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Effective 1 July 2024

Dental services can be invoiced online via HICAPS Digital Claims for next business day payments.

For dental services provided on or after 1 July 2024
GeneralSpecialist
Service DescriptionADA NumberMaximum
Payment
Rate 		Maximum
Payment
Rate
Diagnostic services
Comprehensive Oral Examination 011 $115.61$115.61
Periodic Oral Examination 012 $73.08 $73.08
Consultation 014 $115.61$115.61
Written report (not elsewhere included) 018 $160.85 $211.74
Intraoral periapical or bitewing radiograph - per exposure 022 $56.95 $56.95
Cone Beam Volumetric Tomography - scan acquisition - per appointment 026 $181.79 $181.79
Cephalometric Radiograph - per exposure 036 $128.52$128.52
Panoramic radiograph - per exposure 037 $128.52$128.52
Pulp Testing - per appointment 061 $41.34$41.34
Diagnostic model - per model 071 $79.98$79.98
Photographic records - intraoral - per appointment 072 $45.68$45.68
Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (both arches) 089 $84.84$84.84
Preventive Services
(Prior approval from TAC required for these services)
Removal Of Calculus - first appointment 114 $143.64 $143.64
Bleaching, Internal - per tooth 117 $254.87 $254.87
Topical application of remineralisation and/or cariostatic agents - one treatment 121 $52.41 $52.41
Oral hygiene instruction 141 $57.28$57.28
Desensitising Procedure - per appointment 165 $53.96$53.96
Odontoplasty - per tooth 171 $57.72 $57.72
Periodontal Debridement - per tooth 222 $65.44 $75.25
Periodontal Flap Surgery - per tooth - Limit of 10 per visit, 20 per 12 month period 232 $323.18 $323.18
Surgical treatment of Peri-implant Disease - per implant 233 $389.93$389.93
Gingival Graft - per tooth, implant or extraction 235 $562.73 $662.05
Guided Tissue Regeneration - per tooth or implant 236 $562.73$662.05
Guided Tissue Regeneration - membrane removal 237 $653.71 $769.10
Periodontal Surgery for Crown Lengthening - per tooth 238 $565.38 $665.15
Osseous Graft- per tooth or implant 243 $562.73 $662.05
Oral Surgery
Removal of a tooth or part(s) thereof 311 $239.33 $258.82
Sectional removal of tooth or part(s) thereof 314 $315.41 $321.97
Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division 322 $354.83 $371.48
Surgical removal of a tooth or tooth fragment requiring removal of bone 323 $427.26 $456.92
Splinting of displaced tooth/teeth - per tooth 386 $235.29 $294.56
Replantation and splinting of a tooth - per tooth 387 $473.02 $543.97
Endodontics
(These fees include the cost of x-rays where required)    
Direct Pulp Capping 411 $63.72 $66.87
Pulpotomy 414 $157.20 $214.80
Complete chemo-mechanical preparation of root canal - one canal 415 $367.58 $422.70
Complete chemo-mechanical preparation of root canal - each additional canal 416 $180.93 $209.65
Root canal obturation - one canal 417 $360.76 $414.87
Root canal obturation - each additional canal 418 $177.96 $204.65
Extirpation of pulp or debridement of root canal(s) - emergency or palliative 419 $252.43$252.43
Removal Of Root Filling - Per Canal 451 $172.08 $197.91
Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - per tooth 455 $190.54 $219.12
Restorative Services   
Metallic Restoration - One Surface - direct 511 $187.99 $216.18
Metallic Restoration - Two Surfaces - direct 512 $224.67 $258.36
Metallic Restoration - Three Surfaces - direct 513 $263.05 $302.52
Metallic Restoration - Four Surfaces - direct 514 $301.75 $347.02
