Alberta Dental Fee Guide 2017

General Practitioners and Specialists

Note: The below information has been developed by Manulife by using actual Manulife dental claims experience in Alberta. Manulife is unable to use and/or list procedure codes as they are proprietary to the Canadian Dental Association.

Legend: GP is General Practitioner $0.00 indicates that dentist sets the rate

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Examination and diagnosis, first dental visit/orientation oral assessment for patients up to the age of 3 years inclusive

77.47

92.96

Examination and diagnosis, complete oral, primary dentition

77.46

92.95

Examination and diagnosis, complete, mixed dentition

116.19

139.43

Examination and diagnosis, complete oral, permanent dentition

116.19

139.43

Exam and diagnosis, limited, oral, new patient

77.46

92.95

Exam and diagnosis, limited oral, previous patient (recall)

77.46

92.95

Exam and diagnosis, specific examination of specific situation

77.46

92.95

Examination and diagnosis for the investigation of discomfort and/or infection in a localized area.

77.46

92.95

Examination and diagnosis, analysis, mixed dentition

77.46

92.95

Examination and diagnosis, stomatognathic, dysfunctional, comprehensive

212.96

255.56

Examination, stomatognathic, dysfunctional, limited

85.19

102.22

Examination and diagnosis, oral pathology, general

170.37

204.45

Examination and diagnosis, oral pathology, specific

85.19

102.22

Examination and diagnosis, periodontal, general

255.56

306.67

Examination and diagnosis, periodontal, limited

85.19

102.22

Examination and diagnosis, periodontal, specific

77.45

92.95

Examination and diagnosis, surgical, general

170.37

204.45

Examination and diagnosis, surgical, specific

85.19

102.22

Examination and diagnosis, prosthodontic, edentulous and including evaluation for implant-supported or retained prosthesis

116.19

139.43

Examination and diagnosis, prosthodontic, specific

77.46

92.95

Examination and diagnosis, prosthodontic, fixed oral rehabilitation, clinical, evaluation of specific sites for implant- supported or retained prosthesis

170.37

204.45

Examination and diagnosis, endondontic, complete

170.37

204.45

Examination and diagnosis, endodontic, specific

85.19

102.22

Examination and diagnosis, orthodontic, general, to include models, x-rays, consultation & case presentation + L

425.93

511.11

Examination and diagnosis, orthodontic, specific

85.19

102.22

Radiographs, intraoral, complete series (minimum of 12 films incl. Bitewings)

206.32

247.59

Radiographs, intraoral, complete series (minimum of 16 films incl. Bitewings)

206.32

247.59

Radiographs, intraoral, periapical, single film

30.94

37.12

Radiographs, intraoral, periapical, two films

51.51

61.82

Radiographs, intraoral, periapical,three films

72.16

86.59

Radiographs, intraoral, periapical, four films

92.81

111.37

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Radiographs, intraoral, periapical, five films

113.51

136.21

Radiographs, intraoral, periapical, six films

134.09

160.91

Radiographs, intraoral, periapical,seven films

154.68

185.62

Radiographs, intraoral, periapical, eight films

175.31

210.38

Radiographs, intraoral, periapical, nine films

195.89

235.07

Radiographs, intraoral, periapical, ten films

206.30

247.56

Radiographs, intraoral, occlusal, single film

51.51

61.82

Radiographs, intraoral, occlusal, two films

77.35

92.82

Radiographs, intraoral, occlusal, three films

103.12

123.74

Radiographs, intraoral, occlusal, four films

128.90

154.68

Radiographs, intraoral, bitewing, single film

30.94

37.12

Radiographs, intraoral, bitewing, two films

51.51

61.82

Radiographs, intraoral, bitewing, three films

72.16

86.59

Radiographs, intraoral, bitewing, four films

92.81

111.37

Radiographs, intraoral, bitewing, five films

113.51

136.21

Radiographs, intraoral, bitewing, six films

134.09

160.91

Radiographs, intraoral, bitewing, six films

134.09

160.91

Radiographs, extraoral, single film

Deleted

Deleted

Radiographs, extraoral, two films

Deleted

Deleted

Radiographs, extraoral, three films

Deleted

Deleted

Radiographs, extraoral, four films

Deleted

Deleted

Radiographs, extraoral, each additional film over four

Deleted

Deleted

Radiographs, postero-anterior and lateral skull and facial bone, single image

77.33

92.80

Radiographs, postero-anterior and lateral skull and facial bone, two images

128.90

154.68

Radiographs, postero-anterior and lateral skull and facial bone, three images

180.54

216.64

Sinus examination and diagnosis, minimum four images identified as waters, caldwell, lateral skull and basal

232.10

278.53

Sinus examination and diagnosis, each additional image over four

51.11

61.33

Radiographs, sialography, single image

77.35

92.82

Radiographs, sialography, two images

128.90

154.68

Radiographs, sialography, each additional image over two

51.11

61.33

Radiopaque dyes, use of, to demonstrate lesions, one unit of time

0.00

0.00

Radiopaque dyes, use of, to demonstrate lesions, two units of time

0.00

0.00

Radiopaque dyes, use of, to demonstrate lesions, each additional unit over two

0.00

0.00

Radiographs, temporomandibular joint, single image

77.33

92.80

Radiographs, temporomandibular joint, two images

128.90

154.68

Radiographs, temporomandibular joint, three images

180.54

216.64

Radiographs, temporomandibular joint, four images (minimum exam and diagnosis closed and open each side)

232.10

278.53

Radiographs, temporomandibular joint, each additional image over four

51.11

61.33

Arthrography, temporo-mandibular joint, performing the arthrographic procedure

255.54

306.65

Radiographs, tmj interpretation of the arthrogram, one unit of time

77.46

92.95

Radiographs, tmj,interpretation of arthrogram, each addit. Unit of time

77.46

92.95

Radiographs, panoramic, single image

103.12

123.74

Radiographs, cephalometric, single image

123.36

148.03

Radiographs, cephalometric, two images

193.44

232.13

Radiographs, cephalometric, three images

260.10

312.12

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Radiographs, cephalometric, four images

322.36

386.83

Radiographs, cephalometric, each additonal image over 4

38.39

46.06

Radiographs, cephalometric, tracing & interpretation, one unit of time

85.19

102.22

Radiographs, cephalometric, tracing & interpretation, two units of time

170.37

204.45

Radiographs, cephalometric, tracing & interpretation, each additional unit over two

85.19

102.22

Radiographs, interpretation, (received from another source) one unit of time + E

81.33

97.60

Radiographs, interpretation, (received from another source) two units of time + E

162.64

195.17

Radiographs, interpretation, (received from another source) each additional unit over two + E

81.09

97.31

Radiographs, duplications, single image

5.89

7.07

Radiographs, duplications, two images

11.69

14.03

Radiographs, duplications, three images

17.51

21.01

Radiographs, duplications, four images

23.35

28.02

Radiographs, duplications, five images

29.20

35.04

Radiographs, duplications, six images

35.04

42.05

Radiographs, duplications, seven images

40.89

49.07

Radiographs, duplications, eight images

45.26

54.31

Radiographs, duplications, each additional image over eight

5.89

7.07

Radiographs, tomography, single view

123.36

148.03

Radiographs, tomography, two views

193.51

232.21

Radiographs, tomography, threeviews

260.10

312.12

Radiographs, tomography, four views

322.36

386.83

Radiographs, tomography, each additional view over four

51.11

61.33

Radiographs, tomography, each additional view over four

51.11

61.33

Radiographs, hand & wrist,as a diagnostic aid for dental treatment (per case)

123.34

148.01

Radiographic guide, diagnostic wax-up,osseo-integrated implant, max. Guide + L + E

0.00

0.00

Radiographic guide, diagnostic wax-up,osseo-integrated implant, mand. Guide + L + E

0.00

0.00

Template, surgical, diag wax up,osseo-integrated implnts, max. Template + L + E

77.46

92.95

Template, surgical, diag. Wax-up,osseo-integrated implnt,mandib template+ L + E

77.46

92.95

Test/analysis, microbiological (technical procedure only), for the determination of pathological agents + L

73.60

88.32

Bacteriological test/analysis, caries susceptibility (technical procedure only) for the determination of dental caries susceptibility + L

73.60

88.32

Test/analysis, histopathological (technical procedure only) biopsy, soft oral tissue – by puncture + L

85.19

102.22

Test/analysis, histopathological (technical procedure only) biopsy, soft oral tissue – by incision + L

85.19

102.22

Test/analysis, histopathological (technical procedure only) biopsy, soft oral tissue – by aspiration+ L

85.19

102.22

Test/analysis, histopathological, biopsy, hard oral tissue – by puncture + L

0.00

0.00

Test/analysis, histopathological, biopsy, hard oral tissue – by incision + L

0.00

0.00

Test/analysis, histopathological, biopsy, hard oral tissue – by aspiration + L

0.00

0.00

Tests/analysis, cytological (technical procedure only) cytological smear from the oral cavity + L + E

73.60

88.32

Test/analysis, cytological (technical procedure only) vital staining of oral mucosal tissues + E

73.60

88.32

Tests/analysis, cytological (technical procedure only) direct fluorescence visualization

28.89

34.66

Tests/analysis, pulp vitality and interpretation, one unit of time

73.60

88.32

Tests/analysis, pulp vitality and interpretation, each additional unit

73.60

88.32

Interpretation and/or reports laboratory, microbiological by oral microbiologist + L

220.78

264.94

Interpretation and/or reports laboratory, histopathological by oral pathologist or microbiologist + L

255.56

306.67

Interpretation and/or reports laboratory, cytological by oral pathologist + L

73.60

88.32

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Interpretation and/or reports laboratory, other

0.00

0.00

Supplementary diagnostic procedures (interpretation only), equilibration, casts, one unit of time + L

77.46

92.95

Supplementary diagnostic procedures (interpretation only), equilibration, casts, diagnostic (pilot eqilibration) for extensive or complicated restorative dentistry, two units + L

154.93

185.91

Supplementary diagnostic procedures (interpretation only), equilibration, casts, three units + L

232.37

278.84

Supplementary diagnostic procedures (interpretation only), equilibration, casts, four units + L

309.82

371.79

Supplementary diagnostic procedures (interpretation only), equilibration, casts, each additional unit over four + L

77.46

92.95

Wax-up, diagnostic (to evaluate cosmetic and/or preparation design and/or occlusal considerations, (gnathological wax-up) one unit of time + L

77.46

92.95

Wax-up, diagnostic (to evaluate cosmetic and/or preparation design and/or occlusal considerations, (gnathological wax-up) two units + L

154.93

185.91

Wax-up, diagnostic (to evaluate cosmetic and/or preparation design and/or occlusal considerations, (gnathological wax-up) three units + L

232.37

278.84

Wax-up, diagnostic (to evaluate cosmetic and/or preparation design and/or occlusal considerations, (gnathological wax-up) four units + L

309.82

371.79

Wax-up, diagnostic (to evaluate cosmetic and/or preparation design and/or occlusal considerations, (gnathological wax-up) each additional unit over four + L

77.46

92.95

Split cast mounting, diagnostic, one unit of time + L

77.46

92.95

Split cast mounting, diagnostic, two units of time + L

154.93

185.91

Split cast mounting, diagnostic, three units of time + L

232.37

278.84

Split cast mounting, diagnostic, four units of time + L

309.82

371.79

Split cast mounting, diagnostic, each additional unit over four + L

77.46

92.95

Interpretation of diagnostic casts, first unit of time

73.60

88.32

Interpretation of diagnostic casts, each additional unit over one

73.60

88.32

Photographs, diagnostic, (technical procedure only) single photograph

18.40

22.09

Photographs, diagnostic (technical procedure only), two photos

36.79

44.15

Photographs, diagnostic (technical procedure only) three photos

55.20

66.23

Photographs, diagnostic (technical procedure only), each additional photo over three

18.40

22.09

Casts, diagnostic (technical procedure only) unmounted + L

73.60

88.32

Casts, diagnostic, unmounted, duplicate + L

36.79

44.15

Cast, diagnostic, unmounted, upper and lower combined + L

147.21

176.65

Casts, diagnostic, mounted + L

110.39

132.47

Casts, diagnostic, mounted, using face bow transfer + L

147.18

176.62

Casts, diagnostic, mounted, using face bow + occlusal records + L

325.28

390.34

Casts, diagnostic, mounted using fully adjustable articulator (used with 04941 and 04942) + L

0.00

0.00

Casts, diagnostic, orthodontic (unmounted, angle trimmed and soaped) + L

147.18

176.62

Casts, diagnostic, miscellaneous procedures, transverse axis location and transfer, used in conjunction with 04922, 04923, 04924 + L

0.00

0.00

Pantographic records, comprehensive + L

0.00

0.00

Casts, diagnostic, custom incisal guide table + L

0.00

0.00

Case presentation/treatment planning, one unit of time

77.46

92.95

Case presentation/treatment planning, two units

154.93

185.91

Case presentation/treatment planning, three units

232.37

278.84

Case presentation/treatment planning, four units

309.82

371.79

Case presentation/treatment planning, each additional unit over four

77.46

92.95

Consultation with patient, one unit of time

77.46

92.95

Consultation with patient, two units

154.93

185.91

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Consultation with patient, each additional unit over two

77.46

92.95

Radiographs, cbct, small field of view

0.00

0.00

Radiographs, cbct, large field of view (1 arch)

0.00

0.00

Radiographs, cbct, large field of view (2 arches)

0.00

0.00

Radiographs, cbct, image processing, one unit of time

0.00

0.00

Radiographs, cbct, image processing, two units of time

0.00

0.00

Radiographs, cbct, image processing, one half unit of time

0.00

0.00

Radiographs, cbct, image processing, each additional unit over two

0.00

0.00

Radiographs, cbct, interpretation, one unit of time

0.00

0.00

Radiographs, cbct, interpretation, two units of time

0.00

0.00

Radiographs, cbct, interpretation, one half unit of time

0.00

0.00

Radiographs, cbct, interpretation, each additional unit over two

0.00

0.00

Radiographs, cbct, acquisition, processing and interpretation, small field of view

0.00

0.00

Radiographs, cbct, acquisition, processing and interpretation, large field of view (1 arch)

0.00

0.00

Radiographs, cbct, acquisition, processing and interpretation, large field of view (2 arches)

0.00

0.00

Polishing, 1 unit of time

69.40

83.28

Polishing, 2 units of time

138.80

166.56

Polishing, one half unit

34.72

41.66

Scaling, one unit of time

73.03

87.64

Scaling, two units of time

146.10

175.32

Scaling-45 minutes

219.14

262.97

Scaling-60 minutes

292.18

350.61

Scaling-75 minutes

365.24

438.29

Scaling-90 minutes

438.27

525.93

Scaling-7.5 Minutes

36.52

43.83

Scaling-each additional 15 minutes

73.03

87.64

Fluoride treatment, topical application

34.70

41.64

Fluoride treatment, supervised, self-administered brush-in

34.70

41.64

Fluoride, custom appliance (home application) – maxillary arch + L

69.40

83.28

Fluoride, custom appliance (home application) – mandibular arch + L

69.40

83.28

Medication, custom appliance – maxillary arch + L

69.40

83.28

Medication, custom appliance – mandibular arch + L

69.40

83.28

Preventive services, nutritional counselling, including: recording and analysis up to seven days dietary intake and consultation, one unit of time

69.40

83.28

Preventive services, nutritional counselling including: recording and analysis up to seven days dietary intake and consultation, two units

138.80

166.56

Preventive services, nutritional counselling, recording & analysis up to seven days dietary intake and consultation, three units

208.21

249.86

Preventive services, nutritional counselling, recording & analysis up to seven days dietary intake and consultation, four units

277.61

333.13

Preventive services, nutritional counselling, recording & analysis up to seven days dietary intake and consultation, each additional unit over four

69.40

83.28

Oral hygiene instruction/plaque control, individual instruction, excluding audio-visualtime, one unit of time

69.40

83.28

Oral hygiene instruction/plaque control, individual instruction, excluding audio-visualtime, two units of time

138.80

166.56

Oral hygiene instruction/plaque control, individual instruction, excluding audio-visualtime, three units of time

208.21

249.86

Oral hygiene instruction/plaque control, individual instruction, excluding audio-visualtime, four units of time

277.61

333.13

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Oral hygiene instruction/plaque control, individual instruction, excluding audio-visualtime, one half unit of time

34.72

41.66

Oral hygiene instruction/plaque control, individual instruction, excluding audio-visualtime, each additional unit over four

69.40

83.28

Oral hygiene instruction/plaque control, group instruction, one unit of time

69.40

83.28

Oral hygiene instruction/plaque control, group instruction, two units of time

138.80

166.56

Oral hygiene instruction/plaque control, group instruction, three units of time

208.21

249.86

Oral hygiene instruction/plaque control, group instruction, four units of time

277.61

333.13

Oral hygiene instruction/plaque control, group instruction, each additional unit over four

69.40

83.28

Oral hygiene, re-instruction (within 6 months) – excluding audio-visual time, one unit of time

69.40

83.28

Oral hygiene, re-instruction (within 6 months) – excluding audio-visual time, two units

138.80

166.56

Oral hygiene, re-instruction (within 6 months) – excluding audio-visual time, each additional unit over two

69.40

83.28

Oral hygiene instruction, audio visual, one unit of time

69.40

83.28

Oral hygiene instruction, audio visual, two units

138.80

166.56

Oral hygiene instruction, audio visual, each additional unit over two

69.40

83.28

Sealants, pit and fissure (acid etch preparation included, first tooth

34.70

41.64

Sealants, pit and fissure (acid etch preparation included), each additional tooth – same quadrant

17.35

20.82

Sealants, pit and fissure, (preparation of the pits and/or fissures in tooth enamel, may extend into dentin in limited areas) preventive restorative resin, first tooth

67.08

80.49

Sealants, pit and fissure, (preparation of the pits and/or fissures in tooth enamel, may extend into dentin in limited areas, preventive restorative resin, each additional tooth, same quadrant

67.08

80.49

Topical application to hard tissue lesion(s) of antimicrobial or remineralization agent, one unit of time + E

66.73

80.07

Topical application to hard tissue lesion(s) of antimicrobial or remineralization agent, two units of time + E

133.46

160.15

Topical application to hard tissue lesion(s) of antimicrobial or remineralization agent, each additional unit over two

66.73

80.07

Appliances, removable, control of oral habits, appliance, maxillary + L

481.99

578.39

Appliances, removable, control of oral habits, mandibular + L

481.99

578.39

Appliances, removable, control of oral habits, maxillary plus mandibular + L

722.98

867.58

Appliances, fixed/cemented, control of oral habits, maxillary + L

562.34

674.81

Appliances, fixed/cemented, control of oral habits, mandibular + L

562.34

674.81

Control of oral habits, miscellaneous, motivation of patient, psychological approach, per visit + L

80.33

96.40

Control of oral habits, myofunctional therapy, (to correct mouth breathing, abnormal swallowing, tongue thrust, etc.) First unit of time per visit + L

80.33

96.40

Control of oral habits, myofunctional therapy, (to correct mouth breathing, abnormal swallowing, tongue thrust, etc.) Two units + L

160.66

192.79

Control of oral habits, myofunctional therapy, (to correct mouth breathing, abnormal swallowing, tongue thrust, etc.) Each additional unit over 2 + L

80.33

96.40

Appliances, control of oral habits, adjustments, repairs, maintenance, one unit of time + L

80.33

96.40

Appliances, control of oral habits, adjustments, repairs, maintenance, two units of time + L

160.66

192.79

Appliances, control of oral habits, adjustments, repairs, maintenance, three units of time + L

240.99

289.19

Appliances, control of oral habits, adjustments, repairs, maintenance, each additional unit over three + L

80.33

96.40

Appliances, protective mouth guards preformed

69.40

83.28

Appliances, protective mouth guards preformed + L

69.40

83.28

Appliances, periodontal (including bruxism appliance) – includes impression, insertion and adjustment (no post insertion adjustments) maxillary appliance + L

412.26

494.72

Appliances, periodontal (including bruxism appliance) – includes impression, insertion and adjustment (no post insertion adjustments) mandibular appliance + L

412.26

494.72

Appliances, adjustment, repair one unit of time + L

74.97

89.97

Appliances, adjustment, repair two units of time + L

149.94

179.93

Appliances, adjustment, repair three units of time + L

224.92

269.90

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Appliances, adjustment, repair each additional unit over three + L

74.97

89.97

Appliances, reline, direct

224.92

269.90

Appliances, reline, processed + L

224.92

269.90

Appliance, tmj, diagnostic/therapeutic includes impression, insertion and insertion adjustment (no post insertion adjustments) maxillary appliance + L

606.89

728.27

Appliance, tmj, diagnostic/therapeutic includes impression, insertion and insertion adjustment (no post insertion adjustments) mandibular appliance + L

606.89

728.27

Appliance, tmj, intraoral repositioning; includes impression, insertion and insertion adjustment (no post insertion adjustments) maxillary appliance + L

606.89

728.27

Appliance, tmj, intraoral repositioning; includes impression, insertion and insertion adjustment (no post insertion adjustments) mandibular appliance + L

606.89

728.27

Appliance, tmj, periodic maintanance, adjustment, repair one unit of time + L

78.70

94.44

Appliance, tmj, periodic maintanance, adjustment, repair two units + L

157.42

188.91

Appliance, tmj, periodic maintanance, adjustment, repair three units + L

236.13

283.35

Appliance, tmj, periodic maintanance, adjustment, repair each additional unit over three

