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The Australian Scheduleof Dental Services andGlossaryTenth Edition
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The Australian Schedule of Dental Services and Glossary Australian Dental Association Incorporated Tenth Edition
Published by the Australian Dental Association Inc. 12-14 Chandos St, St Leonards, NSW 2065 Australia
Australian Dental Association Inc., 2013
First published 1986 An Australian Glossary of Dental Terms Second Edition 1990 An Australian Glossary of Dental Terms Third Edition 1992 An Australian Glossary of Dental Terms Fourth Edition 1994 An Australian Glossary of Dental Terms Fifth Edition 1996 An Australian Schedule of Dental Services and Glossary Sixth Edition 2000 An Australian Schedule of Dental Services and Glossary Seventh Edition 2002 The Australian Schedule of Dental Services and Glossary Eighth Edition 2004 The Australian Schedule of Dental Services and Glossary Ninth Edition 2009 The Australian Schedule of Dental Services and Glossary Tenth Edition 2013 The Australian Schedule of Dental Services and Glossary
All rights reserved. No part of this work covered by copyright may be reproduced or copied in any form or by any means (graphic, electronic or mechanical, including photocopying, recording, taping, or information and retrieval systems) without the written permission of the publisher.
ISBN 0 909961 31 X
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Table of Contents
Tenth Edition Updates iii
Introduction iv
General iv
PurposeandPrinciples iv
Clarification v
GuidelinesforSubmissionstotheScheduleandThirdPartyCommittee v
Notes for Guidance vi
MultipleAppointmentProcedures vi
DentalMaterials vi
Linings vi
StandardisationofSurfaceDescriptionsofDentalRestorations vi
RestorativeProcedures vii
Endodontics vii
ProvisionalRestorationorProsthesis vii
DefinitiveRestorationorProsthesis vii
DirectandIndirectRestorations,CrownsandBridges vii
Direct,Indirect viii
Cementation viii
ImmediateDentures ix
PartialDentures ix
Item281CourseofNon-SurgicalPeriodontalTreatment ix
Item881CompleteCourseofOrthodonticTreatment x
DentalHealthInsuranceandOtherThirdParties x
ToothIdentification x
ItemisationofAccounts xi
Illustrated Definitions xiixviii
Goods and Services Tax xix
SCHEDULE OF DENTAL SERVICES AND GLOSSARY 1
Diagnostic Services (items 011-086) 1
Examinations 1
RadiologicalExaminationandInterpretation 2
OtherDiagnosticServices 4
Preventive, Prophylactic and Bleaching Services (items 111-171) 7
DentalProphylaxisandBleaching 7
RemineralisationAgents 8
OtherPreventiveServices 8
Periodontics (items 213-282) 10
PeriodontalTreatmentFormforusewithItems281and282 12
HowtoClaimBenefits 13
Oral Surgery (items 311-399) 14
Extractions 14
SurgicalExtractions 14
iThe Australian Schedule of Dental Services and Glossary
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Table of Contents
SurgeryforProstheses 15
TreatmentofMaxillofacialInjuries 16
Dislocations 16
Osteotomies 17
GeneralSurgical 17
OtherSurgicalProcedures 18
Endodontics (items 411-458) 20
PulpandRootCanalTreatments 20
PeriradicularSurgery 21
OtherEndodonticServices 22
Restorative Services (items 511-597) 23
MetallicRestorationsDirect 23
AdhesiveRestorationsAnteriorTeethDirect 23
AdhesiveRestorationsPosteriorTeethDirect 24
MetallicRestorationsIndirect 25
Tooth-colouredRestorationsIndirect 25
OtherRestorativeServices 26
Prosthodontics (items 611-779) 28
Crowns 28
ProvisionalCrownandBridge 29
Bridges 30
CrownandBridgeRepairsandOtherServices 31
ProceduresforImplantProstheses 32
DenturesandDentureComponents 34
DentureMaintenance 36
DentureRepairs 37
OtherProsthodonticServices 38
Orthodontics (items 811-881) 39
RemovableAppliances 39
FixedAppliances 39
ExtraoralAppliances 40
Attachments 40
OtherOrthodonticServices 41
CompleteCourseofOrthodonticTreatment 41
OrthodonticTreatmentFormforusewithItem881 42
HowToClaimBenefits 43
General Services (items 911-972) 44
Emergencies 44
DrugTherapy 44
Anaesthesia,SedationandRelaxationTherapy 44
OcclusalTherapy 45
Miscellaneous (items 981-999) 47
Alphabetical Index of Procedures 49
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Tenth Edition Updates
New items, changes and additions since the Ninth Edition
Newitems,changesandadditionssincetheNinthEditionareannotatedbelow.
Amended items
025,031,033,035,036,039,061,081,111,113,115,116,121,151,153,161,222,231,232,242,243,314,322,323,324,371,373,412,572,576,595,596,632,663,664,666,727,728,735,761,762,765
Renumbered items
662now633
Deleted items
225
New items
054,633,634,665,667,690,766
iiiThe Australian Schedule of Dental Services and Glossary
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Introduction
AnAustralian Glossary of Dental Terms was first published by theAustralianDental Association Inc.in1986.TheFifthEditionwasexpanded toThe Australian Schedule of Dental Services and Glossary (Schedule)in1996.Sinceitsinception,ithasbeenuniversallyacceptedasthedefinitivecodingsystemofdentaltreatmentandisendorsedbytheNationalCodingCentre.
