Code

Procedure description

DM/+

MP

TC

General Dental Practice

Maxillo-facial and Oral Surgery

Prosthodontics

C.  RESTORATIVE

AMALGAM RESTORATIONS (including polishing)

All adhesives, liners and bases are included as part of the restoration. If pins are used, they should be reported separately

8341

Amalgam - one surface

T

B

327.31

-

-

8342

Amalgam - two surfaces

T

B

409.73

-

-

8343

Amalgam - three surfaces

T

B

492.33

-

-

8344

Amalgam - four or more surfaces

T

B

490.97

-

-

RESIN-BASED COMPOSITE RESTORATIONS

Resin refers to a broad category of materials including but not limited to composites and may include bonded composite, light-cured

8351

Resin - one surface, anterior

T

B

320.14

-

-

8352

Resin - two surfaces, anterior

T

B

408.95

-

-

8353

Resin - three surfaces, anterior

T

B

540.80

-

-

8354

Resin - four or more surfaces, anterior

T

B

600.51

-

-

Use to report the involvement of four or more surfaces or the incisal line angle. The incisal line angle is the junction of the incisal and the mesial or distal surface of an anterior tooth.

8367

Resin one surface, posterior

T

B

387.04

-

-

This is not a preventative procedure and should only be used to restore a carious lesion or a deeply eroded area into a natural tooth.

8368

Resin two surfaces, posterior

T

B

530.33

-

-

8369

Resin three surfaces, posterior

T

B

578.42

-

-

8370

Resin - four or more surfaces, posterior

T

B

613.51

-

-

Inlay / Onlay restorations

METAL INLAYS / ONLAYS

8361

Inlay, metallic - one surface, posterior

+L

T

A

656.36

-

984.54

8362

Inlay/onlay - metal - two surfaces

+L

T

A

849.10

-

1 273.65

8363

Inlay/onlay - metal - three surfaces

+L

T

A

1 751.12

-

2 626.68

8364

Inlay/onlay - metal - four or more surfaces

+L

T

A

1 751.32

-

2 626.98

CERAMIC AND / OR RESIN INLAYS

Porcelain / ceramic inlays include either all ceramic or porcelain inlays. Composite / resin inlays must be laboratory processed

8371

Inlay - porcelain - one surface

+L

T

A

594.31

-

891.47

8372

Inlay/onlay - porcelain - two surfaces

+L

T

A

868.29

-

1 302.44

8373

Inlay/onlay - porcelain - three surfaces

+L

T

A

1 449.04

-

2 173.56

8374

Inlay/onlay - porcelain - four or more surfaces

+L

T

A

1 751.32

-

2 626.98

CROWNS - SINGLE RESTORATIONS

Use these codes for single crown restorations. See the Fixed Prosthodontic Service section for crown bridge retainers and the

8401

Crown - full cast metal

+L

T

A

2 079.97

-

2 885.44

8403

Crown - 3/4 cast metal

+L

T

A

2 079.97

-

2 885.44

8404

Crown - 3/4 porcelain/ceramic

+L

T

A

2 079.97

-

2 885.44

8405

Crown - resin laboratory

+L

T

A

2 079.97

-

2 885.44

Refers to all resin-based crowns that are indirectly fabricated. All fiber, porcelain or ceramic reinforced polymer materials/systems are considered resin-based crowns

8407

Crown - resin with metal

+L

T

A

2 220.36

-

3 211.77

8409

Crown - porcelain/ceramic

+L

T

A

2 220.36

-

2 885.44

8411

Crown - porcelain with metal

+L

T

A

2 220.36

-

3 602.87

Other restorative

8133

Recement inlay, onlay, crown or veneer

T

B

190.62

-

285.93

Use to report the recementation of a permanent single inlay, onlay, crown or veneer. See code 8514 in the Fixed Prosthodontic Section for the recementation of a bridge retainer.

Comment: This code may not be used for the recementation of temporary or provisional restorations, which is included as part of the restoration.