78.70

94.44

Appliance, tmj, reline, direct

224.92

269.90

Appliance, tmj, reline, processed + L

224.92

269.90

Appliances, myofascial pain dysfunction syndrome maxillary appliance + L

702.53

843.04

Appliances, myofascial pain dysfunction syndrome mandibular appliance + L

702.53

843.04

Appliance, myofacial pain syndrome, periodic maintenance, adjustment and repairs one unit of time + L

78.70

94.44

Appliance, myofacial pain syndrome, periodic maintenance, adjustment and repairs two units + L

157.42

188.91

Appliance, myofacial pain syndrome, periodic maintenance, adjustment and repairs three units + L

236.13

283.35

Appliance, myofacial pain syndrome, periodic maintenance, adjustment and repairs each additional unit over three + L

78.70

94.44

Sleep apnea appliance, intraoral + L

0.00

0.00

Sleep apnea appliance, tongue retaining device + E

0.00

0.00

Sleep apnea appliance, maintenance, adjustment and repairs, one unit of time + L

0.00

0.00

Sleep apnea appliance, maintenance, adjustment and repairs, two units of time + L

0.00

0.00

Sleep apnea appliance, maintenance, adjustment and repairs, each additional unit over two + L

0.00

0.00

Sleep apnea appliance, evaluation, one unit of time

0.00

0.00

Sleep apnea appliance, evaluation, two units of time

0.00

0.00

Sleep apnea appliance, evaluation, each additional unit over two

0.00

0.00

Space maintainers, (includes design, separation, fabrication, insertion and where applicable initial cementation and removal) band type, fixed, unilateral + L

240.99

289.19

Space maintainer, band type, fixed, unilateral with intra-alveolar attachment + L

240.99

289.19

Space maintainer, band type, fixed, bilateral (soldered lingual arch) + L

321.33

385.60

Space maintainer, band type, fixed, bilateral (soldered lingual arch), with teeth attached + L

321.33

385.60

Space maintainer, band type, fixed, bilateral tubes and locking wires + L

321.33

385.60

Space maintainer, stainless steel crown type, fixed + L

240.99

289.19

Space maintainer, stainless steel crown type, fixed, with intra alveolar attachment + L

240.99

289.19

Space maintainers, cast type, fixed

0.00

0.00

Space maintainer, cast type, fixed, with intra alveolar attachment

0.00

0.00

Space maintainer, acrylic, removable, bilateral clasps, retaining wires + L

240.99

289.19

Space maintainer, acrylic, removable, bilateral clasps, retaining wires with teeth + L

240.99

289.19

Space maintainer, acrylic, removable, no clasps + L

240.99

289.19

Space maintainer, bonded, pontic type + L

240.99

289.19

Space maintainers, maintenance of, recementation/adjustment after 30 days from insertion

80.33

96.40

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Space maintainer, addition of clasps and or activating wires + L

160.66

192.79

Space maintainers, repairs, includes recementation + L

160.66

192.79

Space maintainers, removal of fixed space maintainer appliances by second dentist

76.70

92.04

Finishing restorations 1 unit of time

73.03

87.64

Finishing restorations 2 units of time

146.11

175.34

Finishing restorations 3 units of time

219.14

262.97

Finishing restorations 4 units of time

292.18

350.61

Finishing restorations each additional unit of time

73.03

87.64

Disking of teeth, interproximal 1 unit of time

69.40

83.28

Disking of teeth, interproximal 2 units of time

138.81

166.58

Disking of teeth, interproximal 3 units of time

208.21

249.86

Disking of teeth, interproximal each additional unit of time

69.40

83.28

Re-contouring of natural teeth for aesthetic reasons one unit of time

76.70

92.04

Re-contouring of natural teeth for aesthetic reasons each additional unit of time

76.70

92.04

Re-contouring of teeth for functional reasons one unit of time

76.70

92.04

Re-contouring of teeth for functional reasons each additional unit of time

76.70

92.04

Occlusal adjustment/equilibration one unit of time

86.18

103.42

Occlusal adjustment/equilibration two units

172.37

206.84

Occlusal adjustment/equilibration three units

258.57

310.28

Occlusal adjustment/equilibration four units

344.76

413.71

Occlusal adjustment/equilibration each additional unit over four

86.18

103.42

Caries/trauma/pain control (removal of carious lesions or existing restorations or gingivally attached tooth fragment and placement of sedative/protective dressings, includes pulp caps when necessary, as a separate procedure, first tooth

 

181.15

 

217.38

Caries, trauma and pain control, each additional tooth in same quadrant

181.15

217.38

Caries, trauma and pain control, (removal of carious lesions or existing restorations and placement of sedative/protective dressings) first tooth

226.40

271.68

Caries, trauma and pain control (removal of carious lesions or existing restorations and placement of sedative/protective dressings) each additional tooth in same quadrant

226.40

271.68

Trauma control, smoothing of fractured surfaces per tooth , first tooth

43.12

51.75

Trauma control, smoothing of fractured surfaces, each additional tooth same quadrant

43.12

51.75

Restorations, amalgam, primary teeth, non-bonded, one surface

105.70

126.84

Restorations, amalgam, primary teeth, non-bonded, 2 surfaces

155.38

186.45

Restorations, amalgam, primary teeth, non-bonded, 3 surfaces

199.77

239.72

Restorations, amalgam, primary teeth, non-bonded, four surfaces

244.15

292.98

Restorations, amalgam, primary teeth, non-bonded, 5 surfaces or maximum surfaces per tooth

266.35

319.62

Restorations, amalgam, bonded, primary teeth, one surface

126.86

152.23

Restorations, amalgam, bonded, primary teeth, two surfaces

177.55

213.06

** Filling-baby tooth amalgam, 3 surfaces, bonded

221.96

266.35

Restorations, amalgam, bonded, primary teeth, four surfaces

266.35

319.62

Restorations, amalgam, bonded, primary teeth, five surfaces or maximum surfaces per tooth

288.56

346.27

Restorations, amalgam, permanent teeth, non-bonded, permanent bicuspids and anteriors, one surface

105.70

126.84

Restorations, amalgam, permanent teeth, non-bonded, permanent bicuspids and anteriors, two surfaces

155.38

186.45

Restorations, amalgam, permanent teeth, non-bonded, permanent bicuspids and anteriors, three surfaces

199.77

239.72

Restorations, amalgam, permanent teeth, non-bonded, permanent bicuspids and anteriors, four surfaces

244.15

292.98

Restorations, amalgam, permanent teeth, non-bonded, permanent bicuspids and anteriors, five surfaces

266.35

319.62

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Restorations, amalgam, non-bonded, permanent molars, one surface

105.70

126.84

Restorations, amalgam, non-bonded, permanent molars, two surfaces

155.38

186.45

Restorations, amalgam, non-bonded, permanent molars, three surfaces

199.77

239.72

Restorations, amalgam, non-bonded, permanent molars, four surfaces

244.15

292.98

Restorations, amalgam, non-bonded, permanent molars, five surfaces or maximum surfaces per tooth

266.56

319.88

Restorations, amalgam, bonded, permanent bicuspids and anteriors, one surface

126.86

152.23

Restorations, amalgam, bonded, permanent bicuspids and anteriors, two surfaces

177.55

213.06

Restorations, amalgam, bonded, permanent bicuspids and anteriors, three surfaces

221.96

266.35

Restorations, amalgam, bonded, permanent bicuspids and anteriors, four surfaces

266.35

319.62

Restorations, amalgam, bonded, permanent bicuspids and anteriors, five surfaces per tooth

288.56

346.27

Restorations, amalgam, bonded, permanent molars, one surface

126.86

152.23

Restorations, amalgam, bonded, permanent molars, two surfaces

177.55

213.06

Restorations, amalgam, bonded, permanent molars, three surfaces

221.96

266.35

Restorations, amalgam, bonded, permanent molars, four surfaces

266.35

319.62

Restorations, amalgam, bonded, permanent molars, five surfaces or maximum surfaces per tooth

288.56

346.27

Restorations, amalgam cores, non-bonded in conjunction with crown or fixed bridge retainer

231.22

277.47

Restorations, amalgam cores, bonded, in conjunction with crowns or fixed bridge retainer

254.37

305.25

Pins, retentive per restoration (for amalgams and tooth coloured restorations) one pin

32.79

39.35

Pins, retentive per restoration (for amalgams and tooth coloured restorations) two pins

49.16

58.99

Pins, retentive per restoration (for amalgams and tooth coloured restorations) three pins

65.55

78.66

Pins, retentive per restoration (for amalgams and tooth coloured restorations) four pins

81.95

98.34

Pins, retentive per restoration (for amalgams and tooth coloured restorations) five pins or more

98.35

118.02

Restorations made to a tooth supporting an existing partial denture clasp (additional to restoration) per restoration

81.95

98.34

Restorations, prefabricated, metal, primary teeth, primary anterior

199.77

239.72

Restorations, prefabricated, metal, primary teeth, primary anterior, open face, acrylic veneer + L

244.15

292.98

Restorations, prefabricated, metal, primary teeth, primary posterior

199.77

239.72

Restorations, prefabricated, metal, primary teeth, primary posterior, open face

244.15

292.98

Restorations, prefabricated, metal, permanent teeth, permanent anterior

266.35

319.62

Restorations, prefabricated, metal, permanent teeth, permanent anterior – open face

310.74

372.88

Restorations, prefabricated, metal, permanent teeth, permanent posterior

266.35

319.62

Restorations, prefabricated, metal, permanent teeth, permanent posterior – open face

310.74

372.88

Restorations, prefabricated, plastic, primary teeth, primary anterior

181.13

217.35

Restorations, prefabricated, plastic, primary teeth, primary posterior

181.13

217.35

Restorations, prefabricated, plastic, permanent teeth, permanent anterior

249.05

298.86

Restorations, prefabricated, plastic, permanent teeth, permanent posterior

249.05

298.86

Restorations, prefabricated, porcelain/ceramic/polymer glass, primary teeth, primary anterior

0.00

0.00

Restorations, prefabricated, prefabricated, porcelain/ceramic/polymer glass, primary teeth, primary teeth, primary posterior

0.00

0.00

Restorations, tooth coloured, permanent anteriors non bonded technique, one surface

113.21

135.85

Restorations, tooth coloured, permanent anteriors non bonded technique, two surfaces (continuous)

135.84

163.00

Restorations, tooth coloured, permanent anteriors non bonded technique, three surfaces (continuous)

158.46

190.16

Restorations, tooth coloured, permanent anteriors non bonded technique, four surfaces (continuous)

203.76

244.51

Restorations, tooth coloured, permanent anteriors non bonded technique, five surfaces (continuous, maximum surfaces per tooth)

249.05

298.86

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Restorations, permanent anteriors, bonded technique, (not to be used for veneer applications or diastema closures) one surface

155.38

186.45

Restorations, permanent anteriors, bonded technique, (not to be used for veneer applications or diastema closures) two surfaces (continuous)

177.55

213.06

Restorations, permanent anteriors, bonded technique, three surfaces (continuous)

199.77

239.72

Restorations, permanent anteriors, bonded technique, four surfaces (continuous)

244.15

292.98

Restorations, permanent anteriors, bonded technique, five surfaces (continuous, maximum surfaces per tooth)

288.56

346.27

Restorations, tooth coloured, veneer applications, non prefabricated direct buildup- bonded

377.32

452.78

Restorations, tooth coloured, veneer applications, diastema closure, interproximal only, bonded

288.56

346.27

Restorations, tooth coloured/ plastic with/without silver filings, permanent posteriors non bonded, permanent bicuspids, one surface

113.21

135.85

Restorations, tooth coloured/ plastic with/without silver filings, permanent posteriors non bonded, permanent bicuspids, two surfaces

158.46

190.16

Restorations, tooth coloured/ plastic with/without silver filings, permanent posteriors non bonded, permanent bicuspids, three surfaces

181.13

217.35

Restorations, tooth coloured/ plastic with/without silver filings, permanent posteriors non bonded, permanent bicuspids, four surfaces

203.76

244.51

Restorations, tooth coloured/ plastic with/without silver filings, permanent posteriors non bonded, permanent bicuspids, five surfaces

226.40

271.68

Restorations, tooth coloured/ plastic with/without silver filings, permanent molars, one surface

113.21

135.85

Restorations, tooth coloured/ plastic with/without silver filings, permanent molars, two surfaces

158.46

190.16

Restorations, tooth coloured/ plastic with/without silver filings, permanent molars, three surfaces

181.13

217.35

Restorations, tooth coloured/ plastic with/without silver filings, permanent molars, four surfaces

203.76

244.51

Restorations, tooth coloured/ plastic with/without silver filings, permanent molars, five surfaces

226.40

271.68

Restorations, tooth coloured, permanent posteriors, bonded techinque, permanent bicuspids, one surface

155.38

186.45

Restorations, tooth coloured, permanent posteriors, bonded techinque, permanent bicuspids, two surfaces

221.96

266.35

Restorations, tooth coloured, permanent posteriors, bonded techinque, permanent bicuspids, three surfaces

266.35

319.62

Restorations, tooth coloured, permanent posteriors, bonded techinque, permanent bicuspids, four surfaces

310.74

372.88

Restorations, tooth coloured, permanent posteriors, bonded techinque, permanent bicuspids, five surfaces

355.14

426.17

Restorations, tooth coloured, permanent posteriors, bonded techinque, permanent molars, one surface

155.38

186.45

Restorations, tooth coloured, permanent posteriors, bonded techinque, permanent molars, two surfaces

221.96

266.35

Restorations, tooth coloured, permanent posteriors, bonded techinque, permanent molars, three surfaces

266.35

319.62

Restorations, tooth coloured, permanent posteriors, bonded techinque, permanent molars, four surfaces

310.74

372.88

Restorations, tooth coloured, permanent posteriors, bonded techinque, permanent molars, five surfaces

355.14

426.17

Restorations, tooth coloured, primary, anterior, non bonded, one surface

113.21

135.85

Restorations, tooth coloured, primary, anterior, non bonded, two surfaces (continuous)

135.84

163.00

Restorations, tooth coloured, primary, anterior, non bonded, three surfaces (continuous)

158.46

190.16

Restorations, tooth coloured, primary, anterior, non bonded, four surfaces (continuous)

203.76

244.51

Restorations, tooth coloured, primary, anterior, non bonded, five surfaces (continuous or maximum surfaces per tooth)

249.05

298.86

Restorations, tooth coloured, primary, anterior, bonded technique, one surface

155.38

186.45

Restorations, tooth coloured, primary, anterior, bonded technique, two surfaces (continuous)

177.55

213.06

Restorations, tooth coloured, primary, anterior, bonded technique, three surfaces (continuous)

199.77

239.72

Restorations, tooth coloured, primary, anterior, bonded technique, four surfaces (continuous)

244.15

292.98

Restorations, tooth coloured, primary, anterior, bonded technique, five surfaces (continuous or maximum surfaces per tooth)

288.56

346.27

Restorations, tooth coloured/plastic with/without silver filings, primary, posterior, non bonded, one surface

113.21

135.85

Restorations, tooth coloured/plastic with/without silver filings, primary, posterior, non bonded, two surfaces

158.46

190.16

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Restorations, tooth coloured/plastic with/without silver filings, primary, posterior, non bonded, three surfaces

181.13

217.35

Restorations, tooth coloured/plastic with/without silver filings, primary, posterior, non bonded, four surfaces

203.76

244.51

Restorations, tooth coloured/plastic with/without silver filings, primary, posterior, non bonded, five surfaces (or maximum surfaces per tooth)

226.40

271.68

Restorations, tooth coloured, primary, posterior, bonded technique, one surface

155.38

186.45

Restorations, tooth coloured, primary, posterior, bonded technique, two surfaces

221.96

266.35

Restorations, tooth coloured, primary, posterior, bonded technique, three surfaces

266.35

319.62

Restorations, tooth coloured, primary, posterior, bonded technique, four surfaces

310.74

372.88

Restorations, tooth coloured, primary, posterior, bonded technique, five surfaces or maximum surfaces per tooth

355.14

426.17

Restorations, tooth coloured, non-bonded core, in conjunction with crown or fixed bridge retainer

231.24

277.49

Restorations, tooth coloured, bonded core, in conjunction with crown or fixed bridge retainer

277.49

332.99

Resin infiltration, one surface

0.00

0.00

Resin infiltration, each additional surface over one

0.00

0.00

Restorations, foil, gold, anteriors, class i

572.74

687.29

Restorations, foil, gold, anteriors, class iii

763.65

916.38

Restorations, foil, gold, anteriors, class v

572.74

687.29

Restorations, foil, gold, anteriors, class iv

899.93

1079.92

Restorations, foil, gold, posteriors, class i

561.51

673.81

Restorations, foil, gold, posteriors, class ii

763.65

916.38

Restorations, foil, gold, posteriors, class v

572.74

687.29

Restorations, inlays, metal, one surface + L

464.93

557.92

Restorations, inlays, metal, two surfaces + L

557.95

669.54

Restorations, inlays, metal, three surfaces + L

650.95

781.14

Restorations, inlays, metal, three surfaces, modified + L

730.55

876.66

Restorations, inlays, composite/componer, indirect (bonded), one surface + L

501.41

601.69

Restorations, inlays, composite/componer, indirect (bonded), two surfaces + L

557.95

669.54

Restorations, inlays, composite/componer, indirect (bonded) three surfaces + L

683.78

820.53

Restorations, inlays, composite/componer, indirect (bonded) three surfaces, modified + L

764.01

916.82

Restorations, inlays, porcelain/ceramic/polymer glass, one surface + L

464.95

557.94

Restorations, inlays, porcelain/ceramic/polymer glass, two surfaces + L

557.95

669.54

Restorations, inlays, porcelain/ceramic/polymer glass, 3 surfaces + L

650.95

781.14

Restorations, inlays, porcelain/ceramic/polymer glass, 3 surfaces, modified + L

730.55

876.66

Restorations, inlays, porcelain/ceramic/polymer glass (bonded), one surface + L

501.41

601.69

Restorations, inlays, porcelain/ceramic/polymer glass (bonded), two surfaces + L

592.60

711.12

Restorations, inlays, porcelain/ceramic/polymer glass, (bonded), three surfaces + L

683.78

820.53

Restorations, inlays, porcelain/ceramic/polymer glass, (bonded), three surfaces, modified + L

764.01

916.82

Restorations, onlays, cast metal, indirect + L

650.95

781.14

Restorations, onlays, composite/componer, indirect (bonded) + L

683.78

820.53

Restorations, onlays, porcelain/ceramic/polymer glass, (bonded) + L

683.78

820.53

Restoration, pins, retentive (for inlays, onlays, and crowns per tooth), one pin/tooth + L

49.60

59.53

Restoration, pins, retentive (for inlays, onlays, and crowns per tooth), two pins/tooth + L

99.15

118.99

Restoration, pins, retentive (for inlays, onlays, and crowns per tooth), three pins/tooth + L

147.75

177.31

Restoration, pins, retentive (for inlays, onlays, and crowns per tooth), four pins/tooth + L

184.23

221.07

Restoration, pins, retentive (for inlays, onlays, and crowns per tooth), five or more pins/tooth + L

212.56

255.07

Posts, cast metal, (including core) as a separate procedure, single section + L

371.97

446.37

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Posts, cast metal, (including core) as a separate procedure, two sections + L

464.95

557.94

Posts, cast metal, (including core) as a separate procedure, three sections + L

557.95

669.54

Posts, cast metal (including core) concurrent with impression for crown, single section + L

185.98

223.17

Posts, cast metal (including core) concurrent with impression for crown, two sections + L

278.97

334.77

Posts, cast metal (including core) concurrent with impression for crown, three section + L

371.97

446.37

Posts, prefabricated retentive, one post + E

139.50

167.40

Posts, prefabricated retentive, two posts same tooth + E

278.97

334.77

Posts, prefabricated retentive, three posts same tooth + E

418.43

502.12

Posts, prefabricated, retentive and cast core, one post and cast core + L+ E

278.97

334.77

Posts, prefabricated, retentive and cast core, two posts (same tooth) and cast core + L+ E

371.97

446.37

Posts, prefabricated, retentive and cast core, three posts (same tooth) and cast core + L+ E

464.95

557.94

Posts, provisional, per post + L+ E

93.00

111.60

Post removal, one unit of time

97.42

116.91

Post removal, two units of time

194.81

233.77

Post removal, three units oftime

292.24

350.68

Post removal, four units of time

389.62

467.55

Post removal, each additional unit over four

97.42

116.91

Implants, mesostructures,indirect,ang/transmucosal pre-fab. Abut. Per implant + L + E

0.00

0.00

Implants, meostructures, indirect, custom laboratory, fabricated, per implant + L + E

0.00

0.00

Implants, meostructures, direct, with intra-oral preparation, per implant site + E

0.00

0.00

Crowns, single units, acrylic/composite/compomer (with or without cast or prefabricated metal bases), indirect + L

743.91

892.69

Crowns, acrylic/composite/compomer, indirect, complicated (restorative, positional and/or esthetic) + L

929.92

1115.91

Crowns, acrylic/composite/compomer, provisional (long term) indirect (lab fabricated/relined intra-orally + L

