Dental Benefits Amendment Rules 2023 (Cth)

Dental Benefits Amendment Rules 2023

I, Simon Cotterell, as delegate of the Minister for Health and Aged Care, make the following Rules.

Dated 8 December 2023

Simon Cotterell First Assistant Secretary Primary Care Division Department of Health and Aged Care

Contents 1 Name 2 Commencement 3 Authority 4 Schedules Schedule 1—Amendments Dental Benefits Rules 2014

1 Name This instrument is the Dental Benefits Amendment Rules 2023.

2 Commencement (1) Each provision of this instrument specified in column 1 of the table commences, or is taken to have commenced, in accordance with column 2 of the table. Any other statement in column 2 has effect according to its terms.

Commencement information Column 1 Column 2 Column 3 Provisions Commencement Date/Details 1. The whole of this instrument 1 January 2024

Note: This table relates only to the provisions of this instrument as originally made. It will not be amended to deal with any later amendments of this instrument. (2) Any information in column 3 of the table is not part of this instrument. Information may be inserted in this column, or information in it may be edited, in any published version of this instrument.

3 Authority This instrument is made under subsection 60(1) of the Dental Benefits Act 2008.

4 Schedules Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.

Schedule 1—Amendments

Dental Benefits Rules 2014

1 Schedule 1 Dental Benefits Schedule Repeal Schedule 1, substitute: Schedule 1 Dental Benefits Schedule (rule 5)

Item Service Benefit ($) Group U0 – Diagnostic Services Subgroup 1 – Examinations 88011 Comprehensive oral examination 57.65 Evaluation of all teeth, their supporting tissues and the oral tissues in order to record the condition of these structures. This evaluation includes recording an appropriate medical history and any other relevant information. (Item is subject to Rules 18 and 19) 88012 Periodic oral examination 47.90 An evaluation performed on a patient of record to determine any changes in the patient's dental and medical health status since a previous comprehensive or periodic examination. (Item is subject to Rules 18 and 19) 88013 Oral examination – limited 30.10 A limited oral problem-focussed evaluation carried out immediately prior to required treatment. This evaluation includes recording an appropriate medical history and any other relevant information. (Item is subject to Rules 17 and 19) Subgroup 2 – Radiological examination and interpretation 88022 Intraoral periapical or bitewing radiograph – per exposure 33.35 Taking and interpreting a radiograph made with the film inside the mouth. (Item is subject to Rule 17) 88025 Intraoral radiograph – occlusal, maxillary, mandibular – per exposure 67.40 Taking and interpreting an occlusal, maxillary or mandibular intraoral radiograph. This radiograph shows a more extensive view of teeth and maxillary or mandibular bone. Group U1 – Preventive Services Subgroup 1 – Dental Prophylaxis 88111 Removal of plaque and/or stain 58.90 Removal of dental plaque and/or stain from the surfaces of all teeth and/or implants. (Item is subject to Rules 17 and 20) 88114 Removal of calculus – first visit 98.20 Removal of calculus from the surfaces of teeth. (Item is subject to Rules 17 and 20) 88115 Removal of calculus – subsequent visit 63.85 This item describes procedures in item 88114 when, because of the extent or degree of calculus, an additional visit(s) is required to remove deposits from the teeth. (Item is subject to Rules 17 and 20) Subgroup 2 – Remineralising Agents 88121 Topical application of remineralisation and/or cariostatic agents, one treatment 37.85 Application of remineralisation and/or cariostatic agents to the surfaces of the teeth. This may include activation of the agent. Not to be used as an intrinsic part of the restoration. (Item is subject to Rule 17) Subgroup 3 – Other Preventive Services 88161 Fissure and/or tooth surface sealing – per tooth (first four services on a day) 50.45 Sealing of non-carious pits, fissures, smooth surfaces or cracks in a tooth with an adhesive material. Any preparation prior to application of the sealant is included in this item number. (Item is subject to Rule 17 and 20) 88162 Fissure and/or tooth surface sealing – per tooth (subsequent services) 25.25 Sealing of non-carious pits, fissures, smooth surfaces or cracks in a tooth with an adhesive material. Any preparation prior to application of the sealant is included in this item number. (Item is subject to Rule 20) Group U2 – Periodontics 88213 Treatment of acute periodontal infection – per visit 76.30 This item describes the treatment of acute periodontal infection(s). It may include establishing drainage and the removal of calculus from the affected tooth (teeth). Inclusive of the insertion of sutures, normal post-operative care and suture removal. (Item is subject to Rules 17 and 21) 88221 Clinical periodontal analysis and recording 58.00 This is a special examination performed as part of the diagnosis and management of periodontal disease. The procedure consists of assessing and recording a patient's periodontal condition. All teeth and six sites per tooth must be recorded. Written documentation of these measurements must be retained. (Item is subject to Rule 17) Group U3 – Oral Surgery Subgroup 1 – Extractions 88311 Removal of a tooth or part(s) thereof – first tooth extracted on a day 143.75 A procedure consisting of the removal of a tooth or part(s) thereof. Inclusive of the insertion of sutures, normal post-operative care and suture removal. (Item is subject to Rules 17 and 22) 88314 Sectional removal of a tooth or part(s) thereof – first tooth extracted on a day 183.75 The removal of a tooth or part(s) thereof in sections. Bone removal may be necessary. Inclusive of the insertion of sutures, normal post-operative care and suture removal. (Item is subject to Rules 17 and 22) 88316 Additional extraction requiring removal of a tooth or part(s) thereof, or sectional removal of a tooth. 