| 011 |
Comprehensive oral exam |
$50.65 |
| 012 |
Periodic Oral Examination |
$42.10 |
| 013 |
Oral exam- limited |
$26.45 |
| 016 |
Consultation by referral |
$98.80 |
| 018 |
Written Report |
$45.25 |
| 019 |
Letter Of Referral |
$10.70 |
| 022 |
Single X-Ray |
$35.60 |
| 025 |
Intraoral X-ray, occ/max/mand |
$59.20 |
| 031 |
Extraoral Mand. / Maxillary X – Ray |
$67.50 |
| 037 |
O P G X-ray |
$90.65 |
| 039 |
Tomography Of Skull Or Parts Thereof |
$143.05 |
| 047 |
Saliva Screening Test |
$38.95 |
| 051 |
Biopsy Of Tissue |
$119.15 |
| 071 |
Diagnostic Model – Per Model |
$58.10 |
| 072 |
Photographic Record- Intraoral |
$31.25 |
| 073 |
Photographic Record- Extraoral |
$31.25 |
| 074 |
Diagnostic wax-up |
$153.05 |
| 111 |
Removal of plaque/ stains |
$51.75 |
| 113 |
Recontour Restoration |
$19.55 |
| 114 |
Removal of calculus- 1st visit |
$86.30 |
| 115 |
Removal of calculus- 2nd visit |
$56.15 |
| 117 |
Bleaching, internal- per tooth |
$184.55 |
| 121 |
Topical Application Of Fluoride |
$33.25 |
| 123 |
Concentrated Fluoride Application-per tooth |
$26.05 |
| 131 |
Dietary Advice |
$35.00 |
| 141 |
Oral Hygiene Instruction |
$47.90 |
| 151 |
Mouthguard – Indirect |
$144.55 |
| 161 |
Fissure Sealing – Per Tooth |
$44.30 |
| 165 |
Desensitising – Per Visit |
$26.05 |
| 171 |
Odontoplasty – Per Tooth |
$48.85 |
| 213 |
Treat Acute Perio Infection |
$67.05 |
| 221 |
Clinical Perio Analysis & Recording |
$50.95 |
| 222 |
Root Planing & Subgingival Curettage – Per Tooth |
$25.05 |
| 225 |
Non-surgical Perio Treat Per Visit |
$101.70 |
| 238 |
Perio flap surg for crown lengthen -per tooth |
$363.70 |
| 241 |
Root Resection |
$208.30 |
| 245 |
Periodontal Surgery One Tooth |
$76.35 |
| 282 |
Cont Periodontal Treat/maintenance |
$152.55 |
| 311 |
Removal Of Tooth Or Part Thereof |
$126.30 |
| 314 |
Sectional Removal Of Tooth |
$161.40 |
| 322 |
Surgical Exo Tissue Impaction |
$205.05 |
| 323 |
Surgical Exo Bone Removal |
$234.10 |
| 324 |
Surg Exo Bone Rem. & Tooth Division |
$314.95 |
| 331 |
Alveolectomy Per Quadrant |
$127.75 |
| 337 |
Reduction Of Fibrous Tuberosities |
$179.65 |
| 338 |
Reduction Of Flabby Ridge Per Quad |
$101.80 |
| 341 |
Excision Of Fibrous Hyperplasia |
$162.90 |
| 351 |
Repair Of Skin, Mucosal Tissues |
$153.85 |
| 377 |
Removal Or Repair Of Soft Tissue |
$194.90 |
| 378 |
Removal Of Foreign Body |
$110.35 |
| 384 |
Reposition displaced tooth- per tooth |
$183.65 |
| 386 |
Splinting of displaced tooth-per tooth |
$189.45 |
| 387 |
Replantation and splinting of Tooth |
$370.95 |
| 391 |
Frenectomy |
$170.15 |
| 392 |
Drainage Of Abscess |
$93.20 |
| 411 |
Direct Pulp Cap |
$33.55 |
| 412 |
Incomplete Endo Therapy |
$114.85 |
| 414 |
Pulpotomy |
$73.20 |
| 415 |
Root Canal Prep – 1 Canal |
$206.05 |
| 416 |
Root Canal Prep-@ Additional Canal |
$98.15 |
| 417 |
Root Canal Obturation – 1canal |
$200.70 |
| 418 |
Obturation – Each Additional Canal |
$93.85 |
| 419 |
Extirpation Of Pulp- Emergency |
$132.70 |
| 421 |
Resorbable root canal fill – primary tooth |
$114.85 |
| 431 |
Periapical curettage – per root |
$291.00 |
| 432 |
Apicectomy – One Root |
$291.00 |
| 433 |