278.97

334.77

Crowns, acrylic/composite/compomer, direct, provisional, (chairside) + E

139.50

167.40

Crowns, implant, composite/compomer, direct, implant-supported + E

139.50

167.40

Crowns, acrylic/composite/compomer/cast metal base, indirect + L

743.91

892.69

Crowns, implant, acrylic/composite/compomer, cast metal base, implant-supp + L + E

743.91

892.69

Crowns, acrylic/composite/compomer/cast metal base with cast post retention + L

929.92

1115.91

Crowns, porcelain/ceramic/polymer glass + L

1002.74

1203.29

Crowns, porcelain/ceramic/polymer glass, complicated + L

1168.93

1402.71

Crowns, porc/cer/poly glass, implant supported + L + E

1002.74

1203.29

Crowns, porcelain/ceramic/polymer glass, with cast ceramic post retention + L

1168.93

1402.71

Crowns, porcelain/ceramic/polymer glass, fused to metal base + L

1002.74

1203.29

Crowns, porcelain/ceramic/polymer glass, fused to metal base, complicated (restorative, positional and/or aesthetic) + L

1168.93

1402.71

Crowns, implant,porcelain/ceramic fused to metal base, implant supported + L+ E

1007.61

1209.13

Crowns, implant,porcelain/ceramic fused to metal base, with cast metal post retention + L

1168.93

1402.71

Crown, 3/4, porcelain/ceramic/.Polymer glass + L

1002.74

1203.29

Crown, 3/4, porcelain/ceramic/polymer glass, complicated + L

1168.93

1402.71

Crowns, cast metal + L

1002.74

1203.29

Crowns, cast metal, complicated (restorative, positional)+ L

1168.93

1402.71

Crowns, implant, cast metal, implant supported + L+ E

1002.74

1203.29

Crowns, cast metal, with cast metal post retention + L

1168.93

1402.71

Semi-precision rest (interlock) (in addition to cast metal crown)

0.00

0.00

Semi-precision or precision attachment rpd retainer (in addition to cast metal crown)

0.00

0.00

Crowns, 3/4, cast metal, + L

1023.55

1228.26

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Crowns, metal, 3/4 cast metal, complicated + L

1168.93

1402.71

Crowns, 3/4, cast metal, with direct tooth coloured corner + L

1071.48

1285.78

Crowns made to an existing partial denture clasp, one crown

84.16

101.00

Crowns made to an existing partial denture clasp, each additional crown

84.16

101.00

Coping, metal/acrylic, trandfer (thimble) as a separate procedure + L

371.99

446.39

Coping, metal/acrylic, transfer(thimble) concurrent with impression for crown + L

93.00

111.60

Veneers, laboratory processed, acrylic/composite/compomer, bonded + L

743.91

892.69

Veneers, porcelain/ceramic/polymer glass, bonded + L

743.91

892.69

Repairs, inlays, onlays or crowns, acrylic/composite/compomer, direct

278.97

334.77

Repairs, inlays, onlays or crowns, porcelain/ceramic/polymer glass, direct

92.94

111.53

Repairs, inlays onlays or crowns, porcelain/ceramic/polymer glass/fused to metal base, indirect + L

92.94

111.53

Recontouring of existing crowns, per tooth, one unit of time

93.00

111.60

Recontouring of existing crowns, per tooth, each additional unit of time

93.00

111.60

Restorative procedures, overdentures, direct, natural tooth preparation, placement of pulp chamber restoration, endodontically treated tooth

232.48

278.97

Restorative procedures, overdentures, direct, natural tooth preparation and fluoride application, vital tooth

278.97

334.77

Pre-fabricated attachment, as an internal or external overdenture retentive device, direct to natural tooth, per tooth + L + E

278.97

334.77

Implant-supported prefabricated attachment as an overdenture retentive device, direct

139.50

167.40

Restorative procedures, coping crown, cast metal, no attachments, indirect + L+ E

371.97

446.37

Implant, restorative, coping crown,cast metal,no attach,implnt suport,indirec+ L + E

371.97

446.37

Overdenture, coping crown,cast metal w/cast metal retentve post,no attach+ L+ E

557.95

669.54

Overdenture, coping crown,metal cast w/attachmt, indirect + L + E

464.95

557.94

Implant, coping crown,cast metal, implant supported w/attachment + L+ E

464.95

557.94

Overdenture, coping crown,cast metal retentive post, w/attachment + L + E

683.76

820.51

Recementation/rebonding, inlays/onlays/crowns/veneers/ posts/ natural tooth fragments, one unit of time + L

93.00

111.60

Recementation/rebonding, inlays/onlays/crowns/veneers/ posts/ natural tooth fragments, two units of time + L

185.98

223.17

Recementation/rebonding, inlays/onlays/crowns/veneers/ posts/ natural tooth fragments, three units of time + L

278.97

334.77

Recementation/rebonding, inlays/onlays/crowns/veneers/ posts/ natural tooth fragments, four units of time + L

371.97

446.37

Removal, inlays/onlays/crowns/veneers, one unit of time

93.00

111.60

Removal, inlays/onlays/crowns/veneers, two units of time

185.98

223.17

Removal, inlays/onlays/crowns/veneers, three units of time

278.97

334.77

Crowns/inlays/onlays/veneers, removal, 4 units

371.97

446.37

Staining, porcelain (chairside) one unit of time + L

93.00

111.60

Staining, porcelain (chairside), two units + L

185.98

223.17

Staining, porcelain (chairside), three units + L

278.97

334.77

Staining, porcelain (chairside), four units + L

371.97

446.37

Pulpotomy, permanent teeth, (as a separate emergency procedure) anterior & bicuspid teeth

169.07

202.88

Pulpotomy, permanent teeth, (as a separate emergency procedure) molar teeth

169.07

202.88

Pulpotomy, primary tooth as a separate procedure

160.99

193.19

Pulpotomy, primary tooth, concurrent with restorations (but excluding final restoration)

80.51

96.62

Pulpectomy (an emergency procedure and/or as a pre-emptive phase to the preparation of the root canal system for obturation), permanent teeth/retained primary teeth, one canal

126.79

152.15

Pulpectomy (an emergency procedure), permanent teeth/retained primary teeth, 2 canals

169.07

202.88

Pulpectomy (an emergency procedure and/or as a pre-emptive phase to the preparation of the root canal system for obturation), permanent teeth/retained primary teeth, 3 canals

211.34

253.60

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Pulpectomy (an emergency procedure and/or as a pre-emptive phase to the preparation of the root canal system for obturation), permanent teeth/retained primary teeth, 4 canals or more

253.59

304.31

Pulpectomy, primary teeth, anterior tooth

126.79

152.15

Pulpectomy, primary teeth, posterior tooth

211.34

253.60

Root canals, permanent teeth/retained primary teeth, one canal

718.65

862.38

Root canals, permanent teeth/retained primary teeth, difficult access, one canal

929.71

1115.65

Root canals, permanent teeth/retained primary teeth, exceptional anatomy, one canal

929.71

1115.65

Root canals, permanent teeth/retained primary teeth, calcified canal, one canal

929.71

1115.65

Root canals, permanent teeth/retained primary teeth, retreatment of previously completed therapy, one canal

929.71

1115.65

Root canals, permanent teeth/retained primary teeth, two canals

1084.68

1301.62

Root canals, permanent teeth/retained primary teeth, difficult access, two canals

1306.03

1567.24

Root canals, permanent teeth/retained primary teeth, exceptional anatomy, two canals

1306.03

1567.24

Root canals, permanent teeth/retained primary teeth, calcified canals, two canals

1306.03

1567.24

Root canals, permanent teeth/retained primary teeth, retreatment of previously completed therapy, two canals

1306.03

1567.24

Root canals, permanent teeth/retained primary teeth, three canals

1239.62

1487.55

Root canals, permanent teeth/retained primary teeth, difficult access, three canals

1461.00

1753.21

Root canals, permanent teeth/retained primary teeth, exceptional anatomy, three canals

1461.00

1753.21

Root canals, permanent teeth/retained primary teeth, calcified canals, three canals

1461.00

1753.21

Root canals, permanent teeth/retained primary teeth, retreatment of previously completed therapy, 3 canals

1461.00

1753.21

Root canals, permanent teeth/retained primary teeth, four or more canals

1505.26

1806.32

Root canals, permanent teeth/retained primary teeth, difficult access, four or more canals

1726.61

2071.93

Root canals, permanent teeth/retained primary teeth, exceptional anatomy, four or more

1726.61

2071.93

Root canals, permanent teeth/retained primary teeth, calcified canal, four or more canals

1726.61

2071.93

Root canals, permanent teeth/retained primary teeth, retreatment of previously completed therapy, four or more canals

1726.61

2071.93

Pulpal revascularization, one canal

0.00

0.00

Pulpal revascularization, two canals

0.00

0.00

Pulpal revascularization, three canals or more

0.00

0.00

Apexification/apexogenesis/induction of hard tissue repair, one canal

265.64

318.77

Apexification/apexogenesis/induction of hard tissue repair, two canals

398.47

478.16

Apexification/apexogenesis/induction of hard tissue repair, three canals

531.26

637.51

Apexification/apexogenesis/induction of hard tissue repair, four canals or more

708.36

850.04

Apexification/re-insertion of dentogenic media per visit, one canal

132.83

159.39

Apexification/re-insertion of dentogenic media per visit, two canals

177.09

212.50

Apexification/re-insertion of dentogenic media per visit, three canals

265.64

318.77

Apexification/re-insertion of dentogenic media per visit, four canals or more

354.17

425.01

Apicoectomy/apical curettage, maxillary anterior, one root

462.81

555.38

Apicoectomy/apical curettage, maxillary anterior, two roots

676.03

811.24

Apicoectomy/apical curettage, maxillary bicuspid, one root

579.46

695.35

Apicoectomy/apical curettage, maxillary bicuspid, two roots

772.61

927.13

Apicoectomy/apical curettage, maxillary bicuspid, three roots

965.77

1158.93

Apicoectomy/apical curettage, maxillary molar, one root

579.46

695.35

Apicoectomy/apical curettage, maxillary molar, two roots

772.61

927.13

Apicoectomy/apical curettage, maxillary molar, three roots

1158.94

1390.72

Apicoectomy/apical curettage, mandibular anterior, one root

555.36

666.43

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Apicoectomy/apical curettage, mandibular anterior, two or more roots

772.61

927.13

Apicoectomy/apical curettage, mandibular bicuspid, one root

676.03

811.24

Apicoectomy/apical curettage, mandibular bicuspid, two roots

869.20

1043.04

Apicoectomy/apical curettage, mandibular bicuspid, three or more roots

1007.80

1209.36

Apicoectomy/apical curettage, mandibular molar, one root

676.03

811.24

Apicoectomy/apical curettage, mandibular molar, two roots

869.20

1043.04

Apicoectomy/apical curettage, mandibular molar, three roots

1158.94

1390.72

Retrofilling, maxillary anterior, one canal

92.56

111.08

Retrofilling, maxillary anterior, 2 or more canals

185.11

222.13

Retrofilling, maxillary bicuspid,1 canal

92.56

111.08

Retrofilling, maxillary bicuspid, 2 canals

185.11

222.13

Retrofilling, maxillary bicuspid, 3 canals

277.67

333.21

Retrofilling, maxillary bicuspid, 4 or more canals

370.25

444.30

Retrofilling, maxillary molar, 1 canal

92.56

111.08

Retrofilling, maxillary molar, 2 canals

185.11

222.13

Retrofilling, maxillary molar, 3 canals

277.67

333.21

Retrofilling, maxillary molar, 4 or more canals

370.25

444.30

Retrofilling, mandibular anterior, 1 canal

92.56

111.08

Retrofilling, mandibular anterior, 2 or more canals

185.11

222.13

Retrofilling, mandibular bicuspid, 1 canal

92.56

111.08

Retrofilling, mandibular bicuspid, 2 canals

185.11

222.13

Retrofilling, mandibular bicuspid, 3 canals

277.67

333.21

Retrofilling, mandibular bicuspid, 4 or more canals

370.23

444.28

Retrofilling, mandibular molar, 1 canal

92.56

111.08

Retrofilling, mandibular molar, 2 canals

185.11

222.13

Retrofilling, mandibular molar, 3 canals

277.67

333.21

Retrofilling, mandibular molar, 4 or more canals

370.23

444.28

Retreatment, apicoectomy/apical curettage, maxillary anterior, 1 root

555.36

666.43

Retreatment, apicoectomy/apical curettage, maxillary anterior, 2 roots

772.61

927.13

Apicoectomy/apical curettage, maxillary bicuspid, 1 root

676.03

811.24

Retreatment, apicoectomy/apical curettage, maxillary bicuspid, 2 roots

917.49

1100.98

Retreatment, apicoectomy/apical curettage, maxillary bicuspid, 3 roots

1158.94

1390.72

Apicoectomy/apical curettage, maxillary molar, 1 root

676.03

811.24

Apicoectomy/apical curettage, maxillary molar, 2 roots

917.49

1100.98

Retreatment, apicoectomy/apical curettage, maxillary molar, 3 roots

1352.08

1622.50

Retreatment, apicoectomy/apical curettage, mandibular anterior, 1 root

694.20

833.05

Retreatment, apicoectomy/apical curettage, mandibular anterior, 2 or more roots

965.77

1158.93

Retreatment, apicoectomy/apical curettage, mandibular bicuspid, 1 root

772.61

927.13

Retreatment, apicoectomy/apical curettage, mandibular bicuspid, 2 roots

1062.35

1274.82

Retreatment, apicoectomy/apical curettage, mandibular bicuspid, 3 roots

1255.51

1506.61

Retreatment, apicoectomy/apical curettage, mandibular molar, 1 root

772.61

927.13

Retreatment, apicoectomy/apical curettage, mandibular molar, 2 roots

1014.06

1216.87

Apicoectomy/apical curettage, mandibular molar, 3 roots

1352.08

1622.50

Surgical services, amputations, (includes recontouring tooth and furca) one root

277.67

333.21

Surgical services, amputations, two roots

462.81

555.38

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Surgical services, hemisection, maxillary bicuspid

277.67

333.21

Surgical services, hemisection, maxillary molar

277.67

333.21

Surgical services, hemisection, mandibular molar

277.67

333.21

Surgical services, decompression, perio-radicular lesion, first visit

370.25

444.30

Surgical services, decompression, perio-radicular lesion, each additional visit

185.11

222.13

Surgery, endodontic, exploratory, maxillary anterior

277.67

333.21

Surgery, endodontic, exploratory, maxillary bicuspid

370.25

444.30

Surgery, endodontic, exploratory, maxillary molar

462.81

555.38

Surgery, endodontic, exploratory, mandibular anterior

277.67

333.21

Surgery, endodontic, exploratory, mandibular bicuspid

370.25

444.30

Surgery, endodontic, exploratory, mandibular molar

462.81

555.38

Removal, intentional, of tooth, apical filling & replantation, single rooted tooth

386.31

463.57

Removal, intentional, of tooth, apical filling & replantation, two rooted tooth

579.46

695.35

Removal, intentional, of tooth, apical filling and replantation, three rooted tooth or more

772.61

927.13

Perforations/resorptive defects, pulp chamber or root repair, non-surgical, per tooth

84.52

101.43

Perforations/resorptive defect(s), pulp chamber or root repair, surgical, anterior tooth

92.56

111.08

Perforations/resorptive defect(s), pulp chamber or root repair, surgical, bicuspid tooth

185.11

222.13

Perforations/resorptive defect(s), pulp chamber or root repair, molar tooth

277.67

333.21

Enlargement, canal and/or pulp chamber, in previously filled tooth, rct done by another practitioner

88.55

106.26

Enlargement, canal and/or pulp chamber, in calcified canals

265.64

318.77

Isolation of endodontic tooth/teeth for asepsis, banding and/or coronal buildup of tooth/teeth and/or contouring of tissue surrounding tooth to maintain aseptic operating field (per tooth)

169.07

202.88

Open and drain (separate emergency procedures) anteriors and bicuspids

76.50

91.80

Endodontic, procedures, open and drain (separate emergency procedures), molars

76.50

91.80

Open and drain, opening through artificial crown (in addition to procedures) anteriors and bicuspids

84.52

101.43

Endodontic, open and drain, opening through artificial crown, molars

84.52

101.43

Bleaching, non vital, endodontically treated tooth/teeth, one unit of time

84.52

101.43

Bleaching, non vital, endodontically treated tooth/teeth, two units

169.07

202.88

Bleaching, non vital, endodontically treated tooth/teeth, three units

253.59

304.31

Bleaching, non vital, endodontically treated tooth/teeth, each additional unit over three

84.52

101.43

Exploratory access through clinical crown of previously treated tooth, anterior

76.50

91.80

Exploratory access through clinical crown of previously treated tooth, bicuspid

76.50

91.80

Exploratory access through clinical crown of previously treated tooth, molar

83.79

100.55

Oral disease, oral manifestations, oral mucosal disorders, e.G. Lichen planus, aphthous stomatitis, salivary and gland tumours, etc., One unit of time

78.27

93.93

Oral disease, oral manifestations, oral mucosal disorders, e.G. Lichen planus, aphthous stomatitis, salivary and gland tumours, etc., Two units of time

154.99

185.98

Oral disease, oral manifestations, oral mucosal disorders, e.G. Lichen planus, aphthous stomatitis, salivary and gland tumours, etc., Three units of time

231.82

278.18

Oral disease, oral manifestations, oral mucosal disorders, e.G. Lichen planus, aphthous stomatitis, salivary and gland tumours, etc., Four units of time

308.50

370.19

Oral disease, oral manifestations, oral mucosal disorders, e.G. Lichen planus, aphthous stomatitis, salivary and gland tumours, etc., Each additional unit over four

80.07

96.09

Nervous and muscular disorders, disorders of facial sensation and motor dysfunction at the jaw, one unit of time

81.76

98.11

Nervous & muscular disorders, disorders of facial sensation and motor dysfunction at the jaw, two units

160.16

192.19

Nervous & muscular disorders, disorders of facial sensation and motor dysfunction at the jaw, three units

231.78

278.14

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Nervous & muscular disorders, disorders of facial sensation and motor dysfunction at the jaw, four units

308.50

370.19

Nervous & muscular disorders, disorders of facial sensation and motor dysfunction at the jaw, each additional unit over four

80.07

96.09

Oral manifestations of systemic disease or complications of medical therapy, e.G. Chemotherapy, radiation therapy, post operative neuropathics, etc., One unit of time

81.76

98.11

Oral manifestations of systemic disease or complications of medical therapy, e.G. Chemotherapy, radiation therapy, post operative neuropathics, etc.,Two units of time

160.16

192.19

Oral manifestations of systemic disease or complications of medical therapy, e.G. Chemotherapy, radiation therapy, post operative neuropathics, etc., Three units of time

231.78

278.14

Oral manifestations of systemic disease or complications of medical therapy, e.G. Chemotherapy, radiation therapy, post operative neuropathics, etc., Four units of time

308.50

370.19

Oral manifestations of systemic disease, or complications of medical therapy, e.G. Chemotherapy, radiation therapy, post operative neuropathics, etc., Each additional unit over four

80.07

96.09

Desensitization (this may involve application and burnishing of medicinal aids on the root) one unit of time

81.76

98.11

Desensitization, (this may involve application and burnishing of medicinal aids on the root) two units of time

160.16

192.19

Desensitization, (this may involve application and burnishing of medicinal aids on the root) each additional unit over 2

78.39

94.06

Periodontal surgery, gingival curettage, surgical curettage to include definitive root planing, per sextant

202.55

243.06

Periodontal surgery, gingivoplasty, per sextant

244.41

293.29

Periodontal surgery, gingivectomy, uncomplicated, per sextant

275.52

330.63

Periodontal surgery, gingivectomy with curettage, per sextant

369.54

443.44

Periodontal surgery, gingivectomy, gingival fiber incision (supra crestal fibrotomy) first tooth

74.72

89.66

Periodontal surgery, gingivectomy, gingival fiber incision (supra crestal fibrotomy) each additional tooth

75.44

90.53

Periodontal surgery, flap approach, with osteoplasty/ostectomy, per sextant

1057.74

1269.29

Periodontal surgery, flap approach, with curettage of osseous defect, per sextant

594.84

713.80

Periodontal surgery, flap approach with curettage of osseous defect and osteoplasty, per sextant

914.33

1097.19

Periodontal surgery, flap approach, exploratory (for diagnosis) per site

525.12

630.14

Periodontal surgery, grafts, soft tissue, pedicle, per site

626.31

751.58

Periodontal surgery, grafts, soft tissue, periosteal stimulation in addition to 42511

93.14

111.76

Periodontal surgery, grafts, soft tissue, pedicle (coronally positioned) per site

624.31

749.17

Periodontal surgery, grafts, soft tissue, periosteal stimulation in addition to 42521

86.55

103.86

Periodontal surgery, grafts, free soft tissue, per site

614.87

737.84

Periodontal surgery, grafts, soft tissue, pedicle, with free graft placed in pedicle donor site, per site

728.98

874.78

Periodontal surgery, grafts, autografts, free connective tissue (for root coverage) – includes harvesting from donor site, per site

717.09

860.51

Periodontal surgery, grafts, allografts, (for root coverage) – per site + E

0.00

0.00

Periodontal surgery, grafts, allografts, free connective tissue (adjacent to an implant) – per site + E

