Denis Tariff Structure 2016

1 *-Trf Code TariffDescription54626492939495961138025 HANDLING FEE - DIRECT MATERIALS (26% OF MATERIAL COST TO A MAXIMUM OF )R - R - R - 8101 ORAL EXAMINATIONR - R R ORAL EXAMINATIONR - R R - 8104 LIMITED ORAL EXAMINATIONR - R R REPORTR - R - - - 8107 INTRAORAL RADIOGRAPH - PERIAPICALR - R R RADIOGRAPHS - COMPLETE SERIESR - R R CONTROL/BARRIER TECHNIQUESR - R R INSTRUMENTATIONR - R R RADIOGRAPH - BITEWINGR - R R RADIOGRAPH - OCCLUSALR - R R RADIOGRAPH - HAND-WRISTR - R - R RADIOGRAPH - PANORAMICR - R R RADIOGRAPH - CEPHALOMETRICR - R R MODELSR - R - R RADIOGRAPH.

2 SKULL/FACIAL BONER - R - R - 8119 DIAGNOSTIC MODELS MOUNTEDR - R - R - 8121(DIGITAL/CONVENTIONAL)R - R R SUSCEPTIBILITY TESTS (BY ARRANGEMENT)R - - - - - - - - 8124 PULP TESTSR - - - - - - - - 8129 SCHEDULED HOURSR - R - R R - 8131 EMERGENCY DENTAL TREATMENTR - R R REMOVAL (PULPECTOMY)R - - - - - R - 8133 RECEMENT INLAY, ONLAY, CROWN OR VENEERR - - - R - R - 8135 REMOVE INLAY, ONLAY OR CROWNR - - - R - R - 8136 ACCESS THROUGH A PROSTHETIC CROWN OR INLAY TO FACILITATE ROOT CANAL TREATMENTR - R - R - R - Denis shall be entitled to update the Tariff schedule from time to time.

3 The tariffs listed do not consider scheme exclusions and scope of practice and is by no means a commitment of funding. Benefit entitlement is governed by the relevant scheme option and rules as well as risk management interventions and the clinical code requires managed care intervention, all associated lab codes should will be included in the authorisation process. Denis RatesPre-authorisation is required for the dental code to attract benefitNo Tariff amount is availableTrf Code TariffDescription54626492939495961138137 EMERGENCY CROWN (CHAIR-SIDE)R - - - R - R - 8138 REMOVE RETENTION POST (PREFABRICATED OR CAST)R - - - R - R - 8140 HOUSE/EXTENDED CARE FACILITY/HOSPITAL CALL * R * R - * R - * R - * R - 8141 THEREOFR - R - R - R - 8143 INHALATION SEDATION - EACH ADDNL 15 MINUTESR - R - R - R - 8144 INTRAVENOUS SEDATION * R * R - * R - * R - * R - 8145 LOCAL ANAESTHETIC - PER VISITR - R R BONDING FOR RESTORATIONS - - - - - - - - - 8147 MONITORING EQUIPMENT FOR INTRAVENOUS SEDATIONR - R - R - R - 8151 ORAL HYGIENE INSTRUCTIONR - - R - R R - R HYGIENE INSTRUCTION - EACH ADDITIONAL VISITR - - R - R R - - 8155 POLISHING - COMPLETE DENTITIONR - R - R R AND

4 POLISHING OF RESTORATIONS - COMPLETE DENTITIONR - - - - - - - - 8158 ENAMEL MICROABRASIONR - - - - - - - - 8159 PROPHYLAXIS - COMPLETE DENTITIONR - R - R R OF GROSS CALCULUS - - - - - - - - - 8161 TOPICAL APPLICATION OF FLUORIDE - CHILDR - R - R R APPLICATION OF FLUORIDE - ADULTR - - R - R R - R SEALANTR - R - R R FILLINGR - R - R R OF DESENSITISING RESIN, PER TOOTHR - R - R R OF DESENSITISING MEDICAMENT, PER VISITR - R - R R GUARDR - R - R - 8171 MOUTH PROTECTORR - R - R OF ORTHOTIC APPLIANCE * * * * - * - - 8173 SPACE MAINTAINER - FIXED, PER ABUTMENTR - R - R - 8175 SPACE MAINTAINER - REMOVABLER - R - R - 8176 PERIODONTAL SCREENINGR - R - R - R HYGIENE INSTRUCTION (PERIODONTALLY COMPROMISED PATIENT)R - - - - - - - - 8178 ORAL HYGIENE INSTRUCTION - EACH ADDITIONAL VISIT (PERIODONTALLY COMPROMISED PATIENT)R - - - - - - - - Trf Code TariffDescription54626492939495961138179 POLISHING - COMPLETE DENTITION (PERIODONTALLY COMPROMISED PATIENT)

