Type of dental service	ADA dental item code	Description of dental service	DWAU Value
Diagnostic services
Oral examination	011	Comprehensive oral examination	0.09
	012	Periodic oral examination	0.08
	013	Oral Examination – limited	0.05
Consultation	014	Consultation	0.11
	016	Consultation – extended (30 minutes or more)	0.18
Intra‐oral radiographs	022	Intraoral periapical or bitewing radiograph – per exposure	0.06
	024	Intraoral periapical or bitewing radiograph – each subsequent exposure (same day)	0.06
	025	Intraoral radiograph – occlusal, maxillary or mandibular – per exposure	0.11
Preventive services
Plaque and Calculus removal	111	Removal of plaque and/or stain	0.09
	114	Removal of calculus – first visit	0.15
	115	Removal of calculus – subsequent visit	0.10
Topical fluoride	121	Topical application of remineralization and/or cariostatic agents, one treatment	0.06
	123	Concentrated remineralization and/or cariostatic agents, application – single tooth	0.05
Fissure sealant	161	Fissure and/or tooth surface sealing – per tooth (first 4 services on a day)	0.08
	162	Fissure and/or tooth surface sealing – per tooth (after 4 occasions of 161 on a day)	0.08
Dietary advice	131	Dietary analysis and advice	0.06
Oral hygiene instruction	141	Oral hygiene instruction	0.09
Oral Surgery
Simple extraction	311	Removal of a tooth or part(s) thereof	0.23
	314	Sectional removal of a tooth or part(s) thereof	0.29
	316	Removal of additional tooth or part(s) thereof – same quadrant per day	0.23
Surgical extraction	322	Surgical removal of tooth/fragment not requiring removal of bone or tooth division	0.37
	323	Surgical removal of tooth/fragment requiring removal of bone	0.42
	324	Surgical removal of tooth/fragment requiring both removal of bone and tooth division	0.57
	326	Additional surgical removal of tooth/fragment	0.42
Restorative services
Adhesive anterior restorations	521	Adhesive restoration – one surface – anterior tooth – direct	0.2
	522	Adhesive restoration – two surface – anterior tooth – direct	0.24
	523	Adhesive restoration – three surfaces – anterior tooth – direct	0.29
	524	Adhesive restoration – four surfaces – anterior tooth – direct	0.33
	525	Adhesive restoration – five surfaces – anterior tooth – direct	0.39
Adhesive posterior restorations	511	Metallic restoration – one surface – direct	0.18
	512	Metallic restoration – two surfaces – direct	0.22
	513	Metallic restoration – three surfaces – direct	0.26
	514	Metallic restoration – four surfaces – direct	0.3
	515	Metallic restoration – five surfaces – direct	0.34
	531	Composite resin restoration – one surface – posterior tooth – direct	0.21
	532	Composite resin restoration – two surface – posterior tooth – direct	0.27
	533	Composite resin restoration – three surfaces – posterior tooth – direct	0.32
	534	Composite resin restoration – four surfaces – posterior tooth – direct	0.36
	535	Composite resin restoration – five surfaces – posterior tooth – direct	0.42
Stainless steel crown	586	Crown metallic – with tooth preparation – preformed	0.44
	587	Crown metallic – minimal tooth preparation – preformed (Hall crown)	0.44
	588	Crown – tooth coloured – preformed	0.44
General services
Use of interpreter	935	Interpreter	0