0.00

0.00

Periodontal surgery, grafts, autograft,free connective tissue, (for ridge augmentation) – includes harvesting from donor site – per site

884.54

1061.45

Periodontal surgery, grafts, allograft for ridge augmentation per site + E

0.00

0.00

Periodontal surgery, grafts, connective tissue, pedicle, with free graft for root coverage, per site

833.44

1000.13

Periodontal surgery, grafts, gingival onlay, for ridge augmentation, per site

884.54

1061.45

Periodontal surgery, grafts, dermal, onlay, for ridge augmentation autograft per site

884.54

1061.45

Periodontal surgery, grafts, dermal, onlay, for ridge augmentation allograft per site + E

886.79

1064.15

Periodontal surgery, grafts, osseous tissue, autograft (including flap entry, closure and donor site) per site

1041.23

1249.48

Periodontal surgery, grafts, osseous, allograft (including flap entry closure), per site + E

1041.23

1249.48

Periodontal surgery,grafts,osseous, zenograft (including flap entry closure), per site + E

1041.23

1249.48

Periodontal surgery, guided tissue regeneration non-resorbable membrane per site + E

1574.24

1889.09

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Periodontal surgery, guided tissue regeneration resorbable membrane per site + E

1574.24

1889.09

Periodontal surgery, guided tissue regeneration non resorbable membrane surgical reentry for removal

1574.24

1889.09

Biological materials to aid in soft & osseous tissue regneration per site + E

0.00

0.00

Periodontal surgery, proximal wedge procedure (as a separate procedure, with flap curettage, per site

461.29

553.55

Periodontal surgery, proximal wedge procedure, with flap curettage and ostectomy/osteoplasty per site

596.29

715.55

Post surgical periodontal treatment visit per dressing change, one unit of time

73.06

87.67

Post surgical periodontal treatment visit per dressing change, two units

155.52

186.63

Post surgical periodontal treatment visit per dressing change, three units

231.55

277.86

Post surgical periodontal treatment visit per dressing change, each additional unit over three

74.66

89.60

Periodontal abscess or pericoronitis, includes any of the following procedures: lancing, scaling, curettage, surgery or medication, one unit of time

79.91

95.90

Periodontal abscess or pericoronitis, includes any of the following procedures: lancing, scaling, curettage, surgery or medication, two units

158.23

189.88

Periodontal abscess or pericoronitis, includes any of the following procedures: lancing, scaling, curettage, surgery or medication, three units

231.70

278.04

Periodontal abscess or pericoronitis, includes any of the following procedures: lancing, scaling, curettage, surgery or medication, four units

308.50

370.19

Periodontal abscess or pericoronitis, includes any of the following procedures: lancing, scaling, curettage, surgery or medication, each additional unit over four

80.07

96.09

Flap approach for creation of interdental papillae per site

0.00

0.00

Periodontal splint or ligation, provisional, intra coronal, note: this procedure is in addition to the usual code for the tooth preparation on either side of the joint, 'a' splint (acrylic, composite or amalgam, plus knurled wire) per joint + E

152.88

183.45

Periodontal splint or ligation, provisional, extra coronal, bonded, interproximal enamel splint, per joint

74.74

89.69

Periodontal splint or ligation, provisional, extra coronal, wire ligation, per joint

73.06

87.67

Periodontal splint, wire ligation, material covered, per joint

76.27

91.52

Periodontal splint or ligation, orthodontic band splint, per band + E

74.66

89.60

Periodontal splint, cast/soldered/ceramic/polymer glass, splint, bonded, per abutment + L

78.31

93.97

Periodontal splint, removal of fixed periodontal splints, one unit of time

74.66

89.60

Removal of fixed periodontal splints, each additional unit of time

74.66

89.60

Root planing, periodontal, one unit of time

78.39

94.06

Root planing, periodontal, two units of time

155.02

186.02

Root planing-three units of time

231.70

278.04

Root planing-four units of time

308.50

370.19

Root planing-five units of time

386.88

464.26

Root planing-six units of time

465.28

558.34

Root planing-half a unit of time

45.11

54.13

Root planing-each additional unit

85.14

102.16

Chemotherapeutic and/or antimicrobial agents, topical application, one unit of time

83.18

99.82

Chemotherapeutic and/or antimicrobial agents, each additional unit of time

73.90

88.68

Chemotherapeutic and/or antimicrobial therapy, one unit of time + E

78.39

94.06

Chemotherapeutic and/or antimicrobial therapy, each additional unit of time + E

78.31

93.97

Periodontal, re-evaluation/evaluation, ongoing periodontal treatment, post-surgical re-evaluation one month after surgery, one unit of time

74.66

89.60

Periodontal, re-evaluation/evaluation, ongoing periodontal treatment, post-surgical re-evaluation one month after surgery, two units

147.81

177.38

Periodontal, re-evaluation/evaluation, ongoing periodontal treatment, post-surgical re-evaluation one month after surgery, each additional unit over two

74.74

89.69

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Periodontal irrigation, subgingival, one unit of time + E

Deleted

Deleted

Periodontal irrigation, subgingival, each additional unit of time + E

Deleted

Deleted

Gingival mask + L(removable appliance to mask unaesthetic embrasures note: for extensive gingival prostheses required after maxilla facial surgery see sub-classification 57300 prosthesis maxillofacial, other, code 57372 gingival prosthesis + L)

 

0.00

 

0.00

Dentures, complete, standard, (includes impressions, insertion and adjustments, three month post insertion care), maxillary + L

898.46

1078.15

Dentures, complete, standard, (includes impressions, insertion and adjustments, three month post insertion care), mandibular + L

898.46

1078.15

Dentures, complete, standard, (includes impressions, insertion and adjustments, three month post insertion care), liners, processed, resilient, in addition to 51103

0.00

0.00

Dentures, complete, complex, maxillary + L

1788.21

2145.85

Dentures, complete, complex, mandibular + L

1788.21

2145.85

Dentures, complete, complex, liners, processed , resilient

0.00

0.00

Dentures, surgical standard (immediate) maxillary + L

898.46

1078.15

Dentures, surgical standard (immediate) mandibular + L

898.46

1078.15

Dentures, surgical complex (immediate) maxillary + L

1223.53

1468.23

Dentures, surgical complex (immediate) mandibular + L

1223.53

1468.23

Dentures, complete, gnathological (cast base and metal occlusals) maxillary

0.00

0.00

Dentures, complete, gnathological (cast base and metal occlusals) mandibular

0.00

0.00

Dentures, complete, provisional, maxillary + L

599.06

718.87

Dentures, complete, provisional, mandibular + L

599.06

718.87

Dentures, complete, overdentures, tissue borne, supported by natural teeth with or without coping crowns, no attachments, maxillary + L

1129.07

1354.89

Dentures, complete, overdentures, tissue borne, supported by natural teeth with or without coping crowns, no attachments, mandibular + L

1129.07

1354.89

Dentures, complete, overdentures,supported by implants, maxillary + L

1129.39

1355.26

Dentures, complete, overdentures, supported by implants,mandibular + L

1129.39

1355.26

Dentures,supported by natural teeth and implants,no attachments, maxillary + L

1129.39

1355.26

Dentures,supported by natural teeth and implants, no attachments, mand. + L

1129.39

1355.26

Dentures,complete,overdenture, supported by teeth, no attachments, max. + L

1078.17

1293.80

Dentures,complete,overdenture,supported by teeth,no attachments, mand.+ L

1078.17

1293.80

Dentures, complete, overdentures, tissue borne, with independent attachments secured to natural teeth with or without coping crowns, maxillary + L

1078.17

1293.80

Dentures, complete, overdentures, tissue borne, with independent attachments secured to natural teeth with or without coping crowns, mandibular + L

1078.17

1293.80

Dentures, complete, overdentures, tissue borne, with independent attachments secured to implants with or without coping crowns, maxillary + L

0.00

0.00

Dentures, complete, overdentures, tissue borne, with independent attachments secured to implants with or without coping crowns, mandibular + L

0.00

0.00

Dentures, complete, secured to teeth and implants, maxillary + L

0.00

0.00

Dentures, complete, secured to teeth and implants, mandibular + L

0.00

0.00

Dentures, complete, supported by implants, maxillary + L

0.00

0.00

Dentures, complete, supported by implants, mandibular + L

0.00

0.00

Dentures, complete, supported by teeth and implants, maxillary + L

0.00

0.00

Dentures, complete, supported by teeth and implants, mandibular + L

0.00

0.00

Dentures, partial, acrylic base (provisional) (with or without clasps), maxilliary + L

256.73

308.08

Dentures, partial, acrylic base (provisional) (with or without clasps), mandibular + L

256.73

308.08

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Dentures, partial, acrylic base (immediate) (includes first tissue conditioner, but not a processed reline) maxillary + L

256.73

308.08

Dentures, partial, acrylic base (immediate) (includes first tissue conditioner, but not a processed reline) mandibular + L

256.73

308.08

Dentures, partial, acrylic, resilient retainer, maxillary + L

256.73

308.08

Dentures, partial, acrylic, resilient retainer, mandibular + L

256.73

308.08

Dentures, partial, acrylic, resilient retainer, (immediate), (includes first tissue conditioner, but not a processed reline) maxillary + L

256.73

308.08

Dentures, partial, acrylic, resilient retainer, (immediate), (includes first tissue conditioner, but not a processed reline) mandibular + L

256.73

308.08

Dentures, partial, acrylic, with metal wrought/cast clasps and/or rests, maxillary + L

855.79

1026.95

Dentures, partial, acrylic, with metal wrought/cast clasps and/or rests, mandibular + L

855.79

1026.95

Dentures, partial, acrylic, with metal wrought/cast clasps and/or rests, (immediate) (includes first tissue conditioner, but not a processed reline) maxillary + L

855.79

1026.95

Dentures, partial, acrylic, with metal wrought/cast clasps and/or rests, (immediate), (includes first tissue conditioner, but not a processed reline) mandibular + L

855.79

1026.95

Dentures, partial, acrylic, with metal wrought palatal/lingual bar and clasps and/or rests, maxillary + L

855.79

1026.95

Dentures, partial, acrylic, with metal wrought palatal/lingual bar and clasps and/or rests, mandibular + L

855.79

1026.95

Dentures, partial, acrylic, with metal/ wrought palatal/lingual bar, clasps and/or rests, (immediate) (includes first tissue conditioner, but not a processed reline) (maxillary + L

855.79

1026.95

Dentures, partial, acrylic, with metal/ wrought palatal/lingual bar and clasps and/or rests, (immediate) (includes first tissue conditioner, but not a processed reline) mandibular + L

855.79

1026.95

Dentures, partial, (flexible, non metal, non acrylic) maxillary + L

256.73

308.08

Dentures, partial, (flexible, non metal, non acrylic) mandibular + L

256.73

308.08

Dentures, partial, (flexible, non metal, non acrylic) maxillary & mandibular + L

513.49

616.18

Overdentures, supported by teeth or implants, maxillary + L

1026.93

1232.32

Overdentures, supported by teeth or implants, mandibular + L

1026.93

1232.32

Dentures,partial,overdent,acrylic,wrought clasps,supported by implants, max. + L

1026.93

1232.32

Dentures,partial,overdenture,acrylic,wrought, supported by implants, mand.+ L

1026.93

1232.32

Dentures,partial,overdenture,acrylic,wrought, supported by teeth/implant max.+ L

1026.93

1232.32

Dentures,partial,overdenture,acrylic,wrought,supported by teeth/implant,mand.+ L

1026.93

1232.32

Dentures,partial,overdenture,acrylic, support by teeth, no attachments, max.+ L

1026.93

1232.32

Dentures,partial,overdenture,acrylic, support by teeth, no attachments, mand.+ L

1026.93

1232.32

Dentures,partial,ovrdentr,acrylic,wrought,support by implants,no attachms,max+ L

1026.93

1232.32

Dentures,partial,ovrdnture,acrylic,wrought,suppt by implant,no attachmts,man.+ L

1026.93

1232.32

Dentures,partial,ovrdent,acrylic,wrought,supprted by teeth & implants,max.+ L

1026.93

1232.32

Dentures,partial,ovrdent,acrylic,wrought,supprt by teeth & implants,man.+ L

1026.93

1232.32

Dentures,partial,ovrdent,acrylic,wrought,attachmt teeth/implants, max. + L

1026.93

1232.32

Dentures,partial,ovrdent,acrylic,wrought,clasp/rest,attachmt teeth/implant,man.+ L

1026.93

1232.32

Dentures,partial,ovrdent,acrylic,wrought,attachmt secured implants, max.+ L

1026.93

1232.32

Dentures,partial,ovrdent,acrylic,wrought,attachmt secured implants, man.+ L

1026.93

1232.32

Dentures,partial,ovrdent,acrylic,wrought,attachmt teeth/implants,max.+ L

1026.93

1232.32

Dentures,partial,ovrdent,acrylic,wrought,attachmt teeth/implants,man.+ L

1026.93

1232.32

Dentures,partial,ovrdentures, acrylic, with cast/wrought clasps and/or rests, with retentive bar, secured to coping crowns supported by natural teeth, maxillary + L

1026.93

1232.32

Dentures,partial,ovrdentures, acrylic, with cast/wrought clasps and/or rests, with retentive bar, secured to coping crowns supported by natural teeth, mandibular + L

1026.93

1232.32

Denture,partial,ovrdent,acryl,wrought,secured coping crown/implant,max.+ L

1026.93

1232.32

Denture,partial,ovrdent,acryl,wrought,secured coping crown/implant,man + L

1026.93

1232.32

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Denture,partial,ovrdent,acry,wrought,secured crown supprtd teeth/implant,max+ L

1026.93

1232.32

Denture,partial,ovrdent,acryl,wrought,secured crown supprtd teeth/implant,man+ L

1026.93

1232.32

Dentures, partial, free end, cast frame/connector, clasps and rests, maxillary + L

1077.86

1293.43

Dentures, partial, free end, cast frame/connector, clasps and rests, mandibular + L

1077.86

1293.43

Dentures, partial, free end, cast frame/connector, clasps and rests, altered cast impression technique in conjuncion with 53101, 53102 and 53103 + L

89.85

107.81

Dentures, partial, free end, cast frame/connector, clasps and rests, (immediate) (includes first tissue conditioner, but not a processed reline) maxillary + L

1077.86

1293.43

Dentures, partial, free end, cast frame/connector, clasps and rests, (immediate) (includes first tissue conditioner, but not a processed reline) mandibular + L

1077.86

1293.43

Dentures, partial, free end, swing lock/connector, maxillary + L

1129.07

1354.89

Dentures, partial free end, swing lock/connector, mandibular + L

1129.07

1354.89

Dentures, partial, free end, cast frame/connector, clasps + rests (equilibrated), maxillary + L

2164.65

2597.58

Dentures, partial, free end, cast frame/connector, clasps + rests (equilibrated), mandibular + L

2164.65

2597.58

Dentures, partial, tooth borne, cast frame/connector, clasps and rests, maxillary + L

1077.86

1293.43

Dentures, partial, tooth borne, cast frame/connector, clasps and rests, mandibular + L

1077.86

1293.43

Dentures, partial, tooth borne, unilateral, one piece casting, clasps and pontics + L

628.94

754.73

Dentures, partial, tooth borne, cast frame/connector, clasps and rests, (immediate), (includes first tissue conditioner, but not a processed reline) maxillary + L

1077.86

1293.43

Dentures, partial, tooth borne, cast frame/connector, clasps and rests, (immediate), mandibular + L

1077.86

1293.43

Dentures, partial, tooth borne, unilateral, one piece casting, clasps and pontics + L

628.94

754.73

Dentures, partial, tooth borne, cast frame/connector, clasps and rests, (equilibrated) maxillary + L

2164.65

2597.58

Dentures, partial, tooth borne, cast frame/connector, clasps and rests, (equilibrated) mandibular + L

2164.65

2597.58

Dentures, partial, cast, precision attachments, maxillary

0.00

0.00

Dentures, partial, cast, precision attachments, mandibular

0.00

0.00

Denture,partial,altered cast impress techniq in conjunction w/other codes

0.00

0.00

Dentures, partial, cast, semi-precision attachments, maxillary

0.00

0.00

Dentures, partial, cast, semi-precision attachments, mandibular

0.00

0.00

Denture,partial,altered cast impression techniq in conjunction w/other codes

0.00

0.00

Dentures, cast partial, stress breaker attachments, maxillary (resilient) + L

1077.86

1293.43

Dentures, cast partial, stress breaker attachments, maxillary (one hinge) + L

1077.86

1293.43

Dentures, cast partial, stress breaker attachments, maxillary (two hinges) + L

1077.86

1293.43

Denture,cast partial,altered cast impression techniq in conjunctn w/other codes

89.85

107.81

Dentures, cast partial, stress breaker attachments, mandibular (resilient) + L

898.46

1078.15

Dentures, cast partial, stress breaker attachments, mandibular (one hinge) + L

898.46

1078.15

Dentures, cast partial, stress breaker attachments, mandibular (two hinges) + L

898.46

1078.15

Denture,cast partial,altered cast impression techniq in conjunctn w/other codes

89.85

107.81

Dentures, partial, cast, overdenture, supported by natural teeth with or without coping crowns, no attachments, maxillary + L

898.46

1078.15

Dentures, partial, cast, overdenture, supported by natural teeth with or without coping crowns, no attachments, mandibular + L

898.46

1078.15

Denture,partial,cast,altered cast impression techniq in conjunctn w/other codes

89.85

107.81

Dentures,partial,casts,ovrdentures,supported by implants,no attach, max + L

898.46

1078.15

Dentures,partial,casts,ovrdenture,supported by implants,no attach, mand + L

898.46

1078.15

Denture,partial,cast,altered cast impression techniq in conjunctn w/other codes

89.85

107.81

Denture,partial,casts,ovrdenture,supported by teeth/implants,no attach, max + L

898.46

1078.15

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Denture,partial,casts,ovrdent,supported by teeth/implants,no attachment,man.+ L

898.46

1078.15

Denture,partial,ovrdent,altered cast impresson techniq conjunctn w/other codes

89.85

107.81

Dentures, partial,cast,ovrdenture,immed.Supp by natural teeth,no attach,max + L

898.46

1078.15

Dentures,partial,cast,ovrdenture,immed.,Supp by natural teeth,no attach,man + L

898.46

1078.15

Denture,partial,cast,ovrden,altered cast impressn techniq conjunct w/other code

89.85

107.81

Dentures,partial,cast,ovrdent,(immed) supported by implants, no attach, max + L

898.46

1078.15

Dentures,partial,cast,ovrdent,(immed.) Supported by implants,no attach, man + L

898.46

1078.15

Denture,partial,ovrdent,altered cast impressn techniq conjunction w/other codes

89.85

107.81

Dentures,partial,cast,ovrdent.,Supported by teeth/implants,no attach,max + L

898.46

1078.15

Dentures,partial,cast,ovrdent,(immed),support by teeth/implants,no attach,man+ L

898.46

1078.15

Denture,partial,ovrdent,altered cast impressn techniq conjunctn w/other codes

89.85

107.81

Denture,partial,cast,ovrdent,w/independ.Attachs secured to natural teeth,max.+ L

898.46

1078.15

Denture,partial,cast,ovrdent,independent attachmts secured to teeth, man+ L

898.46

1078.15

Denture,partial,altered cast impressn techniq conjunctn with 53911,53912,5313

89.85

107.81

Dentures,partial,cast,overdent,w/independent attachmts to implants, max+ L

898.46

1078.15

Dentures,partial,cast,overdent,w/independent attachmnt to implants, man + L

898.46

1078.15

Denture,partial,ovrdent,altered cast impressn techniq conjunction w/other codes

89.85

107.81

Denture,partial,cast,overdent,independent attachmts to teeth/implants,max + L

898.46

1078.15

Dentures,partial,cast,overdent,independent attachmts to teeth/implants,man + L

898.46

1078.15

Denture,partial,overdent,altered cast impression using 53931,53932,53933

89.85

107.81

Dentures,partial,cast,ovrdentures, with retention from a retentive bar, secured to coping crowns supported by natural teeth, maxillary + L

898.46

1078.15

Dentures,partial,cast,ovrdentures, with retention from a retentive bar, secured to coping crowns supported by natural teeth, mandibular + L

898.46

1078.15

Denture,partial,cast,ovrdent,retentive,attach to crown support by implant,max+ L

898.46

1078.15

Denture,partial,cast,ovrdent,retentive,attach to crown support by implant,man+ L

898.46

1078.15

Denture,partial,overdent,retentive,altered cast impress using 53951,53952,53953

89.85

107.81

Denture,partial,cast,ovrdent,retention,support by natural teeth/implants,max+ L

898.46

1078.15

Denture,partial,cast,ovrdent,retention,support by natural teeth/implant,man+ L

898.46

1078.15

Denture,partial,ovrdent,implants,altered cast impressn done w/53961,53962,53963

89.85

107.81

Denture adjustments, partial or complete denture, minor, one unit of time + L

81.32

97.58

Denture adjustments, partial or complete denture, minor, two units of time + L

162.61

195.13

Denture adjustments, partial or complete denture, minor, each additional unit over two

81.32

97.58

Denture adjustments, partial or complete, remount and occlusal equilibration, maxillary + L

718.77

862.52

Denture adjustments, partial or complete, remount and occlusal equilibration, mandibular + L

718.77

862.52

Denture adjustments, complete denture, cast metal occlusal surfaces, remount and occlusal equilibration, maxillary + L

