Report of the National Advisory Council on Dental Health

Appendix K - Schedule of Dental Services

The National Advisory Council on Dental Health (the Council) was established as a time-limited group to provide strategic, independent advice on dental health issues, as requested by Minister for Health and Ageing, to the Government. The Council’s priority task was to provide advice on dental policy options and priorities for consideration in the 2012-13 Budget.

Page last updated: 03 September 2012

      In principle, the scope of necessary dental services should be determined by requirements for consultation and comprehensive examinations, followed by decisions on what diagnoses are of dental and public health importance (including both preventive and treatment services for those diagnoses), as well as established standards of care. However, there is considerable debate within the dental profession on these areas and what constitutes ‘necessary care’.

      The approach taken by the Council has been to classify dental services into three broad tiers: diagnosis and preventive; routine; and elective. The areas of service which might be included against each tier are noted in Table 7.1 below.

      Upon examining the three tiers, it is the Council’s view that an essential dental care schedule should include diagnostic and preventive as well as routine services. This approach allows for a focus on oral health prevention and early intervention. These are the bulk of existing services, with diagnostic, preventive and routine services accounting for approximately 90 per cent of all dental services. However, only approximately two thirds to three quarters of the total costs of dental services are due to these two tiers.

      However, some patients may require more complex high end dental care which is not categorised as diagnostic, preventive or routine. In this case, we believe that any program using a primary dental care schedule would need to have a mechanism where by patients could access a category of complex care items in exceptional circumstances.

      Importantly, the inclusion or exclusion of specific tiers of services should be guided by the philosophy behind a dental program – for example, the philosophy might be to emphasise preventive clinical services, diagnose dental diseases early and encourage prompt low level interventions to address disease and restore function in the most cost–effective manner.

      Table 7.1 Scope of dental services—diagnostic and preventive, routine and elective services.

      Tiers of service Areas of service % of current services % of current costs
      Diagnostic and preventive Consultations 1.7 0.7
      Diagnostic and preventive Dental examinations 18.2 6.7
      Diagnostic and preventive Radiographs 13.1 3.9
      Diagnostic and preventive Scaling/cleaning 11.6 8.0
      Diagnostic and preventive Specific preventive services, including fluoride treatments 6.3 1.9
      Routine Consultations 0.1 0.1
      Routine Services associated with dental caries
        − Restorations and endodontics (some)
      34.9 37.6
      Routine Services associated with periodontal disease
        − Periodontics (some)
      0.5 0.4
      Routine Services associated with replacement of lost teeth
        − Partial and complete dentures (some)
      2.7 6.5
      Routine and diagnostic Sub–total 89.1 65.8
      Elective Crowns and Inlays 2.5 19.8
      Elective Bridgework 0.2 0.9
      Elective Implants 0.1 0.8
      Elective Orthodontics 1.0 0.4
      Elective Cosmetic dentistry
        including restorations placed without a diagnosis of caries and issues like tooth whitening
      1.2 1.7
      Elective Laser dentistry 0 0
      Elective Other 5.9 10.6
      Elective Sub–total 10.9 34.2

      Source: Spencer, AJ & Harford, J 2008, Improving oral health and dental care for Australians, discussion paper commissioned by the National Health and Hospitals Reform Commission, ARCPOH, based on LSDPA 2003/04; DVA Fee Schedule of Dental Services for Dentists and Dental Specialists. Note: totals will not add due to rounding.

      Using the academic and practical clinical expertise of Council members, a schedule of diagnostic, preventive and routine dental services has been developed by the Council (see Table 7.2 below).

      However, depending on the specific reform options the Government chooses to implement, this schedule may need to be further refined. Such follow–on analysis would cover also cover the high–end services that should be provided under exceptional circumstances.

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      Table 7.2 Schedule of dental services.