8135

Removal of inlays and crowns (per unit) and bridges (per abutment) or sectioning of a bridge, part of which is to be retained as a crown following the failure of a bridge

T

A

374.43

-

374.43

This procedure involves the removal of a permanent inlay, onlay or crown.

Comment: This code may not be used for the removal of temporary or provisional restorations, which is included as part of the restoration

8137

Emergency crown (chair-side)

+L

T

A

640.47

-

640.47

A temporary crown. usually made of resin and in the surgery, which is fitted over a damaged tooth for the immediate protection in tooth injury. Includes emergency crowns manufactured for the replacement of previously fitted, lost or damaged permanent crowns.

Comment: This code should not be used as an interim restoration during restorative treatment and should not be reported on the same day on which an impression is taken to replace a previously fitted lost or damaged permanent crown.

8330

Removal of root canal obstruction

T

B

250.73

-

-

This procedure involves the treatment of a non-negotiable root canal blocked by foreign bodies (e.g. removal and/or bypassing of a fractured instrument) or calcification of 50% or more of a root to achieve an apical seal and forego surgical treatment - Report per canal.

This code may be submitted by the servicing provider and on the same day as a root canal therapy if the obstruction is not iatrogenic by that provider.

8345

Prefabricated post retention, per post (in addition to restoration)

T

B

276.90

-

-

Should not be used with codes 8398 or 8376 (Core build-ups) Remuneration excludes cost of posts - See code 8379

8347

Pin retention - first pin (in addition to restoration

T

B

190.62

-

-

Should not be used with codes 8398 or 8376 (Core build-ups).

8348

Pin retention - each additional pin (in addition to restoration)

T

B

164.63

-

-

Should not be used with codes 8398 or 8376 (Core build-ups). Limitation: A maximum of two additional pins may be levied.

8355

Veneer - resin (chair-side)

T

B

607.11

-

607.11

Involves direct layering of material over tooth. No laboratory processing.

8357

Prefabricated metal crown

T

B

403.13

-

403.13

Includes all preformed metal crowns e.g. stainless steel, nickel-chrome and gold anodised crowns, with or without resin window.

8366

Pin retention as part of cast restoration, irrespective of number of pins.

T

A

294.35

-

441.53

8376

Core build-up with prefabricated posts

T

B

982.50

-

982.50

The direct build-up of a mutilated crown around a prefabricated post to provide a rigid base for retention of a crown restoration.This procedure includes posts and core material. Remuneration excludes cost of posts - See code 8379.

8379

Cost of prefabricated posts - add on to 8376

T

A

Rule 013

-

Rule 013

Applicable to pre-fabricated noble metal, ceramic, iridium and titanium posts - see code 8345 and 8376

8391

Cast core with single post

+L

T

A

446.17

-

-

Report in addition to crown.

8392

Cast post (each additional)

+L

T

A

357.00

-

-

to be used with 8391 for each additional cast posts on the same tooth.

8397

Cast core with pins (any number of pins)

+L

T

A

714.15

-

1 071.23

The cast cor with pins is intended to be used on grossly broken down vital teeth. Report in addition to crown.

8398

Core build-up, including any pins.

Refers to the building up of an anatomical crown when a restorative crown will be placed, irrespective of the number of pins used.

T

B

714.15

-

714.15

The direct build-up of a mutilated crown to provide a rigid base for retention of a crown restoration irrespective of the number of pins used. This code should not be reported when the procedure only involves a filler to eliminate any  undercut, concave irregularity in the preparation,etc.

8413

Repair crown (permanent or provisional)

+L

T

A

436.02

-

436.02

This procedure involves the repair of a permanent crown (e.g. facing replacement). Excludes the removal (8153) and recementation (8133) of the crown. This code may also be reported for the repair/replacement of a provisional crown (8410) after a period of two months. This code may not be used for the repair/replacement of a temporary restorations, which is included as part of the restoration

8414

Additional fee for provision of a crown within an existing clasp or rest

+L

T

A

136.73

-

-