TheScheduleandThirdPartyCommittee,indevelopingtheTenthEdition,hasconsideredsubmissionsfromwithinthemembership,specialistaffiliateddentalgroups,healthfunds,theDepartmentofVeteransAffairs and other interested groups. The contributions of theChief ExecutiveOfficer, secretarial andpublicationsstaffoftheAustralianDentalAssociationInc.andmembersoftheScheduleandThirdPartyCommitteearegratefullyacknowledged.
CurrentinformationontheGSTisincludedonpagexixandisavailableonthemembersonlysectionoftheAssociationswebsite(www.ada.org.au)underInformationResources.
KarinAlexanderPresidentAustralianDentalAssociationInc.April2013
General
Purpose and Principles
TheScheduleandThirdPartyCommitteeassignsathree-digitcodenumbertoitemsorclinicalproceduresitconsiderstobepartofcurrentdentalpractice.InreviewingtheSchedule,thefollowingprinciplesareapplied:
1. AScheduleentrydescribes,asageneralrule,atreatmentoutcome.Itdoesnotaccommodateminorvariationsinclinicaltechniques.
2. ConsiderationforalistingintheSchedulewillonlybegiventoacceptedformsoftherapy.
3. Itisnotpossibletodescribeeverysingledentalserviceoutcome,andassuch,theprincipleofthemostappropriateitemnumbershouldbeutilised.Wherenosuitableitemnumbercanbeidentified,itemnumber990istobeallocatedfordescribingsuchservices.
4. Noitemnumbersarereservedexclusivelyforusebyspecialists.
5. Thereisnodifferentiationbetweenservicesonprimaryorsecondaryteethunlesstheprocedureisuniquewithinthatgroup.
6. Changestomaterialswithinagenericgrouporchangesinlaboratorytechniquesareunlikelytobeallocatednewitemnumbers.
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General
Clarification
Any dentist or third party requiring clarification or interpretation of the Schedule should contact theAustralian Dental Association Inc. In the event of a dispute regarding interpretation or clarificationbetweenadentistandathirdparty,theChiefExecutiveOfficer(CEO)shouldbeinformedofthenamesandaddressesofbothpartiestogetherwithdetailsofthedispute.TheCEOwillthenreferthatinformationontotheAssociationsScheduleandThirdPartyCommitteeChairmanforevaluationanddecision.TheCEOwilltheninformbothpartiesofthedecision.Confidentialitywillbemaintained.
Federaland/orStateandTerritoryspecialistgroupsandAustralianDentalAssociationInc.affiliatedbodiesmustnotoffer interpretationorguidelinesfortheuseof ItemnumberswithinThe Australian Schedule of Dental Services and Glossary withouttheexplicitwrittenendorsementoftheFederalExecutiveoftheAustralianDentalAssociationInc.
Guidelines for Submissions to the Schedule and Third Party Committee
The Schedule and Third Party Committee welcomes submissions and comments on the Schedule.SuggestionsfornewandamendeditemnumbersshouldbeaccompaniedbyasuggesteddraftfortheSchedulethatis,itemnumber,headingandbriefdescription.
An organisation submitting on behalf of a particular discipline of dentistry should first consult withbranchesofequivalentorganisations inotherStatesandTerritories inorder toarriveataconsensus.Thirdpartiesshouldsubmitthroughtheirumbrellaorganisations.
CorrespondenceshouldbedirectedtotheChiefExecutiveOfficer,AustralianDentalAssociation Inc.,POBox520,StLeonards1590.Fax:0299064676oremail:[email protected]
vThe Australian Schedule of Dental Services and Glossary
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Notes for Guidance
Multiple Appointment Procedures
Wheremultiple appointments are required to complete a procedure or course of treatment (such asdentures,crowns,orthodontics,periodontics,etc.),itisentirelyappropriatetorenderanaccountinpartorinfullatanyappointmentduringtheprocedureincludingthefirstappointment.Theitemnumberfortheprocedurecanonlybeusedonce.
Dental Materials
TheTenthEditionoftheSchedulehascontinuedtoclassifydentalmaterialsintobasicgenericgroups.Examplesaregiveninthefollowingtable.
Example Generic Grouping
amalgam metallicrestorationdirect
gold metallicrestorationindirect
non-preciousmetal metallicrestorationindirect
Ketacsilver adhesiverestoration
compomer tooth-colouredadhesiverestoration
compositeresin tooth-colouredadhesiverestoration
glassionomer tooth-colouredadhesiverestoration
polymerglass tooth-colouredadhesiverestoration
porcelain ceramic(fused,castormilled)
acrylic resin
Linings
Liningsusedbeneathrestorations,asinterposingmaterial,formanintegralpartofarestorationandarenottobeitemisedseparately.