Metallic Restoration - Five Surfaces - direct 515 $342.67 $394.06
Adhesive Restoration - One Surface - Anterior Tooth - direct 521 $202.13 $232.44
Adhesive Restoration - Two Surfaces - Anterior tooth - direct 522 $237.71 $273.40
Adhesive Restoration - Three Surfaces - Anterior tooth - direct 523 $278.97 $320.82
Adhesive Restoration - Four Surfaces - Anterior tooth - direct 524 $313.87 $360.97
Adhesive Restoration - Five Surfaces - Anterior tooth - direct 525 $369.19 $424.56
Adhesive Restoration - Veneer - Anterior tooth- direct 526 $416.01 $456.87
Adhesive restoration - one surface - posterior tooth - direct 531 $213.10 $245.06
Adhesive restoration - two surfaces - posterior tooth - direct 532 $253.85 $291.93
Adhesive restoration - three surfaces - posterior tooth - direct 533 $296.91 $341.45
Adhesive restoration - four surfaces - posterior tooth - direct 534 $334.48 $384.66
Adhesive restoration - five surfaces - posterior tooth - direct 535 $398.56 $458.34
Adhesive Restoration - Veneer - Posterior tooth - direct 536 $408.40 $456.87
Tooth coloured restoration - one surface - indirect 551 $1,028.86 $1,183.21
Tooth coloured restoration - two surfaces - indirect 552 $1,140.36 $1,311.42
Tooth coloured restoration - three surfaces - indirect 553 $1,317.30 $1,514.89
Tooth coloured restoration - four surfaces - indirect 554 $1,429.99 $1,644.50
Tooth coloured restoration - five surfaces - indirect 555 $1,568.15 $1,803.37
Tooth - coloured restoration - Veneer - indirect 556 $1,505.14 $1,730.91
Provisional (intermediate/temporary) restoration - per tooth 572 $110.29$110.29
Pin retention - per pin 575 $49.84 $49.84
Post - Direct 597 $204.33 $229.77
Crown and Bridgework
(If these procedures are to be carried out in a hospital under general anaesthesia, prior approval must be obtained from the TAC)
Full crown - non metallic - indirect 613 $1,771.26 $2,036.96
Full crown - veneered - indirect 615 $1,747.26 $2,009.35
Full crown - metallic indirect 618 $1,758.17 $2,021.89
Post and core for crown - indirect 625 $553.13 $665.15
Preliminary restoration for crown - direct 627 $309.20 $328.55
Provisional bridge pontic - per pontic 632 $350.43$350.43
Bridge pontic - direct - per pontic 642 $456.24 $524.69
Bridge pontic - indirect - per pontic 643 $1,317.62 $1,778.78
Retainer for bonded fixture - indirect - per tooth 649 $782.75 $900.16
Implant Procedures
Fitting of an implant abutment - per abutment 661 $1,130.02$1,130.02
Prosthesis with metal frame attached to implants - fixed - per arch 666 $4,071.85 $5,966.03
Removal and reattachment of prosthesis fixed to implant(s) – per implant 669 $196.19 $196.19
Full crown attached to osseointegrated implant - veneered indirect 672 $2,252.85 $2,957.40
Surgical implant guide 679 $267.62 $267.62
Insertion of first stage of two-stage endosseous implant - per implant 684 $2,423.72 $2,423.72
Insertion of one stage endosseous implant - per implant
Includes the cost of hardware		 688 $2,924.83 $2,924.83
Second stage surgery of two stage endosseous implant - per implant
Includes the cost of hardware 		691 $500.98 $500.98
Prosthodontics
Complete Maxillary Denture 711 $1624.07 $1,867.67
Complete Mandibular Denture 712 $1624.07 $1,867.67
Complete Maxillary and Mandibular Denture 719 $2,945.02 $3,386.76
Partial maxillary denture - resin base 721 $1,042.80 $1,042.80
Partial mandibular denture - resin base 722 $1,042.80 $1,042.80