718.77

862.52

Denture adjustments, complete denture, cast metal occlusal surfaces, remount and occlusal equilibration, mandibular + L

718.77

862.52

Denture adjustments, partial denture, cast metal occlusal surfaces, remount and occlusal equilbration, maxillary + L

718.77

862.52

Denture adjustments, partial denture, cast metal occlusal surfaces, remount and occlusal equilbration, mandibular + L

718.77

862.52

Denture, repairs, complete denture, no impression required, maxillary + L

85.57

102.69

Denture, repairs, complete denture, no impression required, mandibular + L

85.57

102.69

Denture, repairs, complete denture, impression required, maxillary + L

171.16

205.39

Denture, repairs, complete denture, impression required, mandibular + L

171.16

205.39

Denture, repairs/additions, partial denture, no impression required, maxillary + L

85.57

102.69

Denture, repairs/additions, partial denture, no impression required, mandibular + L

85.57

102.69

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Denture, repairs/additions, partial denture, impression required, maxillary + L

171.16

205.39

Denture, repairs/additions, partial denture, impression required, mandibular + L

171.16

205.39

Dentures/implant retained prosthesis, prophylaxis and polishing, one unit of time + L

81.32

97.58

Dentures/implant retained prosthesis, prophylaxis and polishing, each additional unit of time

81.32

97.58

Dentures, rebuilding, worn acrylic denture teeth (direct chairside) one unit of time

89.85

107.81

Dentures, rebuilding, worn acrylic denture teeth (direct chairside) each additional unit of time

89.85

107.81

Dentures, custom stained (pigmented) denture bases (direct chairside) one unit of time

89.85

107.81

Dentures, custom stained (pigmented) denture bases (direct chairside) each additional unit of time

89.85

107.81

Dentures, replication, complete denture, provisional (no intra-oral impression required) maxillary + L

171.16

205.39

Dentures, replication, complete denture, provisional (no intra-oral impression required) mandibular + L

171.16

205.39

Dentures, replication, partial denture, (provisional) (no intra-oral impression required) maxillary + L

171.16

205.39

Dentures, replication, partial denture, (provisional) (no intra-oral impression required) mandibular + L

171.16

205.39

Dentures, reline, (does not include remount – see 54000) direct, complete denture, maxillary

256.73

308.08

Dentures, reline, (does not include remount – see 54000) direct, complete denture, mandibular

256.73

308.08

Dentures, reline, direct, partial denture, maxillary

256.73

308.08

Dentures, reline, direct, partial denture, mandibular

256.73

308.08

Denture, reline, processed, complete denture, maxillary + L

256.73

308.08

Denture, reline, processed, complete denture, mandibular + L

256.73

308.08

Denture, reline, processed, partial denture, maxillary + L

256.73

308.08

Denture, reline, processed, partial denture, mandibular + L

256.73

308.08

Denture, reline, processed, functional impression requiring three appointments, complete denture, maxillary + L

427.88

513.45

Denture, reline, processed, functional impression requiring three appointments, complete denture, mandibular + L

427.88

513.45

Denture, reline, processed, functional impression requiring three appointments, partial denture, maxillary + L

427.88

513.45

Denture, reline, processed, functional impression requiring three appointments, partial denture, mandibular + L

427.88

513.45

Dentures, rebase, (where the vestibular tissue-contacting surfaces are modified) complete denture, maxillary + L

256.73

308.08

Dentures, rebase, (where the vestibular tissue-contacting surfaces are modified) complete denture, mandibular + L

256.73

308.08

Dentures, rebase partial denture, maxillary + L

256.73

308.08

Dentures, rebase partial denture, mandibular + L

256.73

308.08

Dentures, rebase, complete denture, processed, functional impression requiring three appointments, maxillary + L

427.88

513.45

Dentures, rebase, complete denture, processed, functional impression requiring three appointments, mandibular + L

427.88

513.45

Dentures, rebase, partial denture, processed, functional impression requiring three appointments, maxillary + L

427.88

513.45

Dentures, rebase, partial denture, processed, functional impression requiring three appointments, mandibular + L

427.88

513.45

Dentures, remake, using existing framework, partial denture, (equilibration) maxillary + L

513.49

616.18

Dentures, remake, using existing framework, partial denture, (equilibration) mandibular + L

513.49

616.18

Dentures, therapeutic tissue conditioning, per appointment, complete denture, maxillary

171.16

205.39

Dentures, therapeutic tissue conditioning, per appointment, complete denture, mandibular

171.16

205.39

Dentures, therapeutic tissue conditioning, per appointment, partial denture, maxillary

171.16

205.39

Dentures, therapeutic tissue conditioning, per appointment, partial denture, mandibular

171.16

205.39

Denture,tissue conditioning,per appoint,complete overdent,support by teeth,max

171.16

205.39

Denture,tissue conditioning,per appoint,complete overdent,support by teeth,mand

171.16

205.39

Dentures,tissue condition,/appointment,complete overdent,implant support,max

171.16

205.39

Dentures,tissue conditioning,/appointment,complete overdent,implant support,man

171.16

205.39

Denture,tissue condition,per appointment,partial overdent,support by teeth, max

171.16

205.39

Denture,tissue condition,per appointment,partial overdent,support by teeth,man

171.16

205.39

Denture,tissue condition,per appointment,partial overdent,implant support,max

171.16

205.39

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Denture,tissue condition,per appointment,partial overdent,implant support,man

171.16

205.39

Dentures, miscellaneous services, resilient liner in relined/rebased denture (in addition to reline or rebase of denture) + L

0.00

0.00

Dentures, miscellaneous services, resetting of teeth (not including reline or rebase of denture) + L

359.40

431.28

Dentures, miscellaneous services, cast occlusal surfaces (includes remount and equilibration) + L

718.77

862.52

Prosthesis, facial, orbital + L

5773.01

6927.61

Prosthesis, facial, nose + L

3925.63

4710.76

Prosthesis, facial, ear + L

3925.63

4710.76

Prosthesis, facial, patch + L

577.31

692.77

Prosthesis, facial, complex + L

4733.87

5680.65

Prosthesis, facial moulage impression, complete

376.46

451.75

Prosthesis, facial moulage impression, sectional

282.36

338.83

Prosthesis, facial, ocular conformer prosthesis (temporary post-surgical) + L

577.31

692.77

Prosthesis, facial, ocular prosthesis + L

3117.43

3740.92

Prosthesis, maxillofacial, obturator, cleft palate (prosthesis extra) + L

461.84

554.21

Prosthesis, maxillofacial, obturator, palatal, (prosthesis extra) + L

461.84

554.21

Prosthesis, maxillofacial, obturator, post-maxillectomy (prosthesis extra) + L

1154.60

1385.53

Prosthesis, maxillofacial, obturator, temporary palatal (prosthesis extra) + L

1154.60

1385.53

Prosthesis, maxillofacial, obturator, resilient (prosthesis extra) + L

1154.60

1385.53

Prosthesis, maxillofacial, obturator, hollow bulb (prosthesis extra) + L

1154.60

1385.53

Prosthesis, maxillofacial, obturator, inflatable (prosthesis extra) + L

1385.51

1662.62

Prosthesis, maxillofacial, obturator prosthesis, modification (relines or repairs) + L

808.22

969.87

Prosthesis, maxillofacial, obturator, speech aid prosthesis + L

1500.99

1801.19

Prosthesis, maxillofacial, velar bulb, (prosthesis and obturator extra) + L

1154.60

1385.53

Prosthesis, maxillofacial,velar lift button, mechanical, (prosthesis and obturator extra) + L

1154.60

1385.53

Prosthesis, maxillofacial, retention, spiral spring (prosthesis extra) + L

692.75

831.30

Prosthesis, maxillofacial, retention, magnetic, (prosthesis extra) + L

346.38

415.66

Prosthesis, maxillofacial, guide plan, condylar (prosthesis extra) + L

692.75

831.30

Prosthesis, maxillofacial, implant, silastic chin

0.00

0.00

Prosthesis, maxillofacial, mesh prosthesis, chrome-cobalt mandibular mesh

0.00

0.00

Prosthesis, maxillofacial, skull plate, customized

0.00

0.00

Prosthesis, maxillofacial, akerman, pseudotemporomandibular joint, (prosthesis extra)

0.00

0.00

Prosthesis, maxillofacial, feeding appliance (for infants with cleft palate) + L

1154.60

1385.53

Prosthesis, maxillofacial, lingual prosthesis + L

3463.81

4156.58

Prosthesis, maxillofacial, mandibular resection prosthesis with guide flange + L

1847.37

2216.85

Prosthesis, maxillofacial, mandibular resection prosthesis without guide flange + L

1385.51

1662.62

Prosthesis, maxillofacial, fixed

0.00

0.00

Prosthesis, maxillofacial, palatal augmentation prosthesis + L

1731.90

2078.28

Prosthesis, maxillofacial, palatal lift prosthesis, modification (relines or repairs) + L

808.22

969.87

Prosthesis, maxillofacial, gingival prosthesis + L note: for removable appliance used to mask unaesthetic embrasures see sub-classification 49300 soft tissue prosthesis, code 49301 gingival mask + L.

376.46

451.75

Prosthesis, tmj, exercisers, trismus, therapy + L

1385.51

1662.62

Prosthesis, tmj, splints, permanent cast occlusal + L

3463.81

4156.58

Prosthesis, splints, stout + L

1026.54

1231.85

Prosthesis, splints, cast capped + L

1437.16

1724.59

Prosthesis, splints, gunning (upper and lower) + L

1437.16

1724.59

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Prosthesis, splints, bar splint, cast, labial & lingual + L

1437.16

1724.59

Prosthesis, splints, scaffolding, rhinoplastic + L

1437.16

1724.59

Prosthesis, splints, cast, adjustable + L

1437.16

1724.59

Prosthesis, template, surgical + L

0.00

0.00

Prosthesis, splints, commissure splint + L

1500.99

1801.19

Prosthesis, stents, ridge extension + L

1026.54

1231.85

Prosthesis, stents, palatal + L

1026.54

1231.85

Prosthesis, stents, skin grafts + L

1026.54

1231.85

Prosthesis, stents, mucous membrane grafts + L

1026.54

1231.85

Prosthesis, radiation appliances, radiation vehicle carrier + L

3079.62

3695.55

Prosthesis, radiation appliances, radiation protection shield (extra-oral) + L

1026.54

1231.85

Prosthesis, radiation appliances, radiation protection shield (intra oral) + L

1026.54

1231.85

Prosthesis, radiation appliances, radiation cone locator + L

1847.37

2216.85

Prosthesis, stents, decompression stent, localized + L

1026.54

1231.85

Prosthesis, decompression stent, (prosthesis extra) + L

615.92

739.10

Prosthesis, orthopedic, extraoral + L

1154.60

1385.53

Prosthesis, orthopedic, intraoral + L

1385.51

1662.62

Pontics, bridge, cast metal + L

520.56

624.67

Pontics, cast metal framework with separate porcelain/ceramic/polymer glass jacket pontic + L

520.56

624.67

Pontics, prefabricated attachable facing + L

404.87

485.84

Pontics, retentive bar, pre-fabricated or custom (dolder or hader) bar attached to retainer + L

520.56

624.67

Pontics,cast metal,retentive bar,prefab,attach implant support retainer + L + E

520.56

624.67

Pontics, porcelain/ceramic/polymer glass, fused to metal + L

520.56

624.67

Pontics, porcelain/ceramic/polymer glass, aluminous + L

520.56

624.67

Pontics, acrylic/composite/compomer, processed to metal + L

404.87

485.84

Pontics, acrylic/composite/compomer, indirect (provisional) + L

110.88

133.05

Pontics, acrylic/composite/compomer, bonded to adjacent teeth direct (provisional)

110.88

133.05

Pontics, acrylic/composite/compomer, + L

110.87

133.05

Pontics, natural tooth crown, direct, bonded to adjacent teeth (provisional)

202.50

243.00

Recontouring of retainer/pontics, (of existing bridgework) one unit of time

101.23

121.48

Recontouring of retainer/pontics, (of existing bridgework) each additional unit of time

101.23

121.48

Master cast, true hinge axis reg.And trans. (One unit of time) + L

91.64

109.97

Master cast, true hinge axis reg.And trans. (Each additional unit of time) + L

91.64

109.97

Master cast, centric registration recording (one unit of time) + L

91.64

109.97

Master cast,centric registration recording (each additional unit of time)+ L

91.64

109.97

Master cast,3 dimensional recording of mandibular movement (1 unit of time)+ L

0.00

0.00

Master cast,3 dimensional of mandibular movement (each addit unit of time) + L

0.00

0.00

Master cast mounting with arbitrary facebow transfer (1 unit of time) + L

91.64

109.97

Master cast mounting w/arbitrary facebow transfer (each addit. Unit/time)+ L

91.64

109.97

Master cast mounting w/kinematic facebow trans. (1 Unit of time) l

0.00

0.00

Master cast mounting w/kinematic facebow trans. (Each addit. Unit of time) + L

0.00

0.00

Master cast mounting with kinematic facebow transfer + L

0.00

0.00

Master cast gnathological wax-up (each additional unit of time) + L

0.00

0.00

Repairs, replacement, replace broken prefabricated attachable facings, one unit of time + L

101.23

121.48

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Repairs, replacement, replace broken prefabricated attachable facings, two units + L

202.50

243.00

Repairs, replacement, replace broken prefabricated attachable facings, three units + L

303.73

364.48

Repairs,replacement broken prefab attach facings – 4 units + L

404.99

485.98

Repairs, replacement, replace broken prefabricated attachable facings, each additional unit over four

101.23

121.48

Repairs, removal, existing fixed bridge/prosthesis – to be recemented, one unit of time + L

110.88

133.05

Repairs, removal, fixed bridge/prosthesis – to be recemented, two units + L

221.72

266.06

Repairs, removal, fixed bridge/prosthesis – to be recemented, three units + L

332.59

399.11

Repairs,removal,fixed bridge – to be recemented, four units + L

443.47

532.17

Repairs, removal, fixed bridge/prosthesis – to be recemented, each additional unit over four + L

110.88

133.05

Repairs,removal fixed bridge/prosthesis, replace w/new prosthesis (1 unit time)

101.23

121.48

Repairs,removal fixed bridge/prosthesis,replace w/new prosthesis (2 units time)

202.50

243.00

Repairs,removal fixed bridge/prosthesis,replace w/new prosthesis (3 units time)

303.73

364.48

Repairs,removal fixed bridge/prosthesis,replace w/new prosthesis (4 units time)

404.99

485.98

Repairs,removal fixed bridge/prosthesis,replace w/new prosthesi,each add unit >4

101.23

121.48

Repairs, reinsertion/recementation (+ Lwhere laboratory charges are incurred during repair of bridge, one unit of time

101.23

121.48

Repairs, reinsertion/recementation, (+ Lwhere laboratory charges are incurred during repair of bridge, two units

202.50

243.00

Repairs, reinsertion/recementation (+ Lwhere laboratory charges are incurred during repair of bridge, three units

303.73

364.48

Repairs, reinsertion/recementation (4 units of time) + L

404.99

485.98

Repairs, reinsertion/recementation (+ Lwhere laboratory charges are incurred during repair of bridge) each additional unit over four

101.23

121.48

Repairs, fixed bridge/prosthesis, porcelain/ceramic/polymer glass/acrylic/composite/compomer, direct, first tooth

212.11

254.53

Repairs, fixed bridge/prosthesis, porcelain/ceramic/polymer glass/acrylic/composite/compomer, direct, each additional tooth

212.11

254.53

Repairs, fixed bridge/prosthesis, solder indexing to repair broken solder joint, one unit of time + L

101.23

121.48

Repairs, fixed bridge/prosthesis, solder indexing to repair broken solder joint, each additional unit of time

101.23

121.48

Repairs, fixed bridge, repair fractured porcelain/metal pontic with telescoping type crown, first pontic + L

520.56

624.67

Repairs, fixed bridge, repair fractured porcelain/metal pontic with telescoping type crown, each additional pontic + L

520.56

624.67

Retainers, acrylic composite/compomer, indirect + L

776.09

931.30

Retainers, acrylic composite/compomer, complicated, indirect + L

996.33

1195.59

Retainers, acrylic, composite/compomer, provisional, indirect + L

332.57

399.09

Retainers, acrylic, composite/compomer, implant supported, indirect + L

776.07

931.28

Retainers, acrylic, composite/compomer, direct (provisional during healing, done at chairside) + E

221.72

266.06

Retainers,acrylic,composite,provisional during healing,implant support,direct + E

221.72

266.06

Retainers, compomer/composite resin/acrylic, processed to cast metal, indirect + L

809.76

971.71

Retainer, compomer/composite resin/acrylic, processed to metal, indirect, implant-supported + L+ E

809.20

971.03

Retainers,acrylic/composite/compomer, 2 surface inlay, bonded, indirect + L

751.92

902.31

Retainers,acrylic/composite/compomer, 3 surface inlay, bonded, indirect + L

925.41

1110.49

Retainers,acrylic/composite/compomer, 2 surface onlay, bonded, indirect + L

1134.10

1360.92

Retainer, porcelain/ceramic/polymer glass + L

1041.12

1249.34

Retainer, porcelain/ceramic/polymer glass, complicated + L

1272.50

1527.00

Retainer,porcelain/ceramic/polymer glass, implant supported + L

1134.10

1360.92

Retainers, porcelain/ceramic/polymer glass, fused to metal base + L

1041.12

1249.34

Retainers, porcelain/ceramic/polymer glass, fused to metal base, complicated + L

1388.15

1665.78

Retainers,porcelain/ceramic/polymer glass fused to metal base,implant support+ L + E

1134.10

1360.92

Retainers, porcelain/ceramic/polymer glass, partial coverage, bonded (external retention) + L

694.07

832.88

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Retainers, porcelain/ceramic/polymer glass, two surface inlay,bonded + L

751.92

902.31

Retainers,porcelain/ceramic/polymer glass. Three surface inlay, bonded + L

925.41

1110.49

Retainers, porcelain/ceramic/polymer glass, onlay, bonded + L

1098.98

1318.77

Retainers, cast metal + L

1041.12

1249.34

Retainers, cast metal, complicated + L

1272.50

1527.00

Retainers,cast metal implant supported + L+ E

1134.10

1360.92

Retainers, 3/4, cast metal + L

1041.12

1249.34

Retainers, 3/4, cast metal, complicated + L

0.00

0.00

Retainers, cast metal inlay, (used with broken stress technique) two surfaces + L

694.07

832.88

Retainer, cast metal inlay, three or more surfaces + L

867.59

1041.11

Retainers, cast metal onlay (internal retention type) + L

1041.12

1249.34

Retainer, cast metal, onlay, with or without perforations, bonded to abutment tooth, (pontic extra) + L

578.38

694.05

Retainer, metal, prefabricated or custom cast, implant-supported, with or without mesostructure with no occlusal component (see 62105 for retentive bar) + L+ E

0.00

0.00

Fixed prosthetics, abutments/retainers, abutment preparation under existing partial denture clasp, in addition to retainer codes + L

91.62

109.95

Fixed prosthetics, abutments/retainers, telescoping crown unit + L

405.01

486.01

Fixed prosthetics, porcelain, to replace a substantial portion of the alveolar process (in addition to retainer and pontics) + L

1233.30

1479.96

Fixed prosthetics, splinting, for extensive or complicated restorative dentistry (per tooth)

0.00

0.00

Fixed prosthetics, retentive pins, one pin/restoration + L

53.99

64.79

Fixed prosthetics, retentive pins, two pins/restoration + L

107.97

129.56

Fixed prosthetics, retentive pins, three pins/restoration + L

160.89

193.07

Fixed prosthetics, retentive pins, four pins/restoration + L

200.58

240.70

Fixed prosthetics, retentive pins, five pins or more/restoration + L

231.44

277.73

Fixed prosthetics, provisional coverage, abutment tooth + L

332.59

399.11

Prosthesis, radiation appliances, radiation protection shield (extra-oral) + L

1026.54

1231.85

Prosthesis, radiation appliances, radiation protection shield (intra oral) + L

1026.54

1231.85

Prosthesis, radiation appliances, radiation cone locator + L

1847.37

2216.85

Prosthesis, stents, decompression stent, localized + L

1026.54

1231.85

Prosthesis, decompression stent, (prosthesis extra) + L

615.92

739.10

Prosthesis, orthopedic, extraoral + L

1154.60

1385.53

Prosthesis, orthopedic, intraoral + L

1385.51

1662.62

Pontics, bridge, cast metal + L

520.56

624.67

Pontics, cast metal framework with separate porcelain/ceramic/polymer glass jacket pontic + L

520.56

624.67

Pontics, prefabricated attachable facing + L

404.87

485.84

Pontics, retentive bar, pre-fabricated or custom (dolder or hader) bar attached to retainer + L

520.56

624.67

Pontics,cast metal,retentive bar,prefab,attach implant support retainer + L + E

520.56

624.67

Pontics, porcelain/ceramic/polymer glass, fused to metal + L

520.56

624.67

Pontics, porcelain/ceramic/polymer glass, aluminous + L

520.56

624.67

Pontics, acrylic/composite/compomer, processed to metal + L

404.87

485.84

Pontics, acrylic/composite/compomer, indirect (provisional) + L

110.88

133.05

Pontics, acrylic/composite/compomer, bonded to adjacent teeth direct (provisional)

