 |
| 8871 | Therapy to control harmful habits – fixed appliance | 0.00 |
| 8873 | Ortho Tx – fixed appliance – both arches, Class 1 mild | 10360.40 |
| 8874 | Ortho Tx – fixed lingual appliance – both arches, Class 1 mild | 20297.90 |
| 8875 | Ortho Tx – fixed appliance – both arches, Class 1 moderate | 12718.80 |
| 8876 | Ortho Tx – fixed lingual appliance – both arches, Class 1 moderate | 23764.90 |
| 8877 | Ortho Tx – fixed appliance – both arches, Class 1 severe | 14826.60 |
| 8878 | Ortho Tx – fixed lingual appliance – both arches, Class 1 severe | 26970.40 |
| 8879 | Ortho Tx – fixed appliance – both arches, Class 1 severe w/ complications | 16662.30 |
| 8880 | Ortho Tx – fixed lingual appliance – both arches, Class 1 severe w/ complications | 29926.30 |
| 8881 | Ortho Tx – fixed appliance – both arches, Class 2/3 mild | 14826.60 |
| 8882 | Ortho Tx – fixed lingual appliance – both arches, Class 2/3 mild | 24774.90 |
| 8883 | Ortho Tx – fixed appliance – both arches, Class 2/3 moderate | 16662.30 |
| 8884 | Ortho Tx – fixed lingual appliance – both arches, Class 2/3 moderate | 27714.80 |
| 8885 | Ortho Tx – fixed appliance – both arches, Class 2/3 severe | 18704.80 |
| 8886 | Ortho Tx – fixed lingual appliance – both arches, Class 2/3 severe | 30867.60 |
| 8887 | Ortho Tx – fixed appliance – both arches, Class 2/3 severe w/ complications | 21074.70 |
| 8888 | Ortho Tx – fixed lingual appliance – both arches, Class 2/3 severe w/ complications | 34346.60 |
| 8889 | Attachment device | 0.00 |
| 8890 | Monthly instalment ortho tx | Blank |
| 8891 | Orthodontic transfer | 0.00 |
| 8892 | Orthodontic re-treatment | 0.00 |
| 8893 | Telephonic/electronic consultation | 0.00 |
| 8894 | Consultation without the patient (with family for consent or writing of special reports, or preparation of quotations ) | 0.00 |
| 8895 | Examination under general anesthesia | 0.00 |
| 8896 | Cost of materials required to aid eruption | 0.00 |
| 8901 | Consultation – MFOS | 0.00 |
| 8902 | Consultation – MFOS (detailed) | 0.00 |
| 8903 | House/Hosp/Nursing home consultation – MFOS | 0.00 |
| 8904 | House/Hosp/Nursing home consultation (subsequent) – MFOS | 0.00 |
| 8905 | After regularly hours consultation – MFOS | 0.00 |
| 8906 | Post-op visit in hospital for Neoplasm/Trauma/CLP (2x/day for duration of hospitalization), reported per visit | 0.00 |
| 8907 | House/Hosp/Nursing home consultation (maximum per week) – MFOS | 0.00 |
| 8908 | Surgical removal of roots from maxillary antrum | 1941.00 |
| 8909 | Oral antral fistula closure | 1488.30 |
| 8910 | Vermillionectomy | 0.00 |
| 8911 | Caldwell-Luc procedure | 582.20 |
| 8912 | Transmasseteric antero-parotid approach | 0.00 |
| 8913 | Condylar Risdon / submandibular approach | 0.00 |
| 8914 | Endoscopic or intra-oral approach to the condyle | 0.00 |
| 8915 | Intra-oral circum-oral mandibular approach | 0.00 |
| 8916 | Preauriculo-temporal approach | 0.00 |
| 8917 | Biopsy of oral tissue – soft | 371.20 |
| 8918 | Brush biopsy | 0.00 |
| 8919 | Biopsy of bone – needle | 571.00 |
| 8920 | Exfoliative cytological specimen collection | 0.00 |
| 8921 | Biopsy extra-oral bone/soft tissue | 934.70 |
| 8923 | Aspiration biopsy (FNA) | 574.60 |
| 8924 | Open biopsy of a single lymphnode in the neck | 0.00 |
| 8925 | Biopsy of soft tissue –extraoral deep or intramuscular, requiring suturing in multiple layers | 0.00 |
| 8926 | Biopsy of tissue –intra-oral bone | 934.70 |
| 8927 | Biopsy of tissue –extra-oral bone | 934.70 |