Partial maxillary denture - cast metal framework including rests and retainers 727 $1,809.30 $2,080.72
Partial mandibular denture - cast metal framework including rests and retainers 728 $1,809.30 $2,080.72
Additional items for Acrylic Dentures only
Retainer - Per Tooth 731 $65.35 $65.35
Occlusal Rest - per rest 732 $18.95 $18.95
Tooth/teeth partial denture 733 $64.24 $64.24
Immediate tooth replacement - per tooth 736 $12.75 $12.75
Relining - complete denture - processed 743 $511.41 $511.41
Relining - partial denture - processed 744 $497.79 $497.79
Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth 768 $221.66 $257.56
Splint  - Resin - Indirect772$334.22$473.02
Orthodontics
Active removable appliance therapy - per arch 821 $1,169.55 $1,341.07
Full arch banding - per arch 831 $3,224.76 $4,609.37
Minor tooth guidance - fixed 846 $1,045.78 $1,045.78
Complete course of orthodontic treatment 881 $6,661.60 $8,625.87
General
Travel to provide services 916 FBN* FBN*
Clinical occlusal analysis, including muscle and joint palpation - limit one per three year period 963 $110.29 $154.33
Occlusal splint 965 $734.02 $752.37
Adjustment of pre-existing occlusal splint - per appointment 966 $104.55 $133.73
For dental services provided on or after 1 July 2024
GeneralSpecialist
Service DescriptionADA NumberMaximum
Payment
Rate 		Maximum
Payment
Rate
Diagnostic services
Comprehensive Oral Examination 011 $115.61$115.61
Periodic Oral Examination 012 $73.08 $73.08
Consultation 014 $115.61$115.61
Written report (not elsewhere included) 018 $160.85 $211.74
Intraoral periapical or bitewing radiograph - per exposure 022 $56.95 $56.95
Cone Beam Volumetric Tomography - scan acquisition - per appointment 026 $181.79 $181.79
Cephalometric Radiograph - per exposure 036 $128.52$128.52
Panoramic radiograph - per exposure 037 $128.52$128.52
Pulp Testing - per appointment 061 $41.34$41.34
Diagnostic model - per model 071 $79.98$79.98
Photographic records - intraoral - per appointment 072 $45.68$45.68
Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (both arches) 089 $84.84$84.84
Preventive Services
(Prior approval from TAC required for these services)
Removal Of Calculus - first appointment 114 $143.64 $143.64
Bleaching, Internal - per tooth 117 $254.87 $254.87
Topical application of remineralisation and/or cariostatic agents - one treatment 121 $52.41 $52.41
Oral hygiene instruction 141 $57.28$57.28
Desensitising Procedure - per appointment 165 $53.96$53.96
Odontoplasty - per tooth 171 $57.72 $57.72
Periodontal Debridement - per tooth 222 $65.44 $75.25
Periodontal Flap Surgery - per tooth - Limit of 10 per visit, 20 per 12 month period 232 $323.18 $323.18
Surgical treatment of Peri-implant Disease - per implant 233 $389.93$389.93
Gingival Graft - per tooth, implant or extraction 235 $562.73 $662.05
Guided Tissue Regeneration - per tooth or implant 236 $562.73$662.05
Guided Tissue Regeneration - membrane removal 237 $653.71 $769.10
Periodontal Surgery for Crown Lengthening - per tooth 238 $565.38 $665.15
Osseous Graft- per tooth or implant 243 $562.73 $662.05
Oral Surgery
Removal of a tooth or part(s) thereof 311 $239.33 $258.82
Sectional removal of tooth or part(s) thereof 314 $315.41 $321.97
Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division 322 $354.83 $371.48
Surgical removal of a tooth or tooth fragment requiring removal of bone 323 $427.26 $456.92
Splinting of displaced tooth/teeth - per tooth 386 $235.29 $294.56
