Dental Billing for GP Dental Practice

In a dental practice environment, various codes need to be utilised to adequately cover the treatments administered during dental visits.

Below is a list of significant Medical Aid tariff codes relevant to a wide range of treatments performed in the dental chair:

1. 8101 – Consultation/Oral Examination: This code is essential for conducting the initial oral examination of new patients and capturing their medical history.
2. 8104 – Limited Oral Examination: Used for specific problems that do not require a full mouth examination.
3. 8107 – Intraoral Radiographs (periapical, per film): This is applicable for diagnostic imaging and is limited to a maximum of six per beneficiary per year.
4. 8112 – Intraoral Radiographs (bitewing): This code is for bitewing X-rays, limited to four per beneficiary per year.
5. 8115 – Extraoral Radiograph (panoramic): Applicable once every three years for beneficiaries aged six and older.
6. 8155 – Polishing (Complete Dentition): Two polishing sessions are allowed per beneficiary per year.
7. 8159 – Prophylaxis (Complete Dentition): Scaling and polishing, limited to those over ten years old, up to two per year.
8. 8161 – Topical Application of Fluoride (Children): Allowed for children from ages three to 11 once a year.
9. 8162 – Topical Application of Fluoride (Adults): For beneficiaries aged 12 to 16, once per year.
10. 8341 – Amalgam Restoration (one surface): This code allows for one-surface amalgam fillings, with a limit of four per year.
11. 8342 – Amalgam Restoration (two surfaces): For amalgam restorations that involve two surfaces.
12. 8343 – Amalgam Restoration (three surfaces): For restorations that involve three surfaces.
13. 8344 – Amalgam Restoration (four surfaces or more): Used for multiple surface restorations.
14. 8351 – Resin Restoration (one surface, anterior): Limited to four per beneficiary per year for anterior teeth.
15. 8367 – Resin Restoration (one surface, posterior): Similar provisions apply for posterior teeth.
16. 8201 – Extraction of Tooth: Limits on the number of extractions apply; each patient can have a maximum of four extractions per year.
17. 8109 – Infection Control/Barrier Techniques: To be billed per visit, two times allowed.
18. 8110 – Sterilised Instrumentation: This code can be billed once per visit.
19. 8145 – Local Anaesthetic: Allows for local anesthetic administration during treatments, billed once per visit.

These codes collectively align with standard treatments provided in a dental chair setting, including examinations, radiographic imaging, preventative care, restorative treatments, and extraction procedures.

Proper utilisation of these codes ensures appropriate billing practices and compliance with most medical aid regulations, facilitating timely reimbursement and efficient patient care.