110.88

133.05

Pontics, acrylic/composite/compomer, + L

110.87

133.05

Pontics, natural tooth crown, direct, bonded to adjacent teeth (provisional)

202.50

243.00

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Recontouring of retainer/pontics, (of existing bridgework) one unit of time

101.23

121.48

Recontouring of retainer/pontics, (of existing bridgework) each additional unit of time

101.23

121.48

Master cast, true hinge axis reg.And trans. (One unit of time) + L

91.64

109.97

Master cast, true hinge axis reg.And trans. (Each additional unit of time) + L

91.64

109.97

Master cast, centric registration recording (one unit of time) + L

91.64

109.97

Master cast,centric registration recording (each additional unit of time)+ L

91.64

109.97

Master cast,3 dimensional recording of mandibular movement (1 unit of time)+ L

0.00

0.00

Master cast,3 dimensional of mandibular movement (each addit unit of time) + L

0.00

0.00

Master cast mounting with arbitrary facebow transfer (1 unit of time) + L

91.64

109.97

Master cast mounting w/arbitrary facebow transfer (each addit. Unit/time)+ L

91.64

109.97

Master cast mounting w/kinematic facebow trans. (1 Unit of time) l

0.00

0.00

Master cast mounting w/kinematic facebow trans. (Each addit. Unit of time) + L

0.00

0.00

Master cast mounting with kinematic facebow transfer + L

0.00

0.00

Master cast gnathological wax-up (each additional unit of time) + L

0.00

0.00

Repairs, replacement, replace broken prefabricated attachable facings, one unit of time + L

101.23

121.48

Repairs, replacement, replace broken prefabricated attachable facings, two units + L

202.50

243.00

Repairs, replacement, replace broken prefabricated attachable facings, three units + L

303.73

364.48

Repairs,replacement broken prefab attach facings – 4 units + L

404.99

485.98

Repairs, replacement, replace broken prefabricated attachable facings, each additional unit over four

101.23

121.48

Repairs, removal, existing fixed bridge/prosthesis – to be recemented, one unit of time + L

110.88

133.05

Repairs, removal, fixed bridge/prosthesis – to be recemented, two units + L

221.72

266.06

Repairs, removal, fixed bridge/prosthesis – to be recemented, three units + L

332.59

399.11

Repairs,removal,fixed bridge – to be recemented, four units + L

443.47

532.17

Repairs, removal, fixed bridge/prosthesis – to be recemented, each additional unit over four + L

110.88

133.05

Repairs,removal fixed bridge/prosthesis, replace w/new prosthesis (1 unit time)

101.23

121.48

Repairs,removal fixed bridge/prosthesis,replace w/new prosthesis (2 units time)

202.50

243.00

Repairs,removal fixed bridge/prosthesis,replace w/new prosthesis (3 units time)

303.73

364.48

Repairs,removal fixed bridge/prosthesis,replace w/new prosthesis (4 units time)

404.99

485.98

Repairs,removal fixed bridge/prosthesis,replace w/new prosthesi,each add unit >4

101.23

121.48

Repairs, reinsertion/recementation (+ Lwhere laboratory charges are incurred during repair of bridge, one unit of time

101.23

121.48

Repairs, reinsertion/recementation, (+ Lwhere laboratory charges are incurred during repair of bridge, two units

202.50

243.00

Repairs, reinsertion/recementation (+ Lwhere laboratory charges are incurred during repair of bridge, three units

303.73

364.48

Repairs, reinsertion/recementation (4 units of time) + L

404.99

485.98

Repairs, reinsertion/recementation (+ Lwhere laboratory charges are incurred during repair of bridge) each additional unit over four

101.23

121.48

Repairs, fixed bridge/prosthesis, porcelain/ceramic/polymer glass/acrylic/composite/compomer, direct, first tooth

212.11

254.53

Repairs, fixed bridge/prosthesis, porcelain/ceramic/polymer glass/acrylic/composite/compomer, direct, each additional tooth

212.11

254.53

Repairs, fixed bridge/prosthesis, solder indexing to repair broken solder joint, one unit of time + L

101.23

121.48

Repairs, fixed bridge/prosthesis, solder indexing to repair broken solder joint, each additional unit of time

101.23

121.48

Repairs, fixed bridge, repair fractured porcelain/metal pontic with telescoping type crown, first pontic + L

520.56

624.67

Repairs, fixed bridge, repair fractured porcelain/metal pontic with telescoping type crown, each additional pontic + L

520.56

624.67

Retainers, acrylic composite/compomer, indirect + L

776.09

931.30

Retainers, acrylic composite/compomer, complicated, indirect + L

996.33

1195.59

Retainers, acrylic, composite/compomer, provisional, indirect + L

332.57

399.09

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Retainers, acrylic, composite/compomer, implant supported, indirect + L

776.07

931.28

Retainers, acrylic, composite/compomer, direct (provisional during healing, done at chairside) + E

221.72

266.06

Retainers,acrylic,composite,provisional during healing,implant support,direct + E

221.72

266.06

Retainers, compomer/composite resin/acrylic, processed to cast metal, indirect + L

809.76

971.71

Retainer, compomer/composite resin/acrylic, processed to metal, indirect, implant-supported + L+ E

809.20

971.03

Retainers,acrylic/composite/compomer, 2 surface inlay, bonded, indirect + L

751.92

902.31

Retainers,acrylic/composite/compomer, 3 surface inlay, bonded, indirect + L

925.41

1110.49

Retainers,acrylic/composite/compomer, 2 surface onlay, bonded, indirect + L

1134.10

1360.92

Retainer, porcelain/ceramic/polymer glass + L

1041.12

1249.34

Retainer, porcelain/ceramic/polymer glass, complicated + L

1272.50

1527.00

Retainer,porcelain/ceramic/polymer glass, implant supported + L

1134.10

1360.92

Retainers, porcelain/ceramic/polymer glass, fused to metal base + L

1041.12

1249.34

Retainers, porcelain/ceramic/polymer glass, fused to metal base, complicated + L

1388.15

1665.78

Retainers,porcelain/ceramic/polymer glass fused to metal base,implant support+ L + E

1134.10

1360.92

Retainers, porcelain/ceramic/polymer glass, partial coverage, bonded (external retention) + L

694.07

832.88

Retainers, porcelain/ceramic/polymer glass, two surface inlay,bonded + L

751.92

902.31

Retainers,porcelain/ceramic/polymer glass. Three surface inlay, bonded + L

925.41

1110.49

Retainers, porcelain/ceramic/polymer glass, onlay, bonded + L

1098.98

1318.77

Retainers, cast metal + L

1041.12

1249.34

Retainers, cast metal, complicated + L

1272.50

1527.00

Retainers,cast metal implant supported + L+ E

1134.10

1360.92

Retainers, 3/4, cast metal + L

1041.12

1249.34

Retainers, 3/4, cast metal, complicated + L

0.00

0.00

Retainers, cast metal inlay, (used with broken stress technique) two surfaces + L

694.07

832.88

Retainer, cast metal inlay, three or more surfaces + L

867.59

1041.11

Retainers, cast metal onlay (internal retention type) + L

1041.12

1249.34

Retainer, cast metal, onlay, with or without perforations, bonded to abutment tooth, (pontic extra) + L

578.38

694.05

Retainer, metal, prefabricated or custom cast, implant-supported, with or without mesostructure with no occlusal component (see 62105 for retentive bar) + L+ E

0.00

0.00

Fixed prosthetics, abutments/retainers, abutment preparation under existing partial denture clasp, in addition to retainer codes + L

91.62

109.95

Fixed prosthetics, abutments/retainers, telescoping crown unit + L

405.01

486.01

Fixed prosthetics, porcelain, to replace a substantial portion of the alveolar process (in addition to retainer and pontics) + L

1233.30

1479.96

Fixed prosthetics, splinting, for extensive or complicated restorative dentistry (per tooth)

0.00

0.00

Fixed prosthetics, retentive pins, one pin/restoration + L

53.99

64.79

Fixed prosthetics, retentive pins, two pins/restoration + L

107.97

129.56

Fixed prosthetics, retentive pins, three pins/restoration + L

160.89

193.07

Fixed prosthetics, retentive pins, four pins/restoration + L

200.58

240.70

Fixed prosthetics, retentive pins, five pins or more/restoration + L

231.44

277.73

Fixed prosthetics, provisional coverage, abutment tooth + L

332.59

399.11

Surgical incision and drainage and/or exploration, intraoral, abscess, soft tissue

242.83

291.39

Surgical incision and drainage and/or exploration, intraoral, abscess, in major anatomical area with drain

413.82

496.58

Surgical incision, intraoral, abscess, hard tissue, trephination and drainage

253.83

304.60

Surgical incision, intraoral, surgical exploration, hard tissue

397.30

476.76

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Surgical incision, intraoral, abscess, hard tissue, trephination and drainage in a major anatomical area

551.75

662.10

Surgical incision and drainage, extraoral, abscess, superficial

573.79

688.54

Surgical incision and drainage, extraoral, abscess, deep

717.23

860.68

Surgical incision and drainage, extraoral, surgical exploration, hard tissue

573.79

688.54

Surgical incision for removal of foreign bodies, removal, from skin or subcutaneous alveolar tissue

1544.61

1853.54

Surgical incision for removal of foreign bodies, removal, of reaction producing foreign bodies

1544.61

1853.54

Surgical incision for removal of foreign bodies, removal, of needle from musculoskeletal system

1544.61

1853.54

Sequestrectomy (for osteomyelitis) , intraoral

529.74

635.69

Sequestrectomy (for osteomyelitis) saucerization

926.76

1112.11

Sequestrectomy (for osteomyelitis) osteomyelitis, non-surgical treatment of

198.63

238.35

Sequestrectomy, extraoral sequestrectomy, 3 cm and less

529.74

635.69

Sequestrectomy, extraoral sequestrectomy 3-4 cm

662.14

794.57

Sequestrectomy, extraoral sequestrectomy, 4-6 cm

827.62

993.14

Sequestrectomy, extraoral sequestrectomy, 6-9 cm

965.57

1158.69

Sequestrectomy, extraoral sequestrectomy, 9 cm and over

1147.57

1377.09

Mandibulectomy 3 cm or less

463.40

556.08

Mandibulectomy 3-4 cm

617.83

741.40

Mandibulectomy 4-6 cm

799.83

959.80

Mandibulectomy 6-9 cm

992.86

1191.43

Mandibulectomy 9-12 cm

1196.87

1436.25

Mandibulectomy 12-15 cm

1411.92

1694.30

Mandibulectomy 15 cm and over

1588.40

1906.08

Mandibulectomy, total mandibulectomy

2514.99

3017.99

Maxillectomy 3 cm or less

772.31

926.77

Maxillectomy 3-4 cm

926.76

1112.11

Maxillectomy 4-6 cm

1119.79

1343.75

Maxillectomy 6-9 cm

1323.80

1588.56

Maxillectomy 9-12 cm

1538.84

1846.61

Maxillectomy 12-15 cm

1764.89

2117.87

Maxillectomy 15 cm and over

2029.64

2435.57

Maxillectomy, total maxillectomy

3000.32

3600.38

Fractures, treatment of, fixation (wiring), wiring of dentures or arch bar

397.30

476.76

Fractures, treatment of, fixation (wiring), acrylic prosthesis or cap splint

397.30

476.76

Fractures, treatment of, fixation (wiring), circumzygomatic wiring, unilateral

132.44

158.93

Fractures, treatment of, fixation (wiring), perialveolar or transpalatal wiring

132.44

158.93

Fractures, treatment of, fixation (wiring), intra or periosseous splinting for pericranial suspension

132.44

158.93

Fractures, treatment of, fixation (wiring), intermaxillary fixation

397.30

476.76

Intra maxillary suspension (wiring), nasal spine wiring

132.44

158.93

Intra maxillary suspension (wiring), piriform apertures suspension

132.44

158.93

Intra maxillary suspension, frontal suspension

573.79

688.54

Intra maxillary suspension, orbital rim suspension, bilateral

573.79

688.54

Intra maxillary suspension, head frame suspension

926.76

1112.11

Circummandibular wiring, one

132.44

158.93

Circummandibular wiring, two

264.88

317.86

Circummandibular wiring, three or over

397.30

476.76

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Splints/wires, removal of wire

220.81

264.98

Splints/wires, removal of arch splint (one or more per jaw)

220.81

264.98

Splints/wires, removal of interosseous ligature or bone plate

529.74

635.69

Splints/wires, removal of intra or periosseous rod or wire for pericranial suspension and/or pericranial apparatus

529.74

635.69

Splints/wires, removal of acrylic prosthesis or cap splint, attached to maxilla or to teeth (one or more per jaw)

413.82

496.58

Splints/wires, removal of wire plate or screw used in osteosynthesis (one or more at the same site)

529.74

635.69

Fractures, reduction, mandibular, closed

1324.32

1589.18

Fractures, reduction, mandibular, open, single

1544.61

1853.54

Fractures, reduction, mandibular, open, double

1853.52

2224.22

Fractures, reduction, mandibular, open, multiple

2051.78

2462.14

Fractures, reductions, maxillary, horizontal le fort's i, reduction, maxillary closed

1059.46

1271.35

Fractures, reductions, maxillary, horizontal le fort's i, reduction, maxillary, open, single

1544.61

1853.54

Fractures, reductions, maxillary, horizontal le fort's i, reduction, maxillary, open, double

1853.52

2224.22

Fractures, reductions, maxillary, horizontal le fort's i, reduction, maxillary, open, multiple

2823.83

3388.60

Fractures, reductions, maxillary, horizontal le fort's i, reduction, compound fracture of maxilla (requiring reduction and soft tissue repair)

3750.42

4500.50

Fractures, reductions, maxilla, pyramidal le fort's ii, reduction, maxillary, closed

1235.69

1482.82

Fractures, reductions, maxilla, pyramidal le fort's ii, reduction, maxillary, open, unilateral

1235.69

1482.82

Fractures, reductions, maxilla, pyramidal le fort's ii, reduction, maxillary, open, bilateral

1853.52

2224.22

Fractures, reductions, naso-orbital, reduction, closed unilateral

959.80

1151.76

Fractures, reductions, naso-orbital, reduction, closed bilateral

1919.62

2303.55

Fractures, reductions, naso-orbital, open, external approach

1709.84

2051.80

Fractures, reductions, naso-orbital, open, sinusal approach

1709.84

2051.80

Fractures, reductions, naso-orbital, open, orbital approach with insertion of subperiosteal implant

1880.81

2256.97

Fractures, reductions, naso-orbital, exploration, of orbital blowout fracture

1235.69

1482.82

Fractures, reductions, naso-orbital, exploration, of orbital blowout fracture and reconstruction with insertion of a subperiosteal implant

2051.78

2462.14

Fractures, reduction, malar bone

529.74

635.69

Fractures, reduction, malar bone, open, by simple elevation

794.58

953.49

Fractures, reduction, malar bone, open, by osteosynthesis

1411.92

1694.30

Fractures, reduction, malar bone, open, by sinus approach

1158.34

1390.01

Fractures, reduction, malar bone, simple fracture, (open reduction with antrostomy and packing)

1158.34

1390.01

Fractures, reduction, zygomatic arch, intraoral approach

529.74

635.69

Fractures, reduction, zygomatic arch, temporal approach

1235.69

1482.82

Fractures, reduction, zygomatico-maxillary fracture dislocation, complex, closed reduction

794.58

953.49

Reduction, zygomatico-maxillary fracture dislocation, open reduction

1544.61

1853.54

Fractures, reductions, craniofacial disjunction, le fort's iii transverse, reduction, craniofacial, disjunction, closed

2117.88

2541.46

Fractures, reduction, craniofacial disjunction, le fort's iii transverse, reduction, craniofacial disjunction, open

3000.32

3600.38

Fractures, reductions, alveolar, debridement, teeth removed, 3 cm or less

1324.32

1589.18

Fractures, reductions, alveolar, debridement, teeth removed, 3-6 cm

1324.32

1589.18

Fractures, reductions, alveolar, debridement, teeth removed, 6 cm and over

1379.41

1655.30

Reduction, alveolar, closed, with teeth, 3 cm or less + E

1324.32

1589.18

Reduction, alveolar, closed, with teeth 3 – 6 cm + E

1324.32

1589.18

Reduction, alveolar, closed, with teeth 6-9 cm + E

1379.41

1655.30

Reduction, alveolar, closed, with teeth, 9 cm and over + E

1379.41

1655.30

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Reduction, alveolar, open, with teeth 3 cm or less + E

1324.32

1589.18

Reduction, alveolar, open, with teeth 3-6 cm + E

1324.32

1589.18

Reduction, alveolar, open, with teeth, 6-9 cm + E

1379.41

1655.30

Reduction, alveolar, open, with teeth, 9 cm and over + E

1434.47

1721.36

Fractures, replantation, avulsed tooth/teeth (including splinting) first tooth

413.82

496.58

Replantation, avulsed tooth/teeth (including splinting), each additional tooth

413.82

496.58

Repositioning of traumatically displaced teeth, one unit of time

126.93

152.31

Repositioning of traumatically displaced teeth, two units of time

264.88

317.86

Repositioning of traumatically displaced teeth, each additional unit over 2

126.93

152.31

Repairs, lacerations, uncomplicated, intraoral or extraoral, 2 cm or less

264.88

317.86

Repairs, lacerations, uncomplicated, intraoral or extraoral, 2-4 cm

297.96

357.56

Repairs, lacerations, uncomplicated, intraoral or extraoral, 4-6 cm

331.07

397.28

Repairs, lacerations, uncomplicated, intraoral or extraoral, 6-9 cm

364.17

437.01

Repairs, lacerations, uncomplicated, intraoral or extraoral, 9-12 cm

413.82

496.58

Repairs, lacerations, uncomplicated, intraoral or extraoral, 12-16 cm

448.30

537.96

Repairs, lacerations, uncomplicated, intraoral or extraoral, 16-20 cm

482.79

579.34

Repairs, lacerations, uncomplicated, intraoral or extraoral, 20-25 cm

537.92

645.51

Repairs, lacerations, uncomplicated, intraoral or extraoral, 25 cm and over

573.79

688.54

Repairs, lacerations, through and through, 2 cm or less

286.87

344.25

Repairs, lacerations, through and through, 2-4 cm

322.75

387.31

Repairs, lacerations, through and through, 4-6 cm

358.62

430.34

Repairs, lacerations, through and through, 6-9 cm

394.48

473.37

Repairs, lacerations, through and through, 9-12 cm

446.86

536.23

Repairs, lacerations, through and through, 12-16 cm

484.10

580.92

Repairs, lacerations, through and through, 16-20 cm

521.34

625.61

Repairs, lacerations, through and through, 20-25 cm

579.24

695.08

Repairs, lacerations, through and through, 25 cm and over

617.83

741.40

Repairs, lacerations, complicated (local tissue shifts), 2 cm or less

308.93

370.71

Repairs, lacerations, complicated (local tissue shifts), 2-4 cm

347.52

417.03

Repairs, lacerations, complicated (local tissue shifts), 4-6 cm

386.16

463.40

Repairs, lacerations, complicated (local tissue shifts), 6-9 cm

424.76

509.71

Repairs, lacerations, complicated (local tissue shifts), 9-12 cm

479.90

575.88

Repairs, lacerations, complicated (local tissue shifts), 12-16 cm

519.90

623.88

Repairs, lacerations, complicated (local tissue shifts), 16-20 cm

559.87

671.85

Repairs, lacerations, complicated (local tissue shifts), 20-25 cm

620.53

744.63

Repairs, lacerations, complicated (local tissue shifts), 25 cm and over

661.90

794.28

Maxillofacial deformities, osteotomy/ostectomy, ramus of the mandible – osteotomy, subcondylar, closed

4721.07

5665.29

Maxillofacial deformities, osteotomy, subcondylar, open

4721.07

5665.29

Maxillofacial deformities, osteotomy, ramus of the mandible, oblique, extraoral

4721.07

5665.29

Maxillofacial deformities, osteotomy, ramus of the mandible, oblique, intraoral

4721.07

5665.29

Maxillofacial deformities, osteotomy/ostectomy, body of the mandible

4721.07

5665.29

Maxillofacial deformities, osteotomy, coronoidectomy

2250.24

2700.29

Maxillofacial deformities, osteotomy, condylar neck

2250.24

2700.29

Maxillofacial deformities, osteotomy, sagittal split

4721.07

5665.29

Osteotomy, miscellaneous, osteotomy, oblique with bone graft

4412.26

5294.71

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Osteotomy, miscellaneous, osteotomy, inverted 'l'

4412.26

5294.71

Osteotomy, miscellaneous, osteotomy, 'c'

4412.26

5294.71

Osteotomy, miscellaneous, osteotomy of the ramus of the mandible for distraction osteogenesis – unilateral

4412.26

5294.71

Osteotomy, miscellaneous, osteotomy of the ramus of the mandible for distraction osteogenesis – bilateral