Replantation and splinting of a tooth - per tooth 387 $473.02 $543.97
Endodontics
(These fees include the cost of x-rays where required)    
Direct Pulp Capping 411 $63.72 $66.87
Pulpotomy 414 $157.20 $214.80
Complete chemo-mechanical preparation of root canal - one canal 415 $367.58 $422.70
Complete chemo-mechanical preparation of root canal - each additional canal 416 $180.93 $209.65
Root canal obturation - one canal 417 $360.76 $414.87
Root canal obturation - each additional canal 418 $177.96 $204.65
Extirpation of pulp or debridement of root canal(s) - emergency or palliative 419 $252.43$252.43
Removal Of Root Filling - Per Canal 451 $172.08 $197.91
Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - per tooth 455 $190.54 $219.12
Restorative Services   
Metallic Restoration - One Surface - direct 511 $187.99 $216.18
Metallic Restoration - Two Surfaces - direct 512 $224.67 $258.36
Metallic Restoration - Three Surfaces - direct 513 $263.05 $302.52
Metallic Restoration - Four Surfaces - direct 514 $301.75 $347.02
Metallic Restoration - Five Surfaces - direct 515 $342.67 $394.06
Adhesive Restoration - One Surface - Anterior Tooth - direct 521 $202.13 $232.44
Adhesive Restoration - Two Surfaces - Anterior tooth - direct 522 $237.71 $273.40
Adhesive Restoration - Three Surfaces - Anterior tooth - direct 523 $278.97 $320.82
Adhesive Restoration - Four Surfaces - Anterior tooth - direct 524 $313.87 $360.97
Adhesive Restoration - Five Surfaces - Anterior tooth - direct 525 $369.19 $424.56
Adhesive Restoration - Veneer - Anterior tooth- direct 526 $416.01 $456.87
Adhesive restoration - one surface - posterior tooth - direct 531 $213.10 $245.06
Adhesive restoration - two surfaces - posterior tooth - direct 532 $253.85 $291.93
Adhesive restoration - three surfaces - posterior tooth - direct 533 $296.91 $341.45
Adhesive restoration - four surfaces - posterior tooth - direct 534 $334.48 $384.66
Adhesive restoration - five surfaces - posterior tooth - direct 535 $398.56 $458.34
Adhesive Restoration - Veneer - Posterior tooth - direct 536 $408.40 $456.87
Tooth coloured restoration - one surface - indirect 551 $1,028.86 $1,183.21
Tooth coloured restoration - two surfaces - indirect 552 $1,140.36 $1,311.42
Tooth coloured restoration - three surfaces - indirect 553 $1,317.30 $1,514.89
Tooth coloured restoration - four surfaces - indirect 554 $1,429.99 $1,644.50
Tooth coloured restoration - five surfaces - indirect 555 $1,568.15 $1,803.37
Tooth - coloured restoration - Veneer - indirect 556 $1,505.14 $1,730.91
Provisional (intermediate/temporary) restoration - per tooth 572 $110.29$110.29
Pin retention - per pin 575 $49.84 $49.84
Post - Direct 597 $204.33 $229.77
Crown and Bridgework
(If these procedures are to be carried out in a hospital under general anaesthesia, prior approval must be obtained from the TAC)
Full crown - non metallic - indirect 613 $1,771.26 $2,036.96
Full crown - veneered - indirect 615 $1,747.26 $2,009.35
Full crown - metallic indirect 618 $1,758.17 $2,021.89
Post and core for crown - indirect 625 $553.13 $665.15
Preliminary restoration for crown - direct 627 $309.20 $328.55
Provisional bridge pontic - per pontic 632 $350.43$350.43
Bridge pontic - direct - per pontic 642 $456.24 $524.69
Bridge pontic - indirect - per pontic 643 $1,317.62 $1,778.78
Retainer for bonded fixture - indirect - per tooth 649 $782.75 $900.16
Implant Procedures
Fitting of an implant abutment - per abutment 661 $1,130.02$1,130.02