5 R - R - R - R - COMPLETE DENTITION (PERIODONTALLY COMPROMISED PATIENT) * R * R - * R - - - - * R DRUG INJECTIONR - - - - - - - - 8189RE-EXAMINATION - EXISTING CONDITIONR - - - - - R - - 8190 CONSULTATION - SECOND OPINION OR ADVICER - R - R - 8192 SUTURE - MINORR - R - R - R - 8201 EXTRACTION - TOOTH OR EXPOSED TOOTH ROOTS (FIRST PER QUADRANT)R - R R - 8202 EXTRACTION - EACH ADDITIONAL TOOTH OR EXPOSED TOOTH ROOTSR - R R - 8213 SURGICAL REMOVAL OF RESIDUAL ROOTS, FIRST TOOTH PER QUADRANTR - R - R - R - 8214 SURGICAL REMOVAL OF RESIDUAL ROOTS, SECOND AND SUBSEQUENT TEETH''S ROOTSR - R - R - R - 8220 COST OF SUTURE MATERIALR - R - R R - 8231 COMPLETE DENTURES - MAXILLARY AND MANDIBULARR 1 - - R 1 - R 3 - R 1 - 8232 COMPLETE DENTURE - MAXILLARY OR MANDIBULARR 1 - - R 1 - R 2 - R 1 - 8233 PARTIAL DENTURE - RESIN BASE - ONE TOOTHR - - R - R - R - 8234 PARTIAL DENTURE - RESIN BASE - TWO TEETHR - - R - R - R - 8235 PARTIAL DENTURE - RESIN BASE - THREE TEETHR - - R - R - R - 8236 PARTIAL DENTURE - RESIN BASE - FOUR TEETHR - - R - R - R - 8237 PARTIAL DENTURE - RESIN BASE - FIVE TEETHR - - R - R - R - 8238 PARTIAL DENTURE - RESIN

6 BASE - SIX TEETHR 1 - - R 1 - R 1 - R 1 - 8239 PARTIAL DENTURE - RESIN BASE - SEVEN TEETHR 1 - - R 1 - R 1 - R 1 - 8240 PARTIAL DENTURE - RESIN BASE - EIGHT TEETHR 1 - - R 1 - R 1 - R 1 - 8241 PARTIAL DENTURE - RESIN BASE - NINE OR MORE TEETHR 1 - - R 1 - R 1 - R 1 - 8244 IMMEDIATE DENTURE - MAXILLARYR 1 - - R 1 - R 1 - R 1 - 8245 IMMEDIATE DENTURE - MANDIBULARR 1 - - R 1 - R 1 - R 1 - 8251 CLASP OR REST - CAST GOLDR - - - - - - - - 8253 CLASP OR REST - WROUGHT GOLDR - - - - - - - - 8255 CLASP OR REST - STAINLESS STEELR - - - - - - - - 8257 BAR - LINGUAL OR PALATALR - - - - - - - - 8259 REBASE COMPLETE OR PARTIAL DENTURE (LABORATORY)R - - R - R - R - Trf Code TariffDescription54626492939495961138261 REMODEL COMPLETE OR PARTIAL DENTURER - - R - R - R - 8263 RELINE COMPLETE OR PARTIAL DENTURE (CHAIR-SIDE)R - - R - R - R - 8265 TISSUES CONDITIONING PER ARCH (INCLUDING SOFT SELF-CURE RELINE)R - R - R - R COMPLETE OR PARTIAL DENTURE (LABORATORY)