4412.26

5294.71

Osteotomy, miscellaneous, activation of distraction device – unilateral

4412.26

5294.71

Osteotomy, miscellaneous, activation of distraction device – bilateral

4412.26

5294.71

Osteotomy, miscellaneous, removal of distraction device – unilateral

4412.26

5294.71

Osteotomy, miscellaneous, removal of distraction device – bilateral

4412.26

5294.71

Osteotomy, maxillary, leforte i

4721.07

5665.29

Osteotomy, maxillary, leforte ii

4985.85

5983.02

Osteotomy, maxillary, leforte iii

5956.50

7147.80

Osteotomy, maxillary, additional to the above osteotomy requiring two segments

617.73

741.27

Osteotomy, maxillary, additional to the above osteotomy requiring three segments

794.21

953.05

Osteotomy, maxillary, additional to the above osteotomy requiring four segments

1014.81

1217.77

Osteotomy, maxillary, additional to the above osteotomy requiring a cranial flap

794.21

953.05

Osteotomy, maxillary, closure of cleft fistula (alveolar)

750.08

900.10

Osteotomy, maxillary, closure of cleft fistula (palatal)

750.08

900.10

Osteotomy, maxillary, pharyngoplasty

1191.30

1429.56

Osteotomy, maxillary, submucous resection

750.08

900.10

Osteotomy, maxillary, leforte i – for distraction osteogenesis

0.00

0.00

Osteotomy, maxillary, leforte ii – for distraction osteogenesis

0.00

0.00

Osteotomy, maxillary, leforte iii – for distraction osteogenesis

0.00

0.00

Activation of distraction device – leforte i

0.00

0.00

Activation of distraction device – leforte ii

0.00

0.00

Activation of distraction device – leforte iii

0.00

0.00

Removal of maxillary distraction device

0.00

0.00

Osteotomy, maxillary/mandibular, osteotomy, segmental, anterior

2117.88

2541.46

Osteotomy, maxillary/mandibular, osteotomy, segmental, posterior

2117.88

2541.46

Osteotomy, maxillary/mandibular, osteotomy, midpalatal split, anterior

1411.92

1694.30

Osteotomy, maxillary/mandibular, osteotomy, midpalatal split, complete

2117.88

2541.46

Osteotomy, segmental, anterior – for distraction osteogenesis

0.00

0.00

Osteotomy, segmental, posterior – for distraction osteogenesis

0.00

0.00

Activation of distraction device

0.00

0.00

Removal of segmental maxillary distraction

0.00

0.00

Osteotomy, segmental, anterior with transfer of mental eminence

2117.88

2541.46

Osteotomy, segmental, anterior, without the transfer of mental eminence

2117.88

2541.46

Osteotomy, segmental, posterior

1919.62

2303.55

Osteotomy, lower border, mandible

2117.88

2541.46

Osteotomy, total dento-alveolar, mandible

4412.26

5294.71

Osteotomy, segmental, anterior, for distraction osteogenesis

0.00

0.00

Osteotomy, segmental, posterior, for distraction osteogenesis

0.00

0.00

Activation of distraction device

0.00

0.00

Removal of segmental mandibular distraction

0.00

0.00

Osteotomy when 'interpositional graft' is required, using bone

529.46

635.35

Osteotomy when 'interpositional graft' is required, using alloplast + E

496.42

595.70

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Osteotomy when 'interpositional graft' is required, using cartilage

529.46

635.35

Osteotomy when 'onlay graft' is required for osteotomy, trauma or reconstructive procedures, using bone

352.97

423.57

Osteotomy when 'onlay graft' is required for osteotomy, trauma or reconstructive procedures, using alloplast + E

330.96

397.15

Osteotomy when 'onlay graft' is required for osteotomy, trauma or reconstructive procedures, using cartilage

352.97

423.57

Genioplasty, sliding, reduction or augmentation

2117.88

2541.46

Genioplasty, reduction (vertical)

2117.88

2541.46

Genioplasty augmentation with graft (see grafting codes)

2117.88

2541.46

Genioplasty, myotomy, suprahyoid

529.74

635.69

Miscellaneous treatment of maxillofacial deformities, corticotomy

617.83

741.40

Miscellaneous treatment of maxillofacial deformities, interdental septotomy

617.83

741.40

Miscellaneous treatment of maxillofacial deformities, surgical expansion of the palate

1058.94

1270.73

Surgical expansion of alveolar ridge – ridge splitting technique, maxilla – per sextant

0.00

0.00

Surgical expansion of alveolar ridge – ridge splitting technique, mandible – per sextant

0.00

0.00

Palatorrhaphy, anterior (closure of palatine fissure)

2117.88

2541.46

Palatorrhaphy, posterior

2117.88

2541.46

Palatorrhaphy, total

2647.34

3176.81

Palatorrhaphy, with bone graft

3529.80

4235.76

Palatorrhaphy, bone graft to anterior alveolar ridge

2294.37

2753.25

Frenectomy/frenoplasty, upper labial

231.82

278.18

Frenectomy/frenoplasty, lower labial

231.82

278.18

Frenectomy/frenoplasty, lower lingual or 'z' plasty

231.82

278.18

Frenectomy, lower lingual or 'z' plasty with myotomy of genioglossus

397.30

476.76

Frenectomy, upper 'z'

347.72

417.26

Frenectomy, lower 'z'

347.72

417.26

Glossectomy, partial, anterior wedge

617.83

741.40

Glossectomy, partial, for orthodontic purposes

617.83

741.40

Glossectomy, full postero-anterior wedge

1147.19

1376.62

Cleft surgery, primary unilateral cleft lip repair

1191.30

1429.56

Cleft surgery, secondary unilateral cleft lip repair

1191.30

1429.56

Cleft surgery, primary bilateral cleft lip repair

1588.40

1906.08

Cleft surgery, secondary bilateral cleft lip repair

1588.40

1906.08

Cleft surgery, reconstruction of cleft lip with lip switch flap

1588.40

1906.08

Cleft surgery, complex reconstruction or revision of cleft lip

1985.51

2382.61

Cleft surgery, closure of alveolar cleft (see grafting codes)

1985.51

2382.61

Oral nasal fistula, primary closure at time of initial surgery

705.97

847.16

Oral nasal fistula, secondary closure with palatal flap

1058.94

1270.73

Oral nasal fistula, secondary closure with pharyngeal flap

1058.94

1270.73

Oral nasal fistula, secondary closure with tongue flap

1191.30

1429.56

Oral nasal fistula, secondary closure with buccal flap

1058.94

1270.73

Rigid fixation, rigid internal fixation

0.00

0.00

Rigid fixation, rigid internal fixation using bone

0.00

0.00

Rigid fixation, rigid internal fixation using alloplast + E

0.00

0.00

Rigid fixation, rigid internal fixation using cartilage

0.00

0.00

Tmj dysfunctions, dislocation management, dislocation, open reduction

1147.19

1376.62

Tmj, dysfunctions, dislocation management, dislocation, closed reduction, uncomplicated

209.79

251.74

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Tmj, dislocation, closed reduction, under general anesthetic

220.81

264.98

Tmj, luxation, reduction without anesthesia

209.79

251.74

Tmj, luxation, reduction under anesthesia

220.81

264.98

Tmj, manipulation, under anesthesia

331.22

397.46

Tmj, fixation

331.22

397.46

Tmj, open procedures, (arthrotomy), condyloplasty

1764.89

2117.87

Tmj, open procedures, (arthrotomy), condylotomy

1058.94

1270.73

Tmj, open procedures, (arthrotomy) condylectomy

1897.26

2276.72

Tmj, open procedures, (arthrotomy) eminoplasty

1897.26

2276.72

Tmj, open procedures, re-contour of glenoid fossa

1897.26

2276.72

Tmj, open procedures, menisectomy

1764.89

2117.87

Tmj, open procedures, plication of meniscus

1897.26

2276.72

Tmj, open procedures, repair of meniscus

1897.26

2276.72

Tmj, open procedures, replacement of meniscus (see grafting codes)

1897.26

2276.72

Tmj, arthrotomy for major reconstruction, fossa replacement (see grafting codes)

1897.26

2276.72

Tmj, arthrotomy for major reconstruction, condylar replacement (see grafting codes)

1897.26

2276.72

Tmj, arthrotomy for major reconstruction, gap arthroplasty for ankylosis (see grafting codes)

3000.32

3600.38

Tmj, arthroscopic examination and diagnosis

529.46

635.35

Tmj, arthroscopy, biopsy

750.08

900.10

Tmj, arthroscopy, removal of loose bodies

750.08

900.10

Tmj, arthroscopy, lavage

529.46

635.35

Tmj, arthroscopy, lysis of adhesions

750.08

900.10

Tmj, arthroscopy, synovectomy

1147.19

1376.62

Tmj, arthroscopy, condyloplasty

1147.19

1376.62

Tmj, arthroscopy, eminoplasty

1147.19

1376.62

Tmj, arthroscopy, re-contour of glenoid fossa

1147.19

1376.62

Tmj, arthroscopy, menisectomy

1323.67

1588.41

Tmj, arthroscopy, plication of meniscus

1323.67

1588.41

Tmj, arthroscopy, repair of meniscus

1323.67

1588.41

Tmj, arthrocentesis (puncture and aspiration), one unit of time

126.93

152.31

Tmj, arthrocentesis, (puncture and aspiration) two units

253.83

304.60

Tmj, arthrocentesis, (puncture and aspiration) each additional unit over two

126.93

152.31

Tmj, injection, with anti-inflammatory drugs

132.44

158.93

Tmj, injection, with sclerosing agent

132.44

158.93

Tmj, appliance splints, orthopedic rehabilitation (post operative), appliance splint, maxillary + L

893.72

1072.46

Tmj, appliance splints, orthopedic rehabilitation (post operative), appliance splint, mandibular + L

893.72

1072.46

Salivary glands, treatment of, salivary duct, dilation of

182.13

218.56

Salivary glands, salivary duct, insertion of polyethylene tube

242.83

291.39

Salivary glands, salivary duct, sialodochoplasty

529.74

635.69

Salivary glands, salivary duct, reconstruction of

794.58

953.49

Salivary duct, sialolithotomy, anterior 1/3 of canal

485.67

582.81

Salivary duct, sialolithotomy, posterior 2/3 of canal

1324.32

1589.18

Salivary duct, sialolithotomy, external approach

2051.78

2462.14

Salivary gland, excisions, excision of submaxillary gland

1323.80

1588.56

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Salivary gland, excisions, excision of sublingual gland

1654.74

1985.69

Salivary gland, excisions, excision of mucocele

165.59

198.71

Salivary gland, excisions, excision of ranula

529.74

635.69

Salivary gland, excisions, marsupialization of ranula

485.67

582.81

Salivary gland, removal, parotid (sub total)

1764.89

2117.87

Salivary gland, removal, parotid (radical, including facial nerve)

2823.83

3388.60

Neurological disturbances, treatment of, trigeminal nerve, injection for destruction

264.88

317.86

Neurologial disturbances, treatment of, trigeminal nerve, avulsion at periphery

551.75

662.10

Neurological disturbances, treatment of, trigeminal nerve, total avulsion of a branch

1004.10

1204.93

Neurological disturbances, treatment of, trigeminal nerve, alcoholization of a branch

264.88

317.86

Neurological disturbances, trigeminal nerve, infiltration of a branch for diagnosis

126.93

152.31

Neurological disturbances, trigeminal nerve, intraoperative, diagnosis or physiologic monitoring (stimulation with recording evoked potentials, ultrasound, or impedance)

242.83

291.39

Neurological disturbances, trigeminal nerve, neurolysis or tumor excision of trigeminal nerve branch in soft tissue

794.58

953.49

Neurological disturbances, trigeminal nerve, neurolysis or tumor excision of trigeminal nerve branch in bone (mandible, maxilla or orbit) (not to include osteotomy)

1544.61

1853.54

Neurological disturbances, mental nerve, transportation of

926.76

1112.11

Neurological disturbances, mental nerve, decompression in canal

926.76

1112.11

Neurological disturbances, inferior dental nerve, complete avulsion

926.76

1112.11

Neurological disturbances, inferior dental nerve, decompression in the canal

959.80

1151.76

Neurological disturbances, surgery, injured nerve repair, primary

1235.69

1482.82

Neurological disturbances, surgery, injured nerve repair, secondary

3132.69

3759.23

Neurological disturbances, surgery, injured nerve repair, secondary (when repair delayed more than four weeks)

3529.80

4235.76

Neurological disturbances, surgery, neural transposition and decompression

926.76

1112.11

Neurological disturbances, surgery, implantation of electrode for peripheral nerve stimulation

1235.69

1482.82

Neurological disturbances, surgery, excision of tumor or neuroma

1323.80

1588.56

Neurological disturbances, surgery, nerve repair with graft + E

4412.26

5294.71

Neurological disturbances, surgery, harvesting of nerve graft

1544.61

1853.54

Neurological disturbances, surgery, epineurial suture of trigeminal nerve branch per anastomosis

959.80

1151.76

Neurological disturbances, surgery, fascicular suture of trigeminal nerve branch per anastomosis

959.80

1151.76

Neurological disturbances, surgery, conduit implant for repair of nerve gap up to 3 cm

2470.86

2965.03

Neurological disturbances, surgery, conduit implant for repair of nerve gap greater than 3 cm

3529.80

4235.76

Neurological disturbances, surgery, fibrin adhesive per nerve anastomosis

617.83

741.40

Neurological disturbances, surgery, laser coagulation per nerve anastomosis

661.90

794.28

Neurological disturbances, surgery, in addition to above procedures, when using operating microscopes

132.44

158.93

Antral surgery, immediate recovery of a dental root or foreign body from the antrum

827.62

993.14

Antral surgery, immediate closure of antrum by another dental surgeon

827.62

993.14

Antral surgery, delayed recovery of dental root with oral antrostomy

827.62

993.14

Antral surgery with nasal antrostomy

827.62

993.14

Antral surgery, lavage, oral approach

115.90

139.08

Antral surgery, lavage, nasal approach

115.90

139.08

Antral surgery, oro-antral fistula closure (same session) with buccal flap

794.58

953.49

Antral surgery, oro-antral fistula closure (same session) with gold plate + L

794.58

953.49

Antral surgery, oro-antral fistula closure (same session) with palatal flap

794.58

953.49

Antral surgery, oro-antral fistula closure (subsequent session) with buccal flap

794.58

953.49

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Antral surgery, oro-antral fistula closure (subsequent session) with gold plate + L

794.58

953.49

Antral surgery, oro-antral fistula closure (subsequent session) with palatal flap

794.58

953.49

Sinus osseous augmentation, open lateral – autograft + E

0.00

0.00

Sinus osseous augmentation, open lateral – allograft + E

0.00

0.00

Sinus osseous augmentation, open lateral – xenograft + E

0.00

0.00

Sinus osseous augmentation – indirect inferior – autograft + E

0.00

0.00

Sinus osseous augmentation – indirect inferior – allograft + E

0.00

0.00

Sinus osseous augmentation – indirect inferior – xenograft + E

0.00

0.00

Hemorrhage control, primary hemorrhage

529.74

635.69

Hemorrhage control, secondary hemorrhage

1544.61

1853.54

Hemorrhage control, using compression and hemostatic agent

1544.61

1853.54

Hemorrhage control, using hemostatic substance and sutures (including removal of bony tissue, if necessary)

1544.61

1853.54

Grafts, surgical, harvesting of intraoral tissue for grafting to operative site, bone

446.97

536.36

Grafts, surgical, harvesting of intraoral tissue for grafting to operative site, cartilage

446.97

536.36

Grafts, surgical, harvesting of intraoral tissue for grafting to operative site, skin

446.97

536.36

Grafts, surgical, harvesting of intraoral tissue for grafting to operative site, mucosa

446.97

536.36

Grafts, surgical, harvesting of intraoral tissue for grafting to operative site, fascia

446.97

536.36

Grafts, surgical, harvesting of intraoral tissue for grafting to operative site, muscle

446.97

536.36

Grafts, surgical, harvesting of intraoral tissue for grafting to operative site, dermis

446.97

536.36

Grafts, surgical, harvesting of extraoral tissue for grafting to operative site, (to include ilium, rib, etc.), Bone

617.83

741.40

Grafts, surgical, harvesting of extraoral tissue for grafting to operative site, (to include ilium, rib, etc.), Cartilage

617.83

741.40

Grafts, surgical, harvesting of extraoral tissue for grafting to operative site, (to include ilium, rib, etc.), Costochondral

617.83

741.40

Grafts, surgical, harvesting of extraoral tissue for grafting to operative site, (to include ilium, rib, etc.), Skin

617.83

741.40

Grafts, surgical, harvesting of extraoral tissue for grafting to operative site, (to include ilium, rib, etc.), Mucosa

617.83

741.40

Grafts, surgical, harvesting of extraoral tissue for grafting to operative site, (to include ilium, rib, etc.), Fascia

617.83

741.40

Grafts, surgical, harvesting of extraoral tissue for grafting to operative site, (to include ilium, rib, etc.), Muscle

617.83

741.40

Grafts, surgical, harvesting of extraoral tissue for grafting to operative site, (to include ilium, rib, etc.), Dermis

617.83

741.40

Grafts, surgical, harvesting of extraoral tissue for grafting to operative site, (to include ilium, rib, etc.), Nerve

0.00

0.00

Grafts, surgical, vascularized tissue flaps, free

0.00

0.00

Grafts, surgical, vascularized tissue flaps, attached

0.00

0.00

Grafts, surgical, vascularized tissue flaps, micro-anastomosis

0.00

0.00

Harvesting and preparation of platelet rich plasma + E

0.00

0.00

Delivery of growth factors – autologous – per site + E

0.00

0.00

Delivery of growth factors – allogenic – per site + E

0.00

0.00

Delivery of growth factors – human recombinant – per site + E

0.00

0.00

Post surgical care, subsequent to initial post surgical treatment, minor, by treating dentist

110.41

132.49

Post surgical care, minor, by other than treating dentist

115.90

139.08

Post surgical care, major, by treating dentist

1159.10

1390.92

Post surgical care, major, by other than treating dentist

1159.10

1390.92

Post surgical care, alveolitis, treatment of (without anesthesia)

115.90

139.08

Post surgical care, alveolitis, treatment of (with anesthesia)

115.90

139.08

Emergency office procedures, tracheotomy

705.97

847.16

Emergency office procedures, crico-thyroidotomy

705.97

847.16

Muscular disorders, treatment of muscular dysfunctions

0.00

0.00

Treatment of muscular disorders, muscular dysfunctions, myotomy

0.00

0.00

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Implantology, (includes placement of implant, post-surgical care, uncovering and placement of attachment but not prosthesis) implants, blade, maxillary per implant

0.00

0.00

Implantology, (includes placement of implant, post-surgical care, uncovering and placement of attachment but not prosthesis) implants, blade, mandibular per implant

0.00

0.00

Implants, subperiosteal, maxillary + L

0.00

0.00

Implants, subperiosteal, mandibular + L

0.00

0.00

Implants, surgical installation of implant with cover screw – per implant + E

0.00

0.00

Implants, surgical installation of implant with healing transmucosal element – per implant + E

0.00

0.00

Implants, surgical installation of implant with final transmucosal element – per implant + E

0.00

0.00

Implants, surgical re-entry,removal of healing screw placement of healing transmucosal element – per implant + E

0.00

0.00

Implants, surgical re-entry,removal of healing screw placement of fi           standard transmucosal element – per implant + E

0.00

0.00

Implants, surgical re-entry,removal of healing screw placement of final custom transmucosal element – per implant + L + E

0.00

0.00

Implants, surgical installation – per implant + E

0.00

0.00

Implants, installation of provisional implant – per implant

0.00

0.00

Implants, removal of provisional implant – per implant

0.00

0.00

Implants, removal uncomplcated per implant

0.00

0.00

Implants, removal complcated per implant

0.00

0.00

Orthodontic, observations and adjustments, for tooth guidance (i.E. Tooth position, eruption sequence) per appointment

47.74

57.29

Orthodontic, observations and adjustment, to orthodontic appliances and/or the reduction of proximal surfaces of teeth per appointment

47.74

57.29

Orthodontic, repairs to removable or fixed appliances, one unit of time + L

47.74

57.29

Orthodontic, repairs to removable or fixed appliances, two units + L

95.46

114.55

Orthodontic, repairs to removable or fixed appliances, each additional unit over two

47.74

57.29

Orthodontic, alterations to removable or fixed appliances, one unit of time + L

47.74

57.29

Orthodontic, alterations to removable or fixed appliances, two units + L

95.46

114.55

Orthodontic, alterations to removable or fixed appliances, each additional unit over two

47.74

57.29

Orthodontic, recementation of fixed appliances, one unit of time

47.74

57.29

Orthodontic, recementation of fixed appliances, each additional unit

47.74

57.29

Orthodontic, separation (except where included in the fabrication of an appliance), one unit of time

47.74

57.29

Orthodontic, separation (except where included in fabrication of appliance), each additional unit

47.74

57.29

Orthodontic, removal of fixed orthodontic appliances (by a practitioner other than the original treating practice) one unit of time

47.74

57.29

Orthodontics, removal of fixed appliances (by a practitioner other than the original treating practice) each additional unit