| 8928 | Core Needle biopsy | 574.60 |
| 8929 | Removal of temperomandibular joint prosthesis | 0.00 |
| 8930 | Design meeting and/or planning for a custom prosthesis/tempero-mandibular joint, charge per joint/prosthesis designed | 0.00 |
| 8931 | Treatment of post-extraction haemorrhage | 107.50 |
| 8932 | Biopsy of soft tissue – intraoral superficial, with suturing | 0.00 |
| 8933 | Treatment of haemorrhage (blood dyscracias) | 1488.30 |
| 8934 | Biopsy of soft tissue– intraoral deep or intramuscular, requiring suturing in multiple layers | 0.00 |
| 8935 | Treatment of septic socket | 107.50 |
| 8937 | Surgical removal of tooth | 635.00 |
| 8939 | Limited neck dissection. | 0.00 |
| 8940 | Endoscopic management of a condylar fracture – report per side | 0.00 |
| 8941 | Surgical removal of impacted tooth – first tooth | 1210.40 |
| 8943 | Surgical removal of impacted tooth – second tooth | 649.30 |
| 8944 | Zygomatic fracture-open reduction with fixation at three or more sites | 0.00 |
| 8945 | Surgical removal of impacted tooth – third and subsequent teeth | 369.20 |
| 8946 | Zygomatic reconstruction (osteotomy or onlay) | 0.00 |
| 8947 | Anthrostomy for the placement of a sinuspack in order to reduce a zygomatic fracture | 0.00 |
| 8948 | Endoscopic procedure: Wharton’s duct | 0.00 |
| 8949 | Endoscopic procedure: Stenson’s duct | 0.00 |
| 8950 | Excision of a ranula (marsupealization) | 0.00 |
| 8951 | Trigger point injection (local anesthesia) | 0.00 |
| 8952 | Pain point injection (alcohol, phenol, etc) | 0.00 |
| 8953 | Surgical removal of residual roots, first tooth – per tooth | 0.00 |
| 8954 | Laser treatment for facial pain | 0.00 |
| 8955 | Alveoplasty or alveolectomy in conjunction with extractions per quadrant | 0.00 |
| 8956 | Alveoplasty or alveolectomy not in conjunction with extractions – per quadrant | 0.00 |
| 8957 | Alveolotomy or alveolectomy (including extractions) | 779.30 |
| 8958 | Emergency tracheotomy | 654.90 |
| 8959 | Pharyngostomy | 654.90 |
| 8960 | Salivary duct dilatation or canalization | 0.00 |
| 8961 | Tooth transplantation | 1277.60 |
| 8962 | Harvest iliac crest graft | 471.00 |
| 8963 | Harvest rib graft | 540.30 |
| 8964 | Harvest cranium graft | 423.40 |
| 8965 | Peripheral neurectomy | 1277.60 |
| 8966 | Repair of oronasal fistula (local flaps) | 1777.40 |
| 8967 | Surgical removal of jaw cyst – intra-oral approach | 1774.80 |
| 8968 | Excision of benign soft tissue tumour requiring extensive resection and suturing in multiple layers with muscular involvement | 0.00 |
| 8969 | Surgical removal of jaw cyst – extra-oral approach | 2843.40 |
| 8970 | Excision of benign soft tissue tumour requiring suturing in multiple layers no muscular involvement | 0.00 |
| 8971 | Excision of tumour of the soft tissue | 571.00 |
| 8972 | Excision small malignant lesion requiring minimal suturing | 0.00 |
| 8973 | Surgical excision of tumours of the jaw | 2843.40 |
| 8974 | Excision of malignant soft tissue tumour requiring suturing in multiple layers no muscular or intraosseus involvement | 0.00 |
| 8975 | Hemiresection of jaw excluding condyl | 2986.60 |
| 8976 | Extensive resection for malignant soft tissue tumour – excluding reconstruction | 0.00 |
| 8977 | Surgical repair of maxilla or mandible – major | 2984.40 |
| 8978 | Excision of a lesion of the tongue requiring no suture or primary suture, excludes primary suture and may be reported with code 8990 | 0.00 |