90.60 Additional extraction provided on the same day as a service described in item 88311 or 88314 is provided to the patient. (Item is subject to Rule 22) Subgroup 2 – Surgical Extractions 88322 Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division – first tooth extracted on a day 233.30 Removal of a tooth or tooth fragment where an incision and the raising of a mucoperiosteal flap is required, but where removal of bone or sectioning of the tooth is not necessary to remove the tooth. Inclusive of the insertion of sutures, normal post-operative care and suture removal. (Item is subject to Rules 17 and 22) 88323 Surgical removal of a tooth or tooth fragment requiring removal of bone – first tooth extracted on a day 266.45 Removal of a tooth or tooth fragment where removal of bone is required after an incision and a mucoperiosteal flap raised. Inclusive of the insertion of sutures, normal post-operative care and suture removal. (Item is subject to Rules 17 and 22) 88324 Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division – first tooth extracted on a day 358.40 Removal of a tooth or tooth fragment where both removal of bone and sectioning of the tooth are required after an incision and a mucoperiosteal flap raised. The tooth will be removed in portions. Inclusive of the insertion of sutures, normal post-operative care and suture removal. (Item is subject to Rules 17 and 22) 88326 Additional extraction requiring surgical removal of a tooth or tooth fragment 190.85 Additional surgical extraction provided on the same day as a service described in item 88322, 88323 or 88324 is provided to the patient. (Item is subject to Rule 22) Subgroup 5 – Treatment of Maxillo-facial injuries 88351 Repair of skin and subcutaneous tissue or mucous membrane 175.15 The surgical cleaning and repair of a facial skin wound in the region of the mouth or jaws, or the repair of oral mucous membrane, where the wounds involve the subcutaneous tissues. Inclusive of the insertion of sutures, normal post-operative care and suture removal. (Item is subject to Rule 22) Subgroup 8 – Other Surgical Procedures 88384 Repositioning of displaced tooth/teeth – per tooth 209.00 A procedure following trauma where the position of the displaced tooth/teeth is corrected by manipulation. Stabilising procedures are itemised separately. Inclusive of the insertion of sutures, normal post-operative care and suture removal. (Item is subject to Rule 22) 88386 Splinting of displaced tooth/teeth – per tooth 215.60 A procedure following trauma where the position of the displaced tooth/teeth may be stabilized by splinting. Inclusive of the insertion of sutures, normal post-operative care and suture removal. (Item is subject to Rule 22) 88387 Replantation and splinting of a tooth 422.20 Replantation of a tooth which has been avulsed or intentionally removed. It may be held in the correct position by splinting. Inclusive of the insertion of sutures, normal post-operative care and suture removal. (Item is subject to Rule 22) 88392 Drainage of abscess 106.10 Drainage and/or irrigation of an abscess other than through a root canal or at the time of extraction. The drainage may be through an incision or inserted tube. Inclusive of the insertion of sutures, normal post-operative care and suture removal. (Item is subject to Rule 22) Group U4 – Endodontics Subgroup 1 – Pulp and Root Canal Treatments 88411 Direct pulp capping 38.15 A procedure where an exposed pulp is directly covered with a protective dressing or cement. 88412 Incomplete endodontic therapy (tooth not suitable for further treatment) 130.70 A procedure where in assessing the suitability of a tooth for endodontic treatment a decision is made that the tooth is not suitable for restoration. (Item is subject to Rule 23) 88414 Pulpotomy 83.30 Amputation within the pulp chamber of part of the vital pulp of a tooth. The pulp remaining in the canal(s) is then covered with a protective dressing or cement. (Item is subject to Rule 23) 88415 Complete chemo-mechanical preparation of root canal – one canal 234.50 Complete chemo-mechanical preparation including removal of pulp or necrotic debris from a canal. (Item is subject to Rule 23) 88416 Complete chemo-mechanical preparation of root canal – each additional canal 111.70 Complete chemo-mechanical preparation including removal of pulp or necrotic debris from each additional canal of a tooth with multiple canals. (Item is subject to Rule 23) 88417 Root canal obturation – one canal 228.40 The filling of a root canal, following chemo-mechanical preparation. (Item is subject to Rule 23) 88418 Root canal obturation – each additional canal 106.80 The filling, following chemo-mechanical preparation, of each additional canal in a tooth with multiple canals. (Item is subject to Rule 23) 88419 Extirpation of pulp or debridement of root canal(s) – emergency or palliative 151.00 The partial or thorough removal of pulp and/or debris from the root canal system of a tooth. This is an emergency or palliative procedure distinct from visits for scheduled endodontic treatment. (Item is subject to Rule 23) 88421 Resorbable root canal filling – primary tooth 130.70 The placement of resorbable root canal filling material in a primary tooth. (Item is subject to Rule 23) Subgroup 4 – Other Endodontic Services 88455 Additional visit for irrigation and/or dressing of the root canal system – per tooth 115.70 Additional debridement irrigation and short-term dressing required where evidence of infection or inflammation persists following prior opening of the root canal and removal of its contents. (Item is subject to Rule 26) 88458 Interim therapeutic root filling – per tooth 154.35 A procedure consisting of the insertion of a long-term provisional (temporary) root canal filling with therapeutic properties which facilitates healing/development of the root and periradicular tissues over an extended time. (Item is subject to Rules 17 and 23) Group U5 – Restorative Services Subgroup 1 – Metallic Restorations – Direct 88511 Metallic restoration – one surface – direct 114.10 Direct metallic restoration involving one surface of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) 88512 Metallic restoration – two surfaces – direct 139.95 Direct metallic restoration involving two surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) 88513 Metallic restoration – three surfaces – direct 167.00 Direct metallic restoration involving three surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) 88514 Metallic restoration – four surfaces – direct 190.35 Direct metallic restoration involving four surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) 88515 Metallic restoration – five surfaces – direct 217.30 Direct metallic restoration involving five surfaces of a tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) Subgroup 2 – Adhesive Restorations – Anterior Teeth – direct 88521 Adhesive restoration – one surface – anterior tooth – direct 126.40 Direct restoration, using an adhesive technique and a tooth-coloured material, involving one surface of an anterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rules 24 and 27) 88522 Adhesive restoration – two surfaces – anterior tooth – direct 153.45 Direct restoration, using an adhesive technique and a tooth-coloured material, involving two surfaces of an anterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) 88523 Adhesive restoration – three surfaces – anterior tooth – direct 181.75 Direct restoration, using an adhesive technique and a tooth-coloured material, involving three surfaces of an anterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) 88524 Adhesive restoration – four surfaces – anterior tooth – direct 210.05 Direct restoration, using an adhesive technique and a tooth-coloured material, involving four surfaces of an anterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) 88525 Adhesive restoration – five surfaces – anterior tooth – direct 246.85 Direct restoration, using an adhesive technique and a tooth-coloured material, involving five surfaces of an anterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) Subgroup 3 – Adhesive Restorations – Posterior Teeth – direct 88531 Adhesive restoration – one surface – posterior tooth – direct 134.95 Direct restoration, using an adhesive technique and a tooth-coloured material, involving one surface of an posterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rules 24 and 27) 88532 Adhesive restoration – two surfaces – posterior tooth – direct 169.45 Direct restoration, using an adhesive technique and a tooth-coloured material, involving two surfaces of an posterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) 88533 Adhesive restoration – three surfaces – posterior tooth – direct 203.70 Direct restoration, using an adhesive technique and a tooth-coloured material, involving three surfaces of an posterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) 88534 Adhesive restoration – four surfaces – posterior tooth – direct 229.65 Direct restoration, using an adhesive technique and a tooth-coloured material, involving four surfaces of an posterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) 88535 Adhesive restoration – five surfaces – posterior tooth – direct 265.20 Direct restoration, using an adhesive technique and a tooth-coloured material, involving five surfaces of an posterior tooth. Inclusive of the preparation of the tooth, placement of a lining, contouring of the adjacent and opposing teeth, placement of the restoration and normal post-operative care. (Item is subject to Rule 24) Subgroup 7 – Other Restorative Services 88572 Provisional (intermediate/temporary) restoration – per tooth 53.40 The provisional (intermediate) restoration of a tooth designed to last until the definitive restoration can be constructed or the tooth is removed. This item should only be used where the provisional (intermediate) restoration is not an intrinsic part of treatment. It does not include provisional (temporary) sealing of the access cavity during endodontic treatment or during construction of indirect restorations. (Item is subject to Rules 17 and 28) 88574 Metal band 44.95 The cementation of a metal band for diagnostic, protective purposes or for the placement of a provisional (intermediate) restoration. 