Prosthesis with metal frame attached to implants - fixed - per arch 666 $4,071.85 $5,966.03
Removal and reattachment of prosthesis fixed to implant(s) – per implant 669 $196.19 $196.19
Full crown attached to osseointegrated implant - veneered indirect 672 $2,252.85 $2,957.40
Surgical implant guide 679 $267.62 $267.62
Insertion of first stage of two-stage endosseous implant - per implant 684 $2,423.72 $2,423.72
Insertion of one stage endosseous implant - per implant
Includes the cost of hardware		 688 $2,924.83 $2,924.83
Second stage surgery of two stage endosseous implant - per implant
Includes the cost of hardware 		691 $500.98 $500.98
Prosthodontics
Complete Maxillary Denture 711 $1624.07 $1,867.67
Complete Mandibular Denture 712 $1624.07 $1,867.67
Complete Maxillary and Mandibular Denture 719 $2,945.02 $3,386.76
Partial maxillary denture - resin base 721 $1,042.80 $1,042.80
Partial mandibular denture - resin base 722 $1,042.80 $1,042.80
Partial maxillary denture - cast metal framework including rests and retainers 727 $1,809.30 $2,080.72
Partial mandibular denture - cast metal framework including rests and retainers 728 $1,809.30 $2,080.72
Additional items for Acrylic Dentures only
Retainer - Per Tooth 731 $65.35 $65.35
Occlusal Rest - per rest 732 $18.95 $18.95
Tooth/teeth partial denture 733 $64.24 $64.24
Immediate tooth replacement - per tooth 736 $12.75 $12.75
Relining - complete denture - processed 743 $511.41 $511.41
Relining - partial denture - processed 744 $497.79 $497.79
Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth 768 $221.66 $257.56
Splint  - Resin - Indirect772$334.22$473.02
Orthodontics
Active removable appliance therapy - per arch 821 $1,169.55 $1,341.07
Full arch banding - per arch 831 $3,224.76 $4,609.37
Minor tooth guidance - fixed 846 $1,045.78 $1,045.78
Complete course of orthodontic treatment 881 $6,661.60 $8,625.87
General
Travel to provide services 916 FBN* FBN*
Clinical occlusal analysis, including muscle and joint palpation - limit one per three year period 963 $110.29 $154.33
Occlusal splint 965 $734.02 $752.37
Adjustment of pre-existing occlusal splint - per appointment 966 $104.55 $133.73
For dental services provided between 1 July 2023 and 30 June 2024
GeneralSpecialist
Service DescriptionADA NumberMaximum
Payment
Rate 		Maximum
Payment
Rate
Diagnostic services
Comprehensive Oral Examination 011 $111.37$111.37
Periodic Oral Examination 012 $70.40 $70.40
Consultation 014 $111.37$111.37
Written report (not elsewhere included) 018 $154.95 $203.97
Intraoral periapical or bitewing radiograph - per exposure 022 $54.86 $54.86
Cone Beam Volumetric Tomography - scan acquisition - per appointment 026 $175.12 $175.12
Cephalometric Radiograph - per exposure 036 $123.80 $123.80
Panoramic radiograph - per exposure 037 $123.80 $123.80
Pulp Testing - per appointment 061 $39.82 $39.82
Diagnostic model - per model 071 $77.04 $77.04
Photographic records - intraoral - per appointment 072 $44.00 $44.00
Cone Beam Volumetric Tomography analysis and/or interpretation - maxillary or mandibular dentition (both arches) 089 $81.73 $81.73
Preventive Services
(Prior approval from TAC required for these services)
Removal Of Calculus - first appointment 114 $ 138.37 $138.37
Bleaching, Internal - per tooth 117 $245.52 $245.52
Topical application of remineralisation and/or cariostatic agents - one treatment 121 $50.49 $50.49
Oral hygiene instruction 141 $55.18$55.18
