Discovery Dental Tariff Codes
Discovery Dental Tariff Codes 2021
| 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 |