| 8979 | Harvesting of autogenous grafts (intra-oral) | 246.10 |
| 8980 | Intraoral harvesting of bone-coagulum/bone-scraping, not per site | 0.00 |
| 8981 | Surgical exposure of impacted or unerupted teeth to aid eruption | 1172.70 |
| 8982 | Local excision of benign lesion of lip with primary closure | 0.00 |
| 8983 | Corticotomy – first tooth | 848.40 |
| 8984 | Corticotomy – each additional tooth | 430.10 |
| 8985 | Frenulectomy/frenulotomy | 779.30 |
| 8986 | Local excision of benign lesion of lip where primary closure is not possible. The appropriate code for the reconstruction should be reported. | 0.00 |
| 8987 | Reduction of mylohyoid ridges – per side | 1277.60 |
| 8988 | Resection for lip malignancy – excludes closure or reconstruction | 0.00 |
| 8989 | Removal torus mandibularis | 1277.60 |
| 8990 | Repair by primary suture | 0.00 |
| 8991 | Removal of torus palatinus | 1277.60 |
| 8992 | Repair by skin graft or local flap | 0.00 |
| 8993 | Surgical reduction of osseous tuberosity – per side | 571.00 |
| 8994 | Placement of Zygomaticus implant | 0.00 |
| 8995 | Gingivectomy – per jaw | 1136.60 |
| 8996 | Placement of a second Zygomaticus implant | 0.00 |
| 8997 | Sulcoplasty / Vestibuloplasty | 2929.20 |
| 8998 | Craniofacial transcutaneous endosseus implant | 0.00 |
| 8999 | Craniofacial transmucosal endosseus implant | 0.00 |
| 9001 | Augmentation of alveolar ridge using block graft / split ridge technique – across one to two tooth sites | 581.20 |
| 9002 | Augmentation of alveolar ridge using block graft / split ridge technique – across three to five tooth sites | 1291.80 |
| 9003 | Reposition mental foramen and nerve – per side | 1774.80 |
| 9004 | Lateralization of inferior dental nerve | 2859.90 |
| 9005 | Alveolar ridge augmentation – total (by bone graft) | 2986.60 |
| 9006 | Lip reconstruction following an injury or tumour removal: primary closure | 0.00 |
| 9007 | Alveolar ridge augmentation – total (by alloplastic material) | 1880.10 |
| 9008 | Alveolar ridge augmentation – one to two tooth sites | 581.20 |
| 9009 | Alveolar ridge augmentation – three across 3 or more tooth sites | 1291.80 |
| 9010 | Sinus lift procedure | 1941.00 |
| 9011 | Incision & drainage of abscess – intra-oral (pyogenic) | 363.40 |
| 9012 | Maxillary sinus floor bone augmentation, buccal-approach, limited | 0.00 |
| 9013 | Incision & drainage of abscess – extra-oral (pyogenic) | 496.90 |
| 9014 | Osteotome sinus floor bone augmentation | 0.00 |
| 9015 | Apicectomy – anteriors (including retrograde filling) | 724.40 |
| 9016 | Apicectomy – posteriors (including retrograde filling) | 1277.60 |
| 9017 | Decortication, saucerisation and sequestrectomy | 2630.30 |
| 9018 | Lip reconstruction following an injury or tumour removal: simple advancement, rotation flap (Abbe or Estlander) (first stage) | 0.00 |
| 9019 | Sequestrectomy – intra oral per sextant and or ramus | 571.00 |
| 9020 | Lip reconstruction following an injury or tumour removal: simple advancement, rotation flap (Abbe or Estlander) (subsequent stages) | 0.00 |
| 9021 | Suture – reconstruction, minor (excludes closure of surgical incisions) | 724.40 |
| 9022 | Lip reconstruction following an injury or tumour removal: Total complicated reconstruction with a complicated advancement flap (Bernard flap) | 0.00 |
| 9023 | Suture – reconstruction, major (excludes closure of surgical incisions) | 1348.00 |
| 9024 | Dento-alveolar fracture – per sextant | 640.50 |
| 9025 | Mandible fracture – closed reduction | 1418.70 |