88575 Pin retention – per pin 30.65 Use of a pin to aid the retention and support of direct or indirect restorations in a tooth. (Item is subject to Rules 17 and 24) 88579 Bonding of tooth fragment 106.10 The direct bonding of a tooth fragment as an alternative to placing a restoration. 88586 Crown - metallic - with tooth preparation – preformed 281.50 Placing a preformed metallic crown as a coronal restoration for a tooth. (Item is subject to Rule 27A) 88587 Crown - metallic - minimal tooth preparation – preformed 167.00 Placing a preformed metallic crown as a coronal restoration for a tooth and where minimal or no restoration of the tooth is required. Commonly referred to as a 'Hall' crown. (Item is subject to Rule 27A) 88597 Post – direct 96.50 Insertion of a post into a prepared root canal to provide an anchor for an artificial crown or other restoration. (Item is subject to Rule 24) Group U7 – Prosthodontics Subgroup 1 – Dentures and Denture Components 88721 Partial maxillary denture – resin, base only 478.10 Provision of a resin base for a removable dental prosthesis for the maxilla where some natural teeth remain. (Item is subject to Rules 17 and 24A) 88722 Partial mandibular denture – resin, base only 478.10 Provision of a resin base for a removable dental prosthesis for the mandible where some natural teeth remain. (Item is subject to Rules 17 and 24A) 88723 Provisional partial maxillary denture 358.50 Provision of a patient removable partial dental prosthesis replacing the natural teeth and adjacent tissues in the maxilla which is designed to last until the definitive prosthesis can be constructed. This item should only be used where a provisional denture is not an intrinsic part of item 88721. (Item is subject to Rules 24A and 25) 88724 Provisional partial mandibular denture 358.50 Provision of a patient removable partial dental prosthesis replacing the natural teeth and adjacent tissues in the mandible which is designed to last until the definitive prosthesis can be constructed. This item should only be used where a provisional denture is not an intrinsic part of item 88722. (Item is subject to Rules 24A and 25) 88731 Retainer – per tooth 48.25 A retainer or attachment fitted to a tooth to aid retention of a partial denture. The number of retainers should be indicated. (Item is subject to Rule 25) 88733 Tooth/teeth (partial denture) 39.60 An item to describe each tooth added to the base of a new partial denture. The number of teeth should be indicated. (Item is subject to Rule 25) 88736 Immediate tooth replacement – per tooth 9.95 Provision within a denture to allow immediate replacement of an extracted tooth. The number of teeth so replaced should be indicated. (Item is subject to Rule 25) Subgroup 4 – Denture Maintenance 88741 Adjustment of a denture 57.50 Adjustment of a denture to improve comfort, function or aesthetics. This item does not apply to routine adjustments following the insertion of a new denture or the maintenance or repair of an existing denture. (Item is subject to Rule 25) Subgroup 6 – Denture Repairs 88761 Reattaching pre-existing clasp to denture 157.85 Repair, insertion and adjustment of a denture involving re-attachment of a pre-existing clasp. 88762 Replacing/adding clasp to denture - per clasp 164.95 Repair, insertion and adjustment of a denture involving replacement or addition of a new clasp or clasps. 88764 Repairing broken base of a partial denture 157.85 Repair, insertion and adjustment of a broken resin partial denture base. 88765 Replacing/adding new tooth on denture – per tooth 164.95 Repair, insertion and adjustment of a denture involving replacement with or addition of a new tooth or teeth to a previously existing denture. 88766 Reattaching existing tooth on denture – per tooth 157.85 Repair, insertion and adjustment of a denture involving reattachment of a pre-existing denture tooth or teeth. 88768 Adding tooth to partial denture to replace an extracted or decoronated tooth - per tooth 167.00 Modification, insertion and adjustment of a partial denture involving an addition to accommodate the loss of a natural tooth or its coronal section. (Item is subject to Rule 17) Subgroup 7 – Other Prosthodontic Services 88776 Impression - dental appliance repair/modification 50.45 An item to describe taking an impression where required for the repair or modification of a dental appliance. Group U9 – General Services Subgroup 1– Emergencies 88911 Palliative care 74.85 An item to describe interim care to relieve pain, infection, bleeding or other problems not associated with other treatment. (Item is subject to Rule 29) Subgroup 4– Sedation 88942 Sedation - intravenous 146.75 Sedative drug(s) administered intravenously, usually in increments. The incremental administration may continue while dental treatment is being provided. (Item is subject to rule 17) 88943 Sedation - inhalation 73.35 Nitrous oxide gas mixed with oxygen is inhaled by the patient while dental treatment is being provided.