Exploratory periradicular surgery |
$122.40 |
| 434 |
Apical seal- per canal |
$349.10 |
| 436 |
Sealing Of Perforation |
$183.25 |
| 437 |
Surg Treat/Repair ext root resorption – per tooth |
$254.50 |
| 438 |
Hemisection |
$234.10 |
| 445 |
Explore Calcified Canal -per canal/per visit |
$101.70 |
| 451 |
Removal Of Root Filling- Per Canal |
$101.70 |
| 452 |
Removal Of Post Or Post Crown |
$101.70 |
| 453 |
Removal Or Bypass Broken Instrument |
$84.80 |
| 455 |
Additional Visit For Dressing R C T |
$101.70 |
| 457 |
Obturation Of Resorption- Non Surg |
$101.70 |
| 458 |
Interim Therapeutic Root Filling |
$13.60 |
| 511 |
Metallic restoration- 1surf- direct |
$100.30 |
| 512 |
Metallic restoration- 2surf- direct |
$122.95 |
| 513 |
Metallic restoration- 3surf- direct |
$146.70 |
| 514 |
Metallic restoration- 4surf- direct |
$167.25 |
| 515 |
Metallic restoration- 5surf- direct |
$190.95 |
| 521 |
Adhesive restoration- 1 surf- ant |
$111.10 |
| 522 |
Adhesive restoration- 2 surf- ant |
$134.85 |
| 523 |
Adhesive restoration- 3 surf- ant |
$159.70 |
| 524 |
Adhesive restoration- 4 surf- ant |
$184.55 |
| 525 |
Adhesive restoration- 5 surf- ant |
$216.90 |
| 531 |
Adhesive restoration- 1 surf- post |
$118.60 |
| 531. |
Adhesive Restoration- 1 Surf- Post |
$118.65 |
| 532 |
Adhesive restoration- 2 surf- post |
$148.90 |
| 532. |
Adhesive Restoration- 2 Surf- Post |
$148.90 |
| 533 |
Adhesive restoration- 3 surf- post |
$179.05 |
| 533. |
Adhesive Restoration- 3+ Surf- Post |
$179.05 |
| 534 |
Adhesive restoration- 4 surf- post |
$201.75 |
| 535 |
Adhesive restoration- 5 surf- post |
$233.05 |
| 541 |
Metallic rest- 1surf indirect |
$523.65 |
| 542 |
Metallic rest- 2surf indirect |
$669.20 |
| 543 |
Metallic rest- 3surf indirect |
$872.90 |
| 544 |
Metallic rest- 4surf indirect |
$974.75 |
| 545 |
Metallic rest- 5surf indirect |
$1,091.00 |
| 551 |
Tooth colored rest- 1s indirect |
$654.65 |
| 552 |
Tooth colored rest- 2s indirect |
$756.40 |
| 553 |
Tooth colored rest- 3s indirect |
$931.00 |
| 554 |
Tooth colored rest- 4s indirect |
$1,120.20 |
| 555 |
Tooth colored rest- 5s indirect |
$1,200.95 |
| 572 |
Temporary Restoration |
$46.90 |
| 574 |
Metal Band |
$39.50 |
| 575 |
Pin Retention – Per Unit Pin |
$27.00 |
| 576 |
Metallic Crown – Direct |
$247.30 |
| 577 |
Cusp Capping – Per Cusp |
$29.15 |
| 578 |
Restore Incisal Corner per corner |
$29.15 |
| 579 |
Bonding Of Tooth Fragment |
$93.20 |
| 582 |
Veneer – direct |
$243.85 |
| 583 |
Veneer – indirect |
$800.50 |
| 595 |
Removal of inlay/ onlay |
$93.20 |
| 596 |
Recementing Of Inlay/ Onlay |
$76.20 |
| 597 |
1 St Post- Direct |
$144.10 |
| 597. |
Step Down Fee For Subsequent Posts In Same Tooth |
$84.80 |
| 611 |
Full Crown- Acrylic Resin- Indirect |
$888.70 |
| 613 |
Full crown- non metallic- indirect |
$1,292.40 |
| 615 |
Full crown- veneered- indirect |
$1,215.85 |
| 618 |
Full crown- metallic- indirect |
$1,139.25 |
| 625 |
Core & Post for crown- indirect |
$307.55 |
| 627 |
Preliminary Restoration For Crown- Direct |
$127.10 |
| 629 |
Cast Post & Root Cap |
$322.15 |
| 631 |
Provisional crown |
$146.60 |
| 632 |
Provisional bridge-per pontic |