| 9026 | Radical neck dissection | 0.00 |
| 9027 | Mandible fracture – compound, with eyelet wiring | 1992.20 |
| 9028 | Modified radical neck dissection | 0.00 |
| 9029 | Mandible fracture – splints | 2205.90 |
| 9030 | Selective neck dissection . | 0.00 |
| 9031 | Mandible fracture – open reduction | 3270.00 |
| 9032 | Reduction of masseter muscle and bone – extra-oral approach | 0.00 |
| 9033 | Reduction of masseter muscle and bone – intra-oral approach | 0.00 |
| 9034 | Extended neck dissection. | 0.00 |
| 9035 | Maxilla fracture – Le Fort I or Guerin | 1995.90 |
| 9036 | Open treatment of maxillary fracture – Le Fort I | 0.00 |
| 9037 | Maxilla fracture – Le Fort II or middle third face | 3270.00 |
| 9038 | Open treatment of maxillary fracture – II or middle third of face | 0.00 |
| 9039 | Maxilla fracture – Le Fort III or craniofacial disjunction | 4689.40 |
| 9040 | Surgical removal of jaw cyst/tumor – intra-oral approach for lesions >1cm with no involvement of vital structures | 0.00 |
| 9041 | Zygomatic arch fracture – closed reduction | 1418.70 |
| 9042 | Surgical removal of jaw cyst/tumor – intra-oral approach for lesions >1cm with involvement of vital structures, reconstructive procedures not included | 0.00 |
| 9043 | Zygomatic arch fracture – open reduction | 2843.40 |
| 9044 | Surgical excision of malignant tumours of the jaws– extra-oral approach, reconstructive procedures not included | 0.00 |
| 9045 | Zygomatic arch fracture – open reduction (requiring osteosynthesis and/or grafting) | 4259.50 |
| 9046 | Placement of Zygomaticus fixture, per fixture | 2813.90 |
| 9047 | Osteotomy – open with stabilisation | 5961.20 |
| 9048 | Surgical removal of internal fixation devices, per site | 546.50 |
| 9049 | Osteotomy – mandible body, anterior segmental | 4968.30 |
| 9050 | Osteotomy – total subapical | 9088.20 |
| 9051 | Genioplasty | 2843.40 |
| 9052 | Midfacial exposure | 4500.70 |
| 9053 | Coronoidectomy (intra-oral approach) | 1773.70 |
| 9054 | Surgical excision of tumours of the midface (zygoma, nose and orbits), reconstructive procedures not included | 0.00 |
| 9055 | Osteotomy – segmented, posterior | 4968.30 |
| 9056 | Radical resection of palate (including skin graft) | 0.00 |
| 9057 | Osteotomy – segmented, anterior | 4968.30 |
| 9058 | Wide excision of lesion of palate | 0.00 |
| 9059 | Reconstruct maxilla – Le Fort I osteotomy, one piece | 9348.40 |
| 9060 | Reconstruct maxilla – Le Fort I osteotomy w/ repositioning and graft | 10494.50 |
| 9061 | Palatal osteotomy | 3270.00 |
| 9062 | Reconstruct maxilla – Le Fort I osteotomy, multiple segments | 11933.60 |
| 9063 | Reconstruct maxilla – Le Fort 2 osteotomy (facial and post-traumatic deformities) | 11939.50 |
| 9064 | Complicated reconstruction of bony defects following major ablative procedure for head and neck cancer – soft tissue reconstruction excluded | 0.00 |
| 9065 | Reconstruct maxilla – Le Fort 3 osteotomy (severe congenital deformities) | 17893.40 |
| 9066 | Surgical expansion – maxilliary or mandibular | 2843.40 |
| 9067 | Distraction osteogenesis – across one to two tooth sites | 0.00 |
| 9068 | Distraction of the alveolar ridge (across 3-5 tooth sites) | 0.00 |
| 9069 | Glossectomy – partial | 2129.50 |
| 9070 | Distraction of the alveolar ridge (full arch) | 0.00 |
| 9071 | Geniohyoidotomy | 1277.60 |
| 9072 | Close secondary oro-nasal fistula w/ bone grafting (complete procedure) | 9348.40 |
| 9073 | Distraction for the reconstruction of the mandibular body (per side) | 0.00 |