7 R - - R - R - R - 8269 REPAIR DENTURE OR OTHER INTRA-ORAL APPLIANCER - - - - R - - - 8270 ADD CLASP TO EXISTING PARTIAL DENTURER - - - - - - - - 8271 ADD TOOTH TO EXISTING PARTIAL DENTURER - - - - - - - - 8273 IMPRESSION TO REPAIR OR MODIFY A DENTURE OR OTHER INTRA-ORAL APPLIANCER - - R - R - R - 8275 ADJUST COMPLETE OR PARTIAL DENTURER - - R - R - R - 8277 INLAY IN DENTURER - - - - R - - - 8281 PARTIAL DENTURE - CAST METAL FRAMEWORK ONLYR 1 - - R 1 - R 1 - R 1 - 8301 PULP CAP - DIRECTR - - - - - - - - 8303 PULP CAP - INDIRECTR - - - - - R - - 8304 RUBBER DAM PER ARCHR - R - R - R - 8306 COST OF MTA - - - - - - - - - 8307 PULP AMPUTATION (PULPOTOMY)

8 R - R - R - R - 8310 SUPPLY OF BLEACHING MATERIALS - - - - - - - - - 8325 INTERNAL BLEACHING - PER TOOTHR - - - - R - - - 8327 INTERNAL BLEACHING - EACH ADDITIONAL VISITR - - - - R - - - 8328 ROOT CANAL OBTURATION - ANTERIORS AND PREMOLARS - EACH ADDITIONAL CANALR - - - - - R - 8329 ROOT CANAL THERAPY - ANTERIORS AND PREMOLARS - EACH ADDITIONAL CANALR - - - - - R - 8330 REMOVAL OF ROOT CANAL OBSTRUCTIONR - R - R - R - 8332 ROOT CANAL PREPARATORY VISIT - SINGLE CANAL TOOTHR - - - - - R - 8333 ROOT CANAL PREPARATORY VISIT - MULTI CANAL TOOTHR - - - R - R - 8334RE-TREATMENT OF PREVIOUSLY COMPLETED ROOT CANAL THERAPY.

9 PER CANALR - R - R - R - 8335 ROOT CANAL OBTURATION - ANTERIORS AND PREMOLARS - FIRST CANALR - - - - - R - 8336 ROOT CANAL OBTURATION - POSTERIORS - FIRST CANALR - - - - - R - Trf Code TariffDescription54626492939495961138337 ROOT CANAL OBTURATION - POSTERIORS - EACH ADDITIONAL CANALR - - - - - R - 8338 ROOT CANAL THERAPY - ANTERIORS AND PREMOLARS - FIRST CANALR - - - - - R - 8339 ROOT CANAL THERAPY - POSTERIORS - FIRST CANALR 1 1 - - - - - R 1 - 8340 ROOT CANAL THERAPY - POSTERIORS - EACH ADDITIONAL CANALR - - - - - R - 8341 AMALGAM - ONE SURFACER - R - R R - 8342 AMALGAM - TWO SURFACESR - R - R R - 8343 AMALGAM - THREE SURFACESR - R - R R - 8344 AMALGAM - FOUR OR MORE SURFACESR - R - R R - 8345 PREFABRICATED POST RETENTION, PER POST (IN ADDITION TO RESTORATION)R - R - R - R - 8347 PIN RETENTION - FIRST PIN (IN ADDITION TO RESTORATION)R - R - R - R - 8348 PIN RETENTION - EACH ADDITIONAL PIN (IN ADDITION TO RESTORATION)R - R - R - R - 8349 CARVE RESTORATION TO ACCOMMODATE EXISTING REMOVABLE PROSTHESISR - - - - - - - - 8350 RESIN CROWN - ANTERIOR PRIMARY TOOTH (DIRECT)

10 R - R - R R - 8351 RESIN - ONE SURFACE, ANTERIORR - R - R R - TWO SURFACES, ANTERIORR - R - R R - 8353 RESIN - THREE SURFACES, ANTERIORR - R - R R - 8354 RESIN - FOUR OR MORE SURFACES, ANTERIORR - R - R R - 8355 VENEER - RESIN (CHAIR-SIDE)R - R - R - R - 8357 PREFABRICATED METAL CROWNR - R - R - R - 8361 INLAY - METAL - ONE SURFACER - - - - R - - - 8362 INLAY/ONLAY - METAL - TWO SURFACESR - - - - R 1 - - - 8363 INLAY/ONLAY - METAL - THREE SURFACESR - - - - R 1 - - - 8364 INLAY/ONLAY - METAL - FOUR OR MORE SURFACESR 1 - - - - R 1 - - - 8366 PIN RETENTION AS PART OF CAST RESTORATION (ANY NUMBER OF PINS)