      Service Type Description Item Number
      Examination Diagnostic Services Comprehensive oral examination 011
      Examination Diagnostic Services Periodic oral examination 012
      Examination Diagnostic Services Oral examination – limited 013
      Examination Diagnostic Services Consultation 014
      Extended Consultation Diagnostic Services Consultation – extended (30 minutes or more) 015
      Referral Consultation Diagnostic Services Consultation by referral 016
      Letter of referral Diagnostic Services Letter of referral 019
      Radiograph Diagnostic Services Intraoral periapical or bitewing radiograph – per exposure 022
      Radiograph Diagnostic Services Intraoral radiograph – occlusal, maxillary, mandibular – per exposure 025
      Radiograph Diagnostic Services Panoramic radiograph – per exposure 037
      Examination Diagnostic Services Biopsy of tissue 051
      Preventive and Prophylactic Services Removal of plaque and/or stain 111
      Preventive and Prophylactic Services Recontouring restorations 113
      Preventive and Prophylactic Services Removal of calculus – first visit 114
      Preventive and Prophylactic Services Removal of calculus – subsequent visit 115
      Preventive and Prophylactic Services Topical application of remineralizing and/or cariostatic agents, one treatment 121
      Preventive and Prophylactic Services Concentrated remineralizing and/or cariostatic agent, application – single tooth 123
      Preventive and Prophylactic Services Dietary advice 131
      Preventive and Prophylactic Services Oral hygiene instruction 141
      Preventive and Prophylactic Services Fissure sealing – per tooth 161
      Periodontics Treatment of acute periodontal infection – per visit 213
      Periodontics Root planing and subgingival curettage – per tooth 222
      Extraction Oral Surgery Removal of a tooth or part(s) thereof 311
      Extraction Oral Surgery Sectional removal of a tooth 314
      Extraction Oral Surgery Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division 322
      Extraction Oral Surgery Surgical removal of a tooth or tooth fragment requiring removal of bone 323
      Extraction Oral Surgery Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division 324
      Emergency Surgery Oral Surgery Repositioning of displaced tooth/teeth – per tooth 384
      Extraction Oral Surgery Splinting of displaced tooth/teeth – per tooth 386
      Extraction Oral Surgery Replantation and splinting of a tooth 387
      Extraction Oral Surgery Drainage of abscess 392
      Endodontics Direct pulp capping 411
      Endodontics Pulpotomy 414
      Endodontics Complete chemo–mechanical preparation of root canal – one canal 415
      Endodontics Complete chemo–mechanical preparation of root canal – each additional canal 416
      Endodontics Root canal obturation – one canal 417
      Endodontics Root canal obturation – each additional canal 418
      Endodontics Extirpation of pulp or debridement of root canal(s) – emergency or palliative 419
      Endodontics Resorbable root canal filling – primary tooth 421
      Endodontics Additional visit for irrigation and/or dressing of the root canal system – per tooth 455
      Endodontics Interim therapeutic root filling – per tooth 458
      Restoration Restorative Services Metallic restoration – one surface – direct 511
      Restoration Restorative Services Metallic restoration – two surfaces – direct 512
      Restoration Restorative Services Metallic restoration – three surfaces – direct 513
      Restoration Restorative Services Metallic restoration – four surfaces – direct 514
      Restoration Restorative Services Metallic restoration – five surfaces – direct 515
      Restoration Restorative Services Adhesive restoration – one surface – anterior tooth – direct 521
      Restoration Restorative Services Adhesive restoration – two surfaces – anterior tooth – direct 522
      Restoration Restorative Services Adhesive restoration – three surfaces – anterior tooth – direct 523
      Restoration Restorative Services Adhesive restoration – four surfaces – anterior tooth – direct 524
      Restoration Restorative Services Adhesive restoration – five surfaces – anterior tooth – direct 525
      Restoration Restorative Services Adhesive restoration – one surface – posterior tooth – direct 531
      Restoration Restorative Services Adhesive restoration – two surfaces – posterior tooth – direct 532
      Restoration Restorative Services Adhesive restoration – three surfaces – posterior tooth – direct 533
      Restoration Restorative Services Adhesive restoration – four surfaces – posterior tooth – direct 534
      Restoration Restorative Services Adhesive restoration – five surfaces – posterior tooth – direct 535
      Restoration Restorative Services Provisional (Intermediate/temporary) restoration 572
      Restoration Restorative Services Metal band 574
      Restoration Restorative Services Pin retention – per pin 575
      Restoration Restorative Services Metallic crown – direct 576
      Restoration Restorative Services Cusp capping – per cusp 577
      Restoration Restorative Services Restoration of an incisal corner – per corner 578
      Restoration Restorative Services Bonding of tooth fragment 579
      Recementing Restorative Services Recementing of inlay/onlay 596
      Restoration Restorative Services Post – direct 597
      Restoration Prosthodontics Preliminary restoration for crown – direct 627
      Recementing Prosthodontics Recementing crown or veneer 651
      Recementing Prosthodontics Recementing bridge or splint – per abutment 652
      Other restorative Prosthodontics Removal of bridge or splint 656
      New denture Prosthodontics Complete maxillary denture 711
      New denture Prosthodontics Complete mandibular denture 712
      New denture Prosthodontics Complete maxillary and mandibular dentures 719
      New denture Prosthodontics Partial maxillary denture – resin base 721
      New denture Prosthodontics Partial mandibular denture – resin base 722
      New denture Prosthodontics Partial maxillary denture – cast metal framework 727
      New denture Prosthodontics Partial mandibular denture – cast metal framework 728
      Other denture Prosthodontics Provision for casting 730
      New denture Prosthodontics Retainer – per tooth 731
      New denture Prosthodontics Occlusal rest – per rest 732
      New denture Prosthodontics Tooth/teeth (partial denture) 733
      New denture Prosthodontics Immediate tooth replacement – per tooth 736
      New denture Prosthodontics Metal backing – per backing 739
      Denture ease Prosthodontics Adjustment of a denture 741
      Denture reline Prosthodontics Relining – complete denture – processed 743
      Denture reline Prosthodontics Relining – partial denture – processed 744
      Denture reline Prosthodontics Reline complete denture direct 751
      Denture repair Prosthodontics Reattaching pre–existing tooth or clasp to denture 761
      Denture repair Prosthodontics Replacing/adding clasp to denture – per clasp 762
      Denture repair Prosthodontics Repairing broken base of a complete denture 763
      Denture repair Prosthodontics Repairing broken base of a partial denture 764
      Denture repair Prosthodontics Replacing tooth on denture – per tooth 765
      Denture repair Prosthodontics Adding tooth to partial denture to replace an extracted or decoronated tooth –per tooth 768
      Denture repair Prosthodontics Repair or addition to metal casting 769
      Denture repair Prosthodontics Impression – dental appliance repair/modification 776
      Denture repair Prosthodontics Identification (ie labelling denture) 777
      Miscellaneous General Services Palliative care 911
      Miscellaneous General Services Provision of medication/medicament 927
      Miscellaneous General Services Splinting and stabilization – direct – per tooth 981
      Miscellaneous General Services Post–operative care not otherwise included 986

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