| 9074 | Tmj arthroscopy diagnostic | 1411.40 |
| 9075 | Condylectomy, coronoidectomy or both | 3545.70 |
| 9076 | TMJ artrocentesis | 779.30 |
| 9077 | TMJ intra-articular injection | 212.60 |
| 9078 | Distraction for the reconstruction of the mandibular condyle and tempero-mandibular joint | 0.00 |
| 9079 | Trigger point injection | 165.90 |
| 9080 | Distraction for the reconstruction of the midface (internal distractor) | 0.00 |
| 9081 | Condylectomy (Ward/Kostecka) | 1418.70 |
| 9082 | Distraction for the reconstruction of the midface (external distractor) | 0.00 |
| 9083 | TMJ srthroplasty | 3545.70 |
| 9084 | Removal of an internal or external distractor device | 0.00 |
| 9085 | Reduction of TMJ disloc w/o anaesthetic | 282.10 |
| 9086 | Tumour resection from infratemporal or pterygopalatine fossa | 0.00 |
| 9087 | Reduction of TMJ disloc w/ anaesthetic | 571.00 |
| 9088 | Tarsorrhaphy | 0.00 |
| 9089 | Reduction of TMJ disloc w/ anaesthetic and immobobilisation | 1418.70 |
| 9090 | Excision of lacrimal sac: Unilateral | 0.00 |
| 9091 | Reduction of TMJ dislocation – open reduction | 3545.70 |
| 9092 | Joint reconstruction | 9466.60 |
| 9093 | Removal of salivary stone (Sialolithotomy) | 640.50 |
| 9094 | Orbitectomy: Removal of tumour | 0.00 |
| 9095 | Excision of sublinglual salivary gland | 1578.90 |
| 9096 | Excision of salivary gland – extra oral approach | 2338.90 |
| 9097 | Orbit: Exenteration | 0.00 |
| 9098 | Partial mandibulectomy | 0.00 |
| 9099 | Unlisted dental procedure or service (By report) | 0.00 |
| 9100 | Multiple extra-oral incision & drainages (eg. Ludiwig’s angina) | 0.00 |
| 9101 | Obturator prosthesis, surgical – modified denture | 196.30 |
| 9102 | Obturator prosthesis, surgical – continuous base | 531.70 |
| 9103 | Obturator prosthesis, surgical – split base | 792.40 |
| 9104 | Obturator prosthesis, interim – on existing denture | 1195.10 |
| 9105 | Obturator prosthesis, interim – on new denture | 3691.00 |
| 9106 | Obturator prosthesis, definitive – open/hollow box | 1195.10 |
| 9107 | Obturator prosthesis, definitive – silicone glove | 2307.60 |
| 9108 | Mandibular resection prosthesis w/ guide flange | 2834.80 |
| 9109 | Mandibular resection prosthesis w/o guide flange | 2634.50 |
| 9110 | Mandibular resection prosthesis, palatal augmentation | 531.70 |
| 9111 | Glossal resection prosthesis – simple | 1109.20 |
| 9112 | Glossal resection prosthesis – complex | 1661.40 |
| 9113 | Radiation carrier – simple | 1195.10 |
| 9114 | Radiation carrier – complex | 3298.60 |
| 9115 | Radiation shield – simple | 1195.10 |
| 9116 | Radiation shield – complex | 3298.60 |
| 9117 | Radiation cone locator | 1195.10 |
| 9118 | Chemotherapeutic agent carrier | 1195.10 |
| 9119 | Feeding aid prosthesis, neonatal | 1057.90 |
| 9120 | Orthopaedic appliance, active presurgical – minor | 1057.90 |
| 9121 | Orthopaedic appliance, active presurgical – moderate | 1565.60 |
| 9122 | Orthopaedic appliance, active presurgical – severe | 2634.50 |
| 9123 | Orthopaedic appliance, active presurgical – modification
|
133.50 |
| 9124 | Mandibular Advancement Device | 2800.90 |
| 9125 | Speech aid/obturator prosthesis – palatal alteration | 532.80 |
| 9126 | Speech aid/obturator prosthesis – velar alteration | 1195.10 |
| 9127 | Speech aid/obturator prosthesis – pharyngeal alteration | 2634.50 |
| 9128 | Speech aid/obturator prosthesis – modification | 133.50 |
| 9129 | Speech aid/obturator prosthesis – surgical | 1057.90 |