Desensitising Procedure - per appointment 165 $51.98$51.98
Odontoplasty - per tooth 171 $55.60 $55.60
Periodontal Debridement - per tooth 222 $63.04 $72.49
Periodontal Flap Surgery - per tooth - Limit of 10 per visit, 20 per 12 month period 232 $311.32 $311.32
Surgical treatment of Peri-implant Disease - per implant 233 $375.62 $375.62
Gingival Graft - per tooth, implant or extraction 235 $542.08 $637.75
Guided Tissue Regeneration - per tooth or implant 236 $542.08 $637.75
Guided Tissue Regeneration - membrane removal 237 $629.72 $740.87
Periodontal Surgery for Crown Lengthening - per tooth 238 $544.63 $640.74
Osseous Graft- per tooth or implant 243 $542.08 $637.75
Oral Surgery
Removal of a tooth or part(s) thereof 311 $230.55 $249.32
Sectional removal of tooth or part(s) thereof 314 $303.83 $310.15
Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division 322 $341.81 $357.85
Surgical removal of a tooth or tooth fragment requiring removal of bone 323 $411.58 $440.15
Splinting of displaced tooth/teeth - per tooth 386 $226.65 $283.75
Replantation and splinting of a tooth - per tooth 387 $455.66 $524.01
Endodontics
(These fees include the cost of x-rays where required)    
Direct Pulp Capping 411 $61.38 $64.42
Pulpotomy 414 $151.43 $206.92
Complete chemo-mechanical preparation of root canal - one canal 415 $354.09 $407.19
Complete chemo-mechanical preparation of root canal - each additional canal 416 $174.29 $201.96
Root canal obturation - one canal 417 $347.52 $399.64
Root canal obturation - each additional canal 418 $171.43 $197.14
Extirpation of pulp or debridement of root canal(s) - emergency or palliative 419 $243.17 $243.17
Removal Of Root Filling - Per Canal 451 $165.76 $190.65
Additional Visit For Irrigation And/Or Dressing Of The Root Canal System - per tooth 455 $183.55 $211.08
Restorative Services   
Metallic Restoration - One Surface - direct 511 $181.09 $208.25
Metallic Restoration - Two Surfaces - direct 512 $216.42 $248.88
Metallic Restoration - Three Surfaces - direct 513 $253.40 $291.42
Metallic Restoration - Four Surfaces - direct 514 $290.68 $334.28
Metallic Restoration - Five Surfaces - direct 515 $330.09 $379.60
Adhesive Restoration - One Surface - Anterior Tooth - direct 521 $194.71 $223.91
Adhesive Restoration - Two Surfaces - Anterior tooth - direct 522 $228.99 $263.37
Adhesive Restoration - Three Surfaces - Anterior tooth - direct 523 $268.73 $309.05
Adhesive Restoration - Four Surfaces - Anterior tooth - direct 524 $302.35 $347.72
Adhesive Restoration - Five Surfaces - Anterior tooth - direct 525 $355.64 $408.98
Adhesive Restoration - Veneer - Anterior tooth- direct 526 $400.74 $440.10
Adhesive restoration - one surface - posterior tooth - direct 531 $205.28 $236.07
Adhesive restoration - two surfaces - posterior tooth - direct 532 $244.53 $281.22
Adhesive restoration - three surfaces - posterior tooth - direct 533 $286.01 $328.92
Adhesive restoration - four surfaces - posterior tooth - direct 534 $322.20 $370.54
Adhesive restoration - five surfaces - posterior tooth - direct 535 $383.93 $441.52
Adhesive Restoration - Veneer - Posterior tooth - direct 536 $393.41 $440.10
Tooth coloured restoration - one surface - indirect 551 $991.10 $1,139.78
Tooth coloured restoration - two surfaces - indirect 552 $1,098.51 $1,263.29
Tooth coloured restoration - three surfaces - indirect 553 $1,268.95 $1,459.29
Tooth coloured restoration - four surfaces - indirect 554 $1,377.51 $1,584.14
