Table 6.
Item code | Service description | Model A National |
Model B Victoria | |||
---|---|---|---|---|---|---|
DH | OHT/DT | Dentist | OHT | Dentist | ||
88011 | Comprehensive oral exam | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88012 | Periodic oral examination | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88013 | Oral examination—limited | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88022 | Intraoral periapical or bitewing radiograph—per exposure | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88025 | Intraoral radiograph—occlusal, maxillary, mandibular—per exposure | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88111 | Removal of plaque and/or stain | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88114 | Removal of calculus—first visit | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88115 | Removal of calculus—subsequent visit | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88121 | Topical application of remineralisation and/or cariostatic agents, one treatment | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88161 | Fissure and/or tooth surface sealing—per tooth (first four services on a day) | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88162 | Fissure and/or tooth surface sealing—per tooth (subsequent services) | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88213 | Treatment of acute periodontal infection—per visit | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88221 | Clinical periodontal analysis and recording | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88311 | Removal of a tooth or part(s) thereof—first tooth extracted on a day | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88314 | Sectional removal of a tooth or part(s) thereof—first tooth extracted on a day | 0 | 0 | 1 | 0 | 1 |
88316 | Additional extraction requiring removal of a tooth or part(s) thereof, or sectional removal of a tooth | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88322 | Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division—first tooth extracted on a day | 0 | 0 | 1 | 0 | 1 |
88323 | Surgical removal of a tooth or tooth fragment requiring removal of bone—first tooth extracted on a day | 0 | 0 | 1 | 0 | 1 |
88324 | Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division—first tooth extracted on a day | 0 | 0 | 1 | 0 | 1 |
88326 | Additional extraction requiring surgical removal of a tooth or tooth fragment | 0 | 0 | 1 | 0 | 1 |
88351 | Repair of skin and subcutaneous tissue or mucous membrane | 0 | 0 | 1 | 0 | 1 |
88384 | Repositioning of displaced tooth/teeth—per tooth | 0 | 0 | 1 | 0 | 1 |
88386 | Splinting of displaced tooth/teeth—per tooth | 0 | 0 | 1 | 0 | 1 |
88387 | Replantation and splinting of a tooth | 0 | 0 | 1 | 0 | 1 |
88392 | Drainage of abscess | 0 | 0 | 1 | 0 | 1 |
88411 | Direct pulp capping | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88412 | Incomplete endodontic therapy (tooth not suitable for further treatment) | 0 | 0 | 1 | 0 | 1 |
88414 | Pulpotomy | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88415 | Complete chemo-mechanical preparation of root canal—one canal | 0 | 0 | 1 | 0 | 1 |
88416 | Complete chemo-mechanical preparation of root canal—each additional canal | 0 | 0 | 1 | 0 | 1 |
88417 | Root canal obturation—one canal | 0 | 0 | 1 | 0 | 1 |
88418 | Root canal obturation—each additional canal | 0 | 0 | 1 | 0 | 1 |
88419 | Extirpation of pulp or debridement of root canal(s)—emergency or palliative | 0 | 0 | 1 | 0 | 1 |
88421 | Resorbable root canal filling—primary tooth | 0 | 0 | 1 | 0 | 1 |
88455 | Additional visit for irrigation and/or dressing of the root canal system—per tooth | 0 | 0 | 1 | 0 | 1 |
88458 | Interim therapeutic root filling—per tooth | 0 | 0 | 1 | 0 | 1 |
88511 | Metallic restoration—one surface—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88512 | Metallic restoration—two surfaces—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88513 | Metallic restoration—three surfaces—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88514 | Metallic restoration—four surfaces—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88515 | Metallic restoration—five surfaces—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88521 | Adhesive restoration—one surface—anterior tooth—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88522 | Adhesive restoration—two surfaces—anterior tooth—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88523 | Adhesive restoration—three surfaces—anterior tooth—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88524 | Adhesive restoration—four surfaces—anterior tooth—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88525 | Adhesive restoration—five surfaces—anterior tooth—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88531 | Adhesive restoration—one surface—posterior tooth—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88532 | Adhesive restoration—two surfaces—posterior tooth—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88533 | Adhesive restoration—three surfaces—posterior tooth—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88534 | Adhesive restoration—four surfaces—posterior tooth—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88535 | Adhesive restoration—five surfaces—posterior tooth—direct | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88572 | Provisional (intermediate/temporary) restoration—per tooth | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88574 | Metal band | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88575 | Pin retention—per pin | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88576 | Metallic crown—preformed | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88579 | Bonding of tooth fragment | 0 | 0.140 | 0.860 | 0.390 | 0.610 |
88597 | Post—direct | 0 | 0 | 1 | 0 | 1 |
88721 | Partial maxillary denture—resin, base only | 0 | 0 | 1 | 0 | 1 |
88722 | Partial mandibular denture—resin, base only | 0 | 0 | 1 | 0 | 1 |
88731 | Retainer—per tooth | 0 | 0 | 1 | 0 | 1 |
88733 | Tooth/teeth (partial denture) | 0 | 0 | 1 | 0 | 1 |
88736 | Immediate tooth replacement—per tooth | 0 | 0 | 1 | 0 | 1 |
88741 | Adjustment of a denture | 0 | 0 | 1 | 0 | 1 |
88761 | Reattaching pre-existing clasp to denture | 0 | 0 | 1 | 0 | 1 |
88762 | Replacing/adding clasp to denture—per clasp | 0 | 0 | 1 | 0 | 1 |
88764 | Repairing broken base of a partial denture | 0 | 0 | 1 | 0 | 1 |
88765 | Replacing/adding new tooth on denture—per tooth | 0 | 0 | 1 | 0 | 1 |
88766 | Reattaching existing tooth on denture—per tooth | 0 | 0 | 1 | 0 | 1 |
88768 | Adding tooth to partial denture to replace an extracted or decoronated tooth—per tooth | 0 | 0 | 1 | 0 | 1 |
88776 | Impression—dental appliance repair/modification | 0 | 0 | 1 | 0 | 1 |
88911 | Palliative care | 0.0657 | 0.131 | 0.804 | 0.390 | 0.610 |
88942 | Sedation—intravenous | 0 | 0 | 1 | 0 | 1 |
88943 | Sedation—inhalation | 0 | 0 | 1 | 0 | 1 |
DH dental hygienist, DT dental therapist, OHT oral health therapist