$291.00 |
| 642 |
Bridge pontic, direct |
$931.00 |
| 643 |
Bridge pontic, indirect |
$992.55 |
| 644 |
Semi fixed attachment |
$223.95 |
| 645 |
Precision Or Magnetic Attachment |
$285.05 |
| 649 |
Retainer for bonded bridge- indirect – per tooth |
$378.25 |
| 651 |
Recementing Crown |
$99.25 |
| 652 |
Recementing Bridge Or Splint |
$96.85 |
| 653 |
Rebond bridge/splint- surface treated |
$88.15 |
| 655 |
Removal Of Crown |
$59.30 |
| 656 |
Removal Of Bridge or splint |
$178.00 |
| 658 |
Repair crown/bridge/splint- indirect |
$223.95 |
| 659 |
Repair crown/bridge/splint- direct |
$285.05 |
| 662 |
Provisional Implant Crown Abutment – Per Abutment |
$146.60 |
| 671 |
Full crown on implant-non metallic-indirect |
$1,292.40 |
| 672 |
Full crown on implant-veneered-indirect |
$1,464.05 |
| 673 |
Full crown on implant- metallic- indirect |
$1,140.85 |
| 472 |
Lab fee/labour on above item (DVA) |
$179.15 |
| 482 |
Lab fee/labour on above item (DVA) |
$102.15 |
| 484 |
Lab fee/labour on above item (DVA) |
$102.15 |
| 485 |
Lab fee/labour on above item (DVA) |
$102.15 |
| 488 |
Lab fee/labour on above item (DVA) |
$39.25 |
| 711 |
Complete Maxillary Denture |
$918.10 |
| 712 |
Complete Mandibular Denture |
$918.10 |
| 719 |
Maxillary & Mandibular Dentures |
$1,628.00 |
| 731 |
Each Retainer |
$42.40 |
| 732 |
Occlusal Rest- per tooth |
$20.60 |
| 735 |
Precision Or Magnetic Denture Attachment |
$254.50 |
| 736 |
Immediate Tooth Replacement / Tooth |
$8.75 |
| 737 |
Resilient Lining To New Denture |
$181.95 |
| 738 |
Wrought Bar |
$169.55 |
| 741 |
Adjust denture |
$50.25 |
| 743 |
Reline Full Denture Processed |
$320.40 |
| 744 |
Reline Partial Denture Processed |
$273.10 |
| 751 |
Relining Full Denture Direct |
$174.55 |
| 752 |
Relining Partial Denture Direct |
$145.45 |
| 753 |
Cleaning & Polishing Old Denture |
$40.75 |
| 761 |
Reattach pre-existing Tooth / Clasp |
$36.55 |
| 762 |
Replace/add Clasp- per clasp |
$144.95 |
| 763 |
Repair Broken Base Full Denture |
$36.55 |
| 764 |
Repair Broken Base Partial Denture |
$36.55 |
| 765 |
Replace tooth on denture- per tooth |
$144.95 |
| 767 |
Any Repair Or Tooth Replacement Additional (Dva) |
$18.05 |
| 768 |
Add Tooth Part Dent For Exo Tooth |
$146.70 |
| 771 |
Tissue Conditioning Prior To Impre. |
$66.60 |
| 772 |
Splint – Resin |
$334.50 |
| 773 |
Splint – Metal |
$334.50 |
| 776 |
Impression For Denture Repair |
$44.30 |
| 777 |
Denture Identification |
$35.45 |
| 911 |
Palliative care |
$65.80 |
| 915 |
After hours call out |
$88.40 |
| 916 |
Travel to provide services |
$64.25 |
| 926 |
Custom Tray – Self Applic Of Medic. |
$152.55 |
| 927 |
Provide medication |
$26.45 |
| 963 |
Clinical Occlusal Analysis |
$84.80 |
| 964 |
Mounting Of Diagnostic Casts |
$72.70 |
| 965 |
Occlusal Splint |
$512.45 |
| 966 |
Adjustment Of Occlusal Splint |
$72.70 |
| 968 |
Occlusal Adjustment per visit |
$101.80 |
| 971 |
Adjunctive Phys. Therapy- T M J |
$72.70 |
| 972 |
Repair/addition- occlusal splint |
$276.35 |
| 986 |
Post Operative Care |
$67.85 |
| 981 |
Splinting & Stabilisation- per tooth |
$93.20 |
| 982 |
Enamel Stripping – Per Visit |
$91.60 |