47.74

57.29

Appliances, removable, space regaining, maxillary, unilateral + L

190.93

229.12

Appliances, removable, space regaining, mandibular, unilateral + L

190.93

229.12

Appliances, removable, space regaining, maxillary, bilateral, + L

190.93

229.12

Appliances, removable, space regaining, mandibular, bilateral + L

190.93

229.12

Appliances, removable, cross-bite correction, maxillary, simple + L

190.93

229.12

Appliances, removable, cross-bite correction, mandibular, simple + L

190.93

229.12

Appliances, removable, dental arch expansion, maxillary, simple + L

190.93

229.12

Appliances, removable, dental arch expansion, mandibular, simple + L

190.93

229.12

Appliances, removable, closure of diastemas, maxillary, simple + L

190.93

229.12

Appliances, removable, closure of diastemas, mandibular, simple + L

190.93

229.12

Appliances, removable, alignment of anterior teeth, maxillary, simple + L

190.93

229.12

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Appliances, removable, alignment of anterior teeth, mandibular, simple + L

190.93

229.12

Appliances, fi or cemented, space regaining (e.G. Lingual or labial arch with molar bands, tubes, locks) maxillary + L

190.93

229.12

Appliances, fixed or cemented, space regaining, mandibular + L

190.93

229.12

Appliances, fixed or cemented, space regaining, unilateral, maxillary + L

143.20

171.84

Appliances, fixed or cemented, space regaining, unilateral, mandibular + L

143.20

171.84

Appliances, fixed, cross-bite correction, anterior, maxillary + L

190.93

229.12

Appliances, fixed, cross-bite correction, anterior, mandibular + L

190.93

229.12

Appliances, fixed, cross-bite correction, posterior, maxillary + L

190.93

229.12

Appliances, fixed, cross-bite correction, posterior, mandibular + L

190.93

229.12

Appliances, fixed, two-molar band, hooked & elastics + L

143.20

171.84

Appliances, fixed, dental arch expansion, maxillary + L

238.67

286.40

Appliances, fixed, dental arch expansion, mandibular + L

238.67

286.40

Appliances, fixed, dental arch rapid expansion, maxillary + L

190.93

229.12

Appliances, fixed, closure of diastemas, maxillary, simple + L

190.93

229.12

Appliances, fixed, closure of diastemas, mandibular, simple + L

190.93

229.12

Appliances, fixed, alignment of incisor teeth, maxillary, simple + L

238.67

286.40

Appliances, fixed, alignment of incisor teeth, mandibular, simple + L

238.67

286.40

Appliances, fixed, grassline or elastic ligatures per visit + L

47.74

57.29

Appliances, fixed, mechanical eruption of tooth/teeth, maxillary, impaction + L

190.93

229.12

Appliances, fixed, mechanical eruption of teeth, mandibular, impaction + L

190.93

229.12

Appliances, fixed, mechanical eruption of teeth, maxillary, erupted + L

190.93

229.12

Appliances, fixed, mechanical eruption of teeth, mandibular, erupted + L

190.93

229.12

Appliances, removable, retention, maxillary + L

143.20

171.84

Appliances, removable, retention, mandibular + L

143.20

171.84

Appliances, removable, retention, tooth positioner + L

143.20

171.84

Appliances, fixed/cemented, retention, maxillary + L

190.93

229.12

Appliances, fixed/cemented, retention, mandibular + L

190.93

229.12

Permanent dentition, class i malocclusion

5728.01

6873.61

Permanent dentition, class ii malocclusion

7637.34

9164.81

Permanent dentition, class iii malocclusion

7637.34

9164.81

Permanent dentition, malocclusion not requiring complete banding

2864.00

3436.80

Mixed dentition, class i malocclusion

5728.01

6873.61

Mixed dentition, class ii malocclusion

7637.34

9164.81

Mixed dentition, class iii malocclusion

7637.34

9164.81

Mixed dentition, class i malocclusion

2864.00

3436.80

Mixed dentition, class ii malocclusion

3818.67

4582.40

Mixed dentition, class iii malocclusion

3818.67

4582.40

Neonatal dento-facial orthopedics, expansion appliance for infants with cleft palate + L

1718.40

2062.08

Neonatal dento-facial orthopedics, extraoral retraction appliance for infants with cleft palate + L

1718.40

2062.08

Neonatal dento-facial orthopedics, stage i – initial expansion + L

716.00

859.20

Neonatal dento-facial orthopedics, stage ii – anterior alignment + L

1432.00

1718.40

Neonatal dento-facial orthopedics, stage 111 – final alignment(complete banding)+ L

3818.67

4582.40

Neonatal dento-facial orthopedics, stage iii – where stage i and ii were not provided for + L

7637.34

9164.81

Unclassified treatment, dental pain, palliative (emergency) treatment of dental pain, minor procedure, one unit of time

82.50

99.00

Unclassified treatment, dental pain, palliative (emergency) treatment of dental pain, minor procedure, two units

165.00

198.00

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Unclassified treatment, dental pain, palliative (emergency) treatment of dental pain, minor procedure, three units

247.51

297.01

Unclassified treatment, dental pain, palliative (emergency) treatment of dental pain, minor procedure, each additional unit over three

82.50

99.00

Emergency services, not otherwise specified in guide, one unit of time

86.84

104.20

Emergency services, not otherwise specified in guide, two units

173.69

208.43

Emergency services, not otherwise specified in guide, three units

260.51

312.61

Emergency services, not otherwise specified in guide, each additional unit over three

86.84

104.20

Unclassified treatment, unusual time and responsibilities, in addition to usual procedures in guide, one unit of time

95.51

114.61

Unclassified treatment, unusual time and responsibilities, in addition to usual procedures in guide, two units

191.00

229.20

Unclassified treatment, unusual time and responsibilities, in addition to usual procedures in guide, three units

286.51

343.81

Unclassified treatment, unusual time and responsibilities, in addition to usual procedures in guide, each additional unit over three

95.51

114.61

Unclassified treatment, unusual time & responsibility, second surgeon (team approach), one unit of time

82.50

99.00

Unclassified treatment, unusual time & responsibility, second surgeon (team approach), two units

165.00

198.00

Unclassified treatment, unusual time & responsibility, second surgeon (team approach), three units

247.51

297.01

Unclassified treatment, unusual time & responsibility, second surgeon (team approach), four units

330.01

396.01

Unclassified treatment, unusual time & responsibility, second surgeon (team approach), five units

412.54

495.05

Unclassified treatment, unusual time & responsibility, second surgeon (team approach), six units

495.04

594.05

Unclassified treatment, unusual time & responsibility, second surgeon (team approach), seven units

577.55

693.06

Unclassified treatment, unusual time & responsibility, second surgeon (team approach), eight units

660.05

792.06

Unclassified treatment, unusual time & responsibility, second surgeon (team approach), each additional unit over eight

82.50

99.00

Unclassified treatment, management of exceptional patient, one unit of time

95.51

114.61

Unclassified treatment, management of exceptional patient, two units

191.00

229.20

Unclassified treatment, management of exceptional patient, three units

286.51

343.81

Unclassified treatment, management of exceptional patient, four units

382.00

458.40

Unclassified treatment, management of exceptional patient, each additional unit over four

95.51

114.61

Anaesthesia, local, (includes pre-anaesthetic evaluation and post-anaesthetic evaluation and follow-up) regional block anaesthesia

86.84

104.20

Anaesthesia, local, (includes pre-anaesthetic evaluation and post-anaesthetic evaluation and follow-up) trigeminal division block

86.84

104.20

Anaesthesia, general (includes pre-anaesthetic evaluation and post-anaesthetic evaluation and follow-up) two units of time

182.34

218.81

Anaesthesia, general (includes pre-anaesthetic evaluation and post-anaesthetic evaluation and follow-up) three units

273.50

328.20

Anaesthesia, general (includes pre-anaesthetic evaluation and post-anaesthetic evaluation and follow-up) four units

364.69

437.63

Anaesthesia, general (includes pre-anaesthetic evaluation and post-anaesthetic evaluation and follow-up) five units

455.84

547.01

Anaesthesia, general (includes pre-anaesthetic evaluation and post-anaesthetic evaluation and follow-up) six units

547.02

656.42

Anaesthesia, general (includes pre-anaesthetic evaluation and post-anaesthetic evaluation and follow-up) seven units

638.19

765.83

Anaesthesia, general (includes pre-anaesthetic evaluation and post-anaesthetic evaluation and follow-up) eight units

729.35

875.21

Anaesthesia, general (includes pre-anaesthetic evaluation and post-anaesthetic evaluation and follow-up) each additional unit over eight

91.16

109.39

Anaesthesia, general, provision of facilities, equipment and support services for general anaesthesia, two units of time

182.34

218.81

Anaesthesia, general, provision of facilities, equipment and support services for general anaesthesia, three units

273.50

328.20

Anaesthesia, general, provision of facilities, equipment and support services for general anaesthesia, four units

364.69

437.63

Anaesthesia, general, provision of facilities, equipment and support services for general anaesthesia, five units

455.84

547.01

Anaesthesia, general, provision of facilities, equipment and support services for general anaesthesia, six units

547.02

656.42

Anaesthesia, general, provision of facilities, equipment and support services for general anaesthesia, seven units

638.19

765.83

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Anaesthesia, general, provision of facilities, equipment and support services for general anaesthesia, eight units

729.35

875.21

Anaesthesia, general, provision of facilities, equipment and support services for general anaesthesia, each additional unit over eight

91.16

109.39

Anaesthesia, deep sedation, neuroleptanalgesia, two units

165.00

198.00

Anaesthesia, deep sedation, neuroleptanalgesia, three units

247.51

297.01

Anaesthesia, deep sedation, neuroleptanalgesia, four units

330.01

396.01

Anaesthesia, deep sedation, neuroleptanalgesia, five units

412.54

495.05

Anaesthesia, deep sedation, neuroleptanalgesia, six units

495.04

594.05

Anaesthesia, deep sedation, neuroleptanalgesia, seven units

577.55

693.06

Anaesthesia, deep sedation, neuroleptanalgesia, eight units

660.05

792.06

Anaesthesia, deep sedation, neuroleptanalgesia, each additional unit over eight

82.50

99.00

Provision of facilities for deep sedation when provided by a separate practitioner (2 unit of time)

165.00

198.00

Provision of facilities for deep sedation when provided by a separate practitioner (3 unit of time)

247.52

297.03

Provision of facilities fordeep sedation when provided by a separate practitioner (4 units of time)

330.01

396.01

Provision of facilities for deep sedation when provided by a separate practitioner (5 units of time)

412.73

495.27

Provision of facilities for deep sedation when provided by a separate practitioner (6 units of time)

495.04

594.05

Provision of facilities for deep sedation when provided by a separate practitioner (7 units of time)

577.55

693.06

Provision of facilities for deep sedation when provided by a separate practitioner (8 units of time)

660.05

792.06

Provision of facilities for deep sedation when provided by a separate practitioner (every unit over 8)

82.50

99.00

Anaesthesia, conscious sedation, nitrous oxide sedation, time is measured from the placement of the inhalation device and terminates with the removal of the inhalation device, one unit of time

43.62

52.34

Anaesthesia, conscious sedation, nitrous oxide sedation, two units

65.44

78.53

Anaesthesia, conscious sedation, nitrous oxide sedation, three units

87.25

104.70

Anaesthesia, conscious sedation, nitrous oxide sedation, four units

109.08

130.90

Anaesthesia, conscious sedation, nitrous oxide sedation, five units

130.89

157.07

Anaesthesia, conscious sedation, nitrous oxide sedation, six units

152.72

183.26

Anaesthesia, conscious sedation, nitrous oxide sedation, seven units

174.54

209.45

Anaesthesia, conscious sedation, nitrous oxide sedation, eight units

196.35

235.62

Anaesthesia, conscious sedation, nitrous oxide sedation, each additional unit over eight

21.83

26.19

Anaesthesia, conscious sedation, oral sedation, one unit of time

43.62

52.34

Anaesthesia, conscious sedation, oral sedation, two units of time

65.43

78.51

Anaesthesia, conscious sedation, oral sedation, three units of time

87.25

104.70

Anaesthesia, conscious sedation, oral sedation, four units of time

109.06

130.88

Anaesthesia, conscious sedation, oral sedation, five units of time

137.08

164.49

Anaesthesia, conscious sedation, oral sedation, six units of time

152.70

183.24

Anaesthesia, conscious sedation, oral sedation, seven units of time

174.52

209.43

Anaesthesia, conscious sedation, oral sedation, eight units of time

196.15

235.38

Anaesthesia, conscious sedation, oral sedation, each additional unit over eight

21.81

26.17

Anaesthesia, parental conscious sedation (regardless of method – im or iv) one unit

43.62

52.34

Anaesthesia, parental conscious sedation (regardless of method – im or iv) two units

65.43

78.51

Anaesthesia, parental conscious sedation (regardless of method – im or iv) three units

87.25

104.70

Anaesthesia, parental conscious sedation (regardless of method – im or iv) four units

109.06

130.88

Anaesthesia, parental conscious sedation (regardless of method – im or iv) five units

137.08

164.49

Anaesthesia, parental conscious sedation (regardless of method – im or iv) six units

152.70

183.24

Anaesthesia, parental conscious sedation (regardless of method – im or iv) seven units

174.52

209.43

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Anaesthesia, parental conscious sedation (regardless of method – im or iv) eight units

196.15

235.38

Anaesthesia, parental conscious sedation (regardless of method – im or iv) each additional unit over eight

21.81

26.17

Non-pharmacological pain control and patient management, hypnosis, one unit of time

43.62

52.34

Non-pharmacological pain control and patient management, hypnosis, two units

65.44

78.53

Non-pharmacological pain control and patient management, hypnosis, three units

87.25

104.70

Non-pharmacological pain control and patient management, hypnosis, four units

109.08

130.90

Non-pharmacological pain control and patient management, hypnosis, each additional unit over four

21.83

26.19

Non-pharmacological pain control and patient management, acupuncture, one unit of time

43.62

52.34

Non-pharmacological pain control and patient management, acupuncture, two units

65.44

78.53

Non-pharmacological pain control and patient management, acupuncture, three units

87.25

104.70

Non-pharmacological pain control and patient management, acupuncture, four units

109.08

130.90

Non-pharmacological pain control and patient management, acupuncture, each additional unit over 4

21.83

26.19

Non-pharmacological pain control and patient management, electronic dental anesthesia, one unit of time

43.62

52.34

Non-pharmacological pain control and patient management, electronic dental anesthesia, two units

65.44

78.53

Non-pharmacological pain control and patient management, electronic dental anesthesia, three units

87.25

104.70

Non-pharmacological pain control and patient management, electronic dental anesthesia, four units

109.08

130.90

Non-pharmacological pain control and patient management, electronic dental anesthesia, each additional unit over four

21.83

26.19

Anaesthesia, general, management of patient with bmi 35 or above, in addition to code series 92200 or 92300

0.00

0.00

Professional communications, consultation with member of the profession or other healthcare providers, in or out of the office, one unit of time

86.84

104.20

Professional communications, consultation with member of the profession or other healthcare providers, in or out of the office, two units

173.69

208.43

Professional communications, consultation with member of the profession or other healthcare providers, in or out of the office, each additional unit over two

86.84

104.20

Professional communications, dental legal letters, reports and opinions, short written or verbal report given to any lay person with patient approval

165.00

198.00

Professional communications, a dental-legal report with patient approval on symptoms, history and records giving diagnosis, treatment and present condition

330.01

396.01

Dental-legal opinion, a comprehensive written report primarily in the field of expert opinion

0.00

0.00

Consultation and/or participation during autopsy (other than forensic) one unit of time + E

108.50

130.20

Consultation and/or participation during autopsy (other than forensic) two units + E

216.99

260.39

Consultation and/or participation during autopsy (other than forensic) each additional unit over two

108.50

130.20

Completing cda "blank" approved standard claim forms

0.00

0.00

Upon request, providing a written treatment plan/outline for a patient, similar to the example in the cda policy manual on claim form completion

0.00

0.00

Completing prepaid claim forms which do not conform with code 93301

27.78

33.33

Claim/treatment forms, extraordinary time spent in relation to claim forms/treatment plan, one unit of time + E

91.16

109.39

Claim/treatment forms, extraordinary time spent in relation to claim forms/treatment plan, two units + E

182.34

218.81

Claim/treatment forms, extraordinary time spent in relation to claim forms/treatment plan, zero units + E

91.16

109.39

Claim/treatment forms, extraordinary time spent in relation to claim forms/treatment plan, each additional unit over two

91.16

109.39

Claim/treatment forms, unreasonable office time spent in forwarding predetermination records, in predetermination situations to third parties, one unit of time + E

20.93

25.11

Claim/treatment forms, unreasonable office time spent in forwarding predetermination records, in predetermination situations to third parties, two units + E

41.87

50.24

Claim/treatment forms, unreasonable office time spent in forwarding predetermination records, in predetermination situations to third parties, each additional unit over two

20.93

25.11

Professional visits, house calls, non emergency visit (in addition to performed procedures)

99.61

119.53

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Professional visits, house calls, emergency visit, when one must immediately leave home/office/hospital

199.25

239.10

Office or institutional visits, during regular office hours, in addition to services performed

82.50

99.00

Office or institutional visits, unscheduled, after regular scheduled office hours

102.13

122.55

Missed or cancelled appointment, with insufficient notice, during regular scheduled hours

52.32

62.79

Missed or cancelled appointment with insufficient notice, being a special appointment outside regular scheduled office hours

364.69

437.63

Office/institutional visits, travelling expenses + E

0.00

0.00

Professional visits out of the office plus actual services performed+ E (out of pocket expense, etc.)

154.50

185.40

Court preparation as an expert witness, one unit of time

0.00

0.00

Court preparation as an expert witness, two units

0.00

0.00

Court preparation as expert witness, three units

0.00

0.00

Court preparation as an expert witness, four units

0.00

0.00

Court appearances/preparation as an expert witness, each additional unit over four

0.00

0.00

Court appearance as an expert witness, one half day

0.00

0.00

Court appearance as an expert witness, full day

0.00

0.00

Forensic services, miscellaneous, forensic identification – opinion as an expert assisting in civil or criminal cases + E

456.83

548.19

Forensic services, miscellaneous, full or part time participation in civil disaster + E

2511.44

3013.73

Forensic services, miscellaneous, written odontology report + E

527.06

632.47

Forensic services, post mortem examination and diagnosis of tissues in forensic cases (non identification)

0.00

0.00

Forensic services, management of oral disease or abnormality

182.34

218.81

Identification disk system, acid etch/bonded + L

82.50

99.00

Prescription, emergency

38.57

46.28

Prescriptions, emergency dispensing of one or two doses of therapeutic drug, plus giving a written prescription + E

53.72

64.47

Prescriptions, dispensing, non emergency (e.G. Fluorides, vitamins, other drugs/medications)+ E

26.18

31.41

Injections, therapeutic, intramuscular drug injection + E

47.74

57.28

Injections, therapeutic, intravenous drug injection + E

47.74

57.28

Injections, therapeutic, intralesional delivery, intra-articular injections – see 78600 + E

47.74

57.28

Injections, aesthetic – administration of aesthetic neuromodulators (eg. Botulinum toxin type a) , 1 to 5 units + E

0.00

0.00

Injections, aesthetic – administration of aesthetic neuromodulators (eg. Botulinum toxin type a) , 6 to 10 units + E

0.00

0.00

Injections, aesthetic – administration of aesthetic neuromodulators (eg. Botulinum toxin type a) , 11 to 20 units + E

0.00

0.00

Injections, aesthetic – administration of aesthetic neuromodulators (eg. Botulinum toxin type a) , 21 to 30 units + E

0.00

0.00

Injections, aesthetic – administration of aesthetic neuromodulators (eg. Botulinum toxin type a) , 31 to 40 units + E

0.00

0.00

Injections, aesthetic – administration of aesthetic neuromodulators (eg. Botulinum toxin type a) , 41 to 50 units + E

0.00

0.00

Injections, aesthetic – administration of aesthetic neuromodulators (eg. Botulinum toxin type a) , 51 to 60 units + E

0.00

0.00

Injections, aesthetic – administration of aesthetic neuromodulators (eg. Botulinum toxin type a) , 61 to 70 units + E

0.00

0.00

Injections, aesthetic – administration of aesthetic neuromodulators (eg. Botulinum toxin type a) , more than 70 units + E

0.00

0.00

Injections, aesthetic – administration of aesthetic dermal filters, first syringe + E

0.00

0.00

Injections, aesthetic – administration of aesthetic dermal filters, each subsequent syringe + E

0.00

0.00

Bleaching,vital, in office, one unit of time

91.16

109.39

Bleaching, vital, in office, two units

182.34

218.81

Bleaching, vital, in office, three units

273.50

328.20

Bleaching, vital, in office, each additional unit over three

91.16

109.39

Bleaching, vital home (includes the fabrication of bleaching trays) maxillary arch + L+ E

260.51

312.61

Bleaching, vital home, mandibular arch + L+ E

260.51

312.61

Micro-abrasion, one unit of time

82.50

99.00

 

Description

2017 GP Fee (0=IC)

2017 Specialist Fee (0=IC)

Micro-abrasion, two units

165.00

198.00

Micro-abrasion, three units

247.51

297.01

Micro-abrasion, four units

330.01

396.01

Micro-abrasion, each additional unit over four

82.50

99.00

Tobacco use cessation service, one unit of time + E

82.52

99.02

Tobacco use cessation service, two units of time + E

164.99

197.98

Tobacco use cessation service, each additional unit of time + E

82.52

99.02

Commercial laboratory procedures

0.00

0.00

Lab charges for biopsy

0.00

0.00

Laboratory and expense procedures, '+ L' in-office laboratory procedures

0.00

0.00

Laboratory and expense procedures, additional expense of materials

0.00

0.00