Standardisation of Surface Descriptions of Dental Restorations
Auniformsystemisrecommendedinordertoquantifythecomplexityofarestorativeprocedure.
Asurfaceisdefinedbythelineangles,withtheincisaledgeregardedasaseparatesurface.
Whereseparateonesurfacerestorationsinthesamematerialareplacedonthesamesurfaceofthesametoothatthesamevisit,theyshallbeitemisedasasingleone-surfacerestoration.
Whereseparateonesurfacerestorationsareplacedondifferentsurfacesofthesametoothatthesamevisit,theyshallbeitemisedasseparateonesurfacerestorationsirrespectiveofthematerialused.
Similarprinciplesapplytomultiplesurfacerestorationsonthesametooth.
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Notes for Guidance
Restorative Procedures
Whentwomaterialsareusedinthesamerestoration,thepredominantmaterialtypeshouldbeusedtoitemisethatrestoration.Wherearestorationincludesafissuresealantonthesametooth,thenonlyoneitemnumbershallbeusedtodescribethatrestoration.
Endodontics
Itemnumbersdescribingchemo-mechanicalpreparation,obturationandotherproceduresassociatedwithrootcanaltreatmentsshouldbeutilisedastheservicestheyrepresentarecompleted,whetherinasinglevisitormultipleappointments.
Ifanadditionalvisitisnecessarytoirrigateandredresstherootcanalsystem,item455shouldbeused.
Chancefillingofanaccessorycanalwhileobturatingamaincanalisnottobedeemedanadditionalcanalobturation.
Theprovisional(temporary)closureoftheaccesscavitybetweenvisitsshouldnotbeseparatelyitemised.
Provisional Restoration or Prosthesis
Provisional refers to a restoration or prosthesis which is intended to be of diagnostic or short-termfunctionaloraestheticvalue.
Definitive Restoration or Prosthesis
Definitivereferstoarestorationorprosthesisplacedafteradequatediagnosticprocedureshavebeencompletedwiththeintentionthattherestorationorprosthesiswillhavelong-termfunctionaloraestheticvalue.
Direct and Indirect Restorations, Crowns and Bridges
Non-specificterminologyhasbeenadoptedtodescribethecomponentsofdirectandindirectrestorations,crownsandbridges.Theonlydistinctionsarebetweenmetallicandtooth-colouredmaterialsanddirectorindirectfabrication.
Bridgesconsistofretainers,suchascrowns,directandindirectrestorations,bondedwingsorfacings,whichattachpontics (replacements formissing teeth) to theabutment teethor implants towhich theretainersarefixed.
Correct itemisation requires description of abutment retainers togetherwith the type and number ofpontics.Thisitemisationisalsoapplicabletoprovisionalcrownsandbridges.Similarprinciplesapplytoimplantsupportedcrownsandbridges.
ExampleAtoothsupportedbridgecarryingtwoindirectponticssupportedbyaveneeredjacketcrownateachend(commonlyknownasafour-unitbridge)wouldbeitemisedas:2x615,2x643
viiThe Australian Schedule of Dental Services and Glossary
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Notes for Guidance
Animplantsupportedbridgecarryingoneindirectponticsupportedbyaveneeredjacketcrownateachend incorporating an abutment attached to the underlying implant (commonly knownas a three unitimplantsupportedbridge)wouldbeitemisedas:2x661,2x672,1x643
Bondedbridgesaresimilarlyitemised.Forinstance,athree-unitindirectbondedbridgewhichhastworetainersandasingleindirectponticisitemisedas:2x649,1x643
Atoothsupportedprovisionalbridgecarryingtwoindirectponticssupportedbyprovisionalcrownsateachend(commonlyknownasaprovisionalfour-unitbridge)wouldbeitemisedas:2x631,2x632
An implant supportedprovisionalbridgecarryingone indirectponticsupportedbyaveneered jacketcrownateachendincorporatingaprovisionalabutmentattachmenttotheunderlyingimplant(commonlyknownasaprovisionalthreeunitimplantsupportedbridge)wouldbeitemisedas:2x633,2x634,1x632
Infrastructures (such as core for crown including post), stress-breakers and precision or magneticattachmentsshouldbeappropriatelyitemised.
Direct, Indirect
Thetermsdirectand indirectareusedtodistinguishbetweenrestorations/servicesfabricateddirectlyinthemouth(direct)andthosefabricatedoutsidethemouthusingmodels,copingsordigitisedimages(indirect).Adentaltechnicianmayassistinthefabricationofindirectrestorations.
Certainrestorationsusebothintraoralandextraoralproceduresbutaretobeitemisedbythepredominantelementoffabrication.
For exampleSomeresin-basedrestorationmaterialsareformedinthemouthbutareremovedforextraoralcuringandfinishingbeforecementation/insertion.Thesearetobeitemisedasdirectrestorations.
Somerestorationsaremilledextraorallybeforecementation/insertion.Thesearetobeitemisedasindirectrestorations
Some cast restorationswill have the casting pattern prepared in themouth before being completedextraorally.Thesearetobeitemisedasindirect.
Cementation
Where the term cementation is used in