| 9130 | Speech aid appliance – palatal lift | 531.70 |
| 9131 | Speech aid appliance – palatal stimulating | 1195.10 |
| 9132 | Speech aid appliance – bulb | 2634.50 |
| 9133 | Speech aid appliance – modification | 133.50 |
| 9134 | Unspecified speech aid appliance | Blank |
| 9135 | Auricular prosthesis – simple | 3298.60 |
| 9136 | Auricular prosthesis – complex | 4303.50 |
| 9137 | Nasal prosthesis – simple | 3298.60 |
| 9138 | Nasal prosthesis – complex | 4303.50 |
| 9139 | Ocular prosthesis – interim | 1195.10 |
| 9140 | Ocular prosthesis – modified stock appliance | 2965.00 |
| 9141 | Ocular prosthesis – custom appliance | 4303.50 |
| 9142 | Orbital prosthesis – simple | 2965.00 |
| 9143 | Orbital prosthesis – complex | 4303.50 |
| 9144 | Facial prosthesis, combination – small | Blank |
| 9145 | Facial prosthesis, combination – medium | Blank |
| 9146 | Facial prosthesis, combination – large | Blank |
| 9147 | Facial prosthesis, combination – complex | Blank |
| 9148 | Unspecified body prosthesis – simple | 2965.00 |
| 9149 | Unspecified body prosthesis – complex | 4303.50 |
| 9150 | Facial prosthesis, surgical – simple | 2307.60 |
| 9151 | Facial prosthesis, surgical – complex | 2965.00 |
| 9152 | Extraoral appliance – additional prosthesis | Blank |
| 9153 | Extraoral appliance – replacement prosthesis | Blank |
| 9154 | Cost of Surgical Splint | 0.00 |
| 9155 | Cranial prosthesis | 1195.10 |
| 9156 | Cranial implant prosthesis, custom made | 1442.90 |
| 9157 | Facial implant prosthesis, custom made – simple | 720.90 |
| 9158 | Facial implant prosthesis, custom made – complex | 1442.90 |
| 9159 | Ocular implant prosthesis, custom made | 720.90 |
| 9160 | Body implant prosthesis – custom made | 3207.50 |
| 9161 | Surgical splint – simple | 325.60 |
| 9162 | Surgical splint – complex | 1195.10 |
| 9163 | Surgical template – simple | 325.60 |
| 9164 | Surgical template – complex | 1195.10 |
| 9165 | Surgical conformer – simple | 325.60 |
| 9166 | Surgical conformer – complex | 1195.10 |
| 9167 | Trismus appliance (simple) | 133.50 |
| 9168 | Trismus appliance (complex) | 1195.10 |
| 9169 | Orthoses appliance | 2634.50 |
| 9170 | Facial palsy appliance | 792.40 |
| 9171 | Commissure splint | 325.60 |
| 9172 | Oral retractor, dynamic – per arm | 325.60 |
| 9173 | Hand splint | 0.00 |
| 9174 | Unspecified burn appliance | 0.00 |
| 9175 | Theatre attendance (MaxFac prosthod) /hour | 440.60 |
| 9176 | Local resection of parotid tumour (lumpectomy) | 0.00 |
| 9177 | Superficial parotidectomy | 0.00 |
| 9178 | Total parotidectomy with preservation of facial nerve | 0.00 |
| 9179 | Total parotidectomy without preservation of facial nerve | 0.00 |
| 9180 | Surgical placement of sub-periosteal implant – preparatory stage | 1933.70 |
| 9181 | Surgical placement of sub-periosteal implant – placement stage | 1933.70 |
| 9182 | Surgical placement of endosteal implant plate | 968.00 |
| 9183 | Surgical placement of endosteal implant – first per jaw | 1362.50 |
| 9184 | Surgical placement of endosteal implant – second per jaw | 1020.00 |
| 9185 | Surgical placement of endosteal implant – third and subsequent per jaw | 682.90 |
| 9186 | Closure of salivary fistula | 0.00 |
| 9187 | Cost of endosteal implant body | Blank |
| 9188 | Cost of prefabricated abutment | Blank |
| 9189 | Cost of other implant compnts | Blank |
| 9190 | Surgical placement of abutment – first per jaw | 505.60 |
| 9191 | Surgical placement of abutment – second per jaw | 379.70 |
| 9192 | Surgical placement of abutment – third and subsequent per jaw | 254.20 |
| 9193 | Report as an additional code for the placement of endosseus implant into fresh extraction socket | 0.00 |
| 9194 | Surgical placement of one-piece transmucosal endosseus implant | 0.00 |
| 9195 | Report as an additional code for the surgical placement of single phase endosseus implant | 0.00 |
| 9196 | Planning for Craniofacial Reconstruction – Simple | 0.00 |
| 9197 | Planning for Craniofacial Reconstruction – Complex | 0.00 |
| 9198 | Surgical removal of implant | 629.80 |
| 9200 | Cranioplasty | 0.00 |
| 9201 | Consultation – oral pathologist | 0.00 |
| 9202 | Excision of submandibular salivary gland with any type of neck dissection | 0.00 |
| 9203 | House/Hosp/Nursing home consultation – Oral pathologist | 0.00 |
| 9204 | Sandwich osteotomy – for placement of an interpositional bone graft to increase the alveolar ridge height, may also be reported if utilized in the maxilla | 0.00 |
| 9205 | Consultation – oral pathologist (subsequent) | 0.00 |
| 9206 | Surgical removal of reconstruction plate | 0.00 |
| 9207 | After hours visit – Oral pathologist | 0.00 |
| 9208 | Harvest iliac crest graft – monocortical | 0.00 |
| 9209 | Harvest iliac crest graft – bicortical | 0.00 |
| 9210 | Harvest tibial bone – spongiosa | 0.00 |
| 9211 | Harvest iliac crest graft – bicortical | 0.00 |
| 9212 | Harvest rib graft – bone | 0.00 |
| 9213 | Harvest rib graft – cartilage | 0.00 |
| 9214 | Harvest auricular cartilage graft | 0.00 |
| 9215 | Intra-oral harvesting of particulate bone | 0.00 |
| 9216 | Harvest fascia lata | 0.00 |
| 9217 | Harvest of free fat | 0.00 |
| 9218 | Nerve repair: 1st Fasciculus | 0.00 |
| 9219 | Nerve repair: 2nd and additonal Fasciculus | 0.00 |
| 9220 | Repair cleft hard palate – unilateral | 5221.20 |
| 9222 | Repair cleft hard palate – bilateral (one procedure) | 6628.60 |
| 9223 | Ligation of maxillary artery | 0.00 |
| 9224 | Repair cleft hard palate – bilateral (two procedures) | 9876.60 |
| 9225 | Nerve repair: entubelation | 0.00 |
| 9226 | Repair cleft soft palate – w/o muscle reconstruction | 4375.60 |
| 9227 | Turbinectomy | 0.00 |
| 9228 | Repair cleft soft palate – w/ muscle reconstruction | 6353.20 |
| 9229 | Choanal artesia repair through a palatal osteotomy | 0.00 |
| 9230 | Repair submucosal cleft and/or bifid uvula – w/ muscle reconstruction | 4730.40 |
| 9232 | Velopharyngeal reconstruction – uncomplicated | 4867.60 |
| 9233 | Obliteration of the frontal sinus | 0.00 |
| 9234 | Velopharyngeal reconstruction – complicated | 5205.20 |
| 9235 | Severe nasal bleeding – anterior pack | 0.00 |
| 9236 | Severe nasal bleeding – anterior + posterior pack or cauterization | 0.00 |
| 9237 | Management of a patient on anti-coagulatives for the performance of a surgical procedure, this code is reported along with the appropriate surgical codes | 0.00 |
| 9238 | Repair oronasal fistula (one procedure) | 2977.30 |
| 9239 | Surgical facility for surgical procedures in consulting rooms | 0.00 |
| 9240 | Repair oronasal fistula (two procedures) | 5193.70 |
| 9241 | Simple local flap (eg. Advancement or rotation flap) | 0.00 |
| 9242 | Complex local flap | 0.00 |
| 9243 | Regional flap (eg pectoral, deltoid or lattisimus dorsi flap) | 0.00 |
| 9244 | Tongue flap – 2 procedures | 0.00 |
| 9245 | Muscle spasm injection (Botulinum toxin) – excludes the cost for the Botulinum toxin (code 8183) | 0.00 |
| 9246 | Secondary periosteal flaps | 2595.70 |
| 9247 | Bicoronal approach | 0.00 |
| 9248 | Lipadhesion | 970.50 |
| 9249 | Blephro-approach | 0.00 |
| 9250 | Repair cleft lip – unilateral w/o muscle reconstruction | 1709.20 |
| 9251 | Transconjunctival/subcilliary approach | 0.00 |
| 9252 | Repair cleft lip – unilateral w/ muscle reconstruction | 2317.00 |
| 9253 | Mandibular swing approach for access to the skullbase | 0.00 |
| 9254 | Repair cleft lip – bilateral w/o muscle reconstruction | 2386.60 |
| 9255 | Geniohyoidotomy (mandibular split) | 0.00 |
| 9256 | Repair cleft lip – bilateral w/ muscle reconstruction | 3687.30 |
| 9257 | Midfacial deglove, including nasal skeleton | 0.00 |
| 9258 | Repair anterior nasal floor | 931.10 |
| 9259 | Distraction device for alveolar bone | 0.00 |
| 9260 | Revision of secondary cleft lip deformity – partial | 931.10 |
| 9261 | Internal distraction device for maxilla or mandible | 0.00 |
| 9262 | Revision of secondary cleft lip deformity – total w/ muscle reconstruction | 2103.70 |
| 9263 | Transport distraction device | 0.00 |
| 9264 | Abbe-flap – two stages | 2381.90 |
| 9265 | External distraction device for maxilla or mandible | 0.00 |
| 9266 | Reconstruct columella | 1408.10 |
| 9267 | Temperomandibular joint prosthesis (stock or custom) | 0.00 |
| 9268 | Reconstruct nose due to cleft deformity – partial | 1789.20 |
| 9269 | Custom prosthesis for facial reconstruction | 0.00 |
| 9270 | Reconstruct nose due to cleft deformity – complete | 2827.60 |
| 9271 | Cost of impression material (only to be used with code 8215 | 0.00 |
| 9272 | Paranasal augmentation for nasal base deviation | 1408.10 |
| 9273 | Open treatment of an orbital wall fracture | 0.00 |
| 9274 | Repair anterior table, frontal sinus and/or supraorbital rim | 0.00 |
| 9275 | Major orbital reconstruction (comminuted orbital fractures) | 0.00 |
| 9276 | Repair anterior and posterior wall w/ obturation and/or cranialisation of frontal sinus | 0.00 |
| 9277 | Secondary reconstruction of orbital defect | 0.00 |
| 9278 | Repair medial canthal ligament (canthopexy), per side | 0.00 |
| 9279 | Eyelid surgery for facial paralysis including tarsoraphy (excludes material) | 0.00 |
| 9280 | Open reduction and fixation of nasal fractures | 1830.50 |
| 9281 | Full thickness eyelid repair (tumor or trauma surgery) | 0.00 |
| 9282 | Manipulation and immobilisation of nasal fracture | 995.80 |
| 9283 | Repair by superior rectus, levator or frontalis muscle operation | 0.00 |
| 9284 | Musculofascial flap | 0.00 |
| 9285 | Ptosis: By lesser procedure e.g. sling operation | 0.00 |
| 9286 | Musculocranial flap | 0.00 |
| 9287 | Dacrocystorhinostomy | 0.00 |
| 9288 | Buccal fat pad (major repair) | 0.00 |
| 9289 | Frenulotomy | 0.00 |
| 9290 | Maxillectomy – Alveolus only, Level I | 0.00 |
| 9291 | Zygomatic fracture-open reduction with fixation at two sites | 0.00 |
| 9292 | Maxillectomy – Alveolus and sinus or nasal floor, Level II | 0.00 |
| 9293 | Zygomatic fracture-closed reduction | 0.00 |
| 9294 | Maxillectomy – Alveolus, sinus, nasal floor and zygoma excluding orbital rim Level III | 0.00 |
| 9296 | Maxillectomy – Alveolus, sinus, nasal floor and zygoma including orbital rim Level IV | 0.00 |
| 9298 | Maxillectomy – Alveolus, sinus, nasal floor, zygoma, orbital rim and pterygoid plates Level V | 0.00 |
| 9299 | Abscess – Retropharyngeal or equivalent | 0.00 |
| 9300 | Hemiresection of jaw including condyle and coronoid process | 0.00 |