Tooth coloured restoration - five surfaces - indirect 555 $1,510.60 $1,737.18
Tooth - coloured restoration - Veneer - indirect 556 $1,449.90 $1,667.38
Provisional (intermediate/temporary) restoration - per tooth 572 $106.24 $106.24
Pin retention - per pin 575 $48.01 $48.01
Post - Direct 597 $196.83 $221.34
Crown and Bridgework
(If these procedures are to be carried out in a hospital under general anaesthesia, prior approval must be obtained from the TAC)
Full crown - non metallic - indirect 613 $1,706.25 $1,962.20
Full crown - veneered - indirect 615 $1,683.13 $1,935.60
Full crown - metallic indirect 618 $1,693.64 $1,947.68
Post and core for crown - indirect 625 $532.83 $640.74
Preliminary restoration for crown - direct 627 $297.85 $316.49
Provisional bridge pontic - per pontic 632 $337.57 $337.57
Bridge pontic - direct - per pontic 642 $439.50 $505.43
Bridge pontic - indirect - per pontic 643 $1,269.26 $1,713.50
Retainer for bonded fixture - indirect - per tooth 649 $754.02 $867.12
Implant Procedures
Fitting of an implant abutment - per abutment 661 $1,088.55 $1,088.55
Prosthesis with metal frame attached to implants - fixed - per arch 666 $3,922.41 $5,747.07
Removal and reattachment of prosthesis fixed to implant(s) – per implant 669 $188.99 $188.99
Full crown attached to osseointegrated implant - veneered indirect 672 $2,170.17 $2,848.86
Surgical implant guide 679 $257.80 $257.80
Insertion of first stage of two-stage endosseous implant - per implant 684 $2,334.77 $2,334.77
Insertion of one stage endosseous implant - per implant
Includes the cost of hardware		 688 $2,817.48 $2,817.48
Second stage surgery of two stage endosseous implant - per implant
Includes the cost of hardware 		691 $482.59 $482.59
Prosthodontics
Complete Maxillary Denture 711 $1,564.46 $1,799.12
Complete Mandibular Denture 712 $1,564.46 $1,799.12
Complete Maxillary and Mandibular Denture 719 $2,836.93 $3,262.46
Partial maxillary denture - resin base 721 $1,004.53 $1,004.53
Partial mandibular denture - resin base 722 $1,004.53 $1,004.53
Partial maxillary denture - cast metal framework including rests and retainers 727 $1,742.90 $2,004.35
Partial mandibular denture - cast metal framework including rests and retainers 728 $1,742.90 $2,004.35
Additional items for Acrylic Dentures only
Retainer - Per Tooth 731 $62.95 $62.95
Occlusal Rest - per rest 732 $18.25 $18.25
Tooth/teeth partial denture 733 $61.88 $61.88
Immediate tooth replacement - per tooth 736 $12.28 $12.28
Relining - complete denture - processed 743 $492.64 $492.64
Relining - partial denture - processed 744 $479.52 $479.52
Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth 768 $213.52 $248.11
Splint  - Resin - Indirect772$321.95$455.66
Orthodontics
Active removable appliance therapy - per arch 821 $1,126.63 $1,291.85
Full arch banding - per arch 831 $3,106.41 $4,440.20
Minor tooth guidance - fixed 846 $1,007.40 $1,007.40
Complete course of orthodontic treatment 881 $6,417.11 $8,309.29
General
Travel to provide services 916 FBN* FBN*
Clinical occlusal analysis, including muscle and joint palpation - limit one per three year period 963 $106.24 $148.67
Occlusal splint 965 $707.08 $724.76
Adjustment of pre-existing occlusal splint - per appointment 966 $100.71 $128.82

* Note: Where the terminology FBN appears in this schedule, the fee must be negotiated with the TAC before any dental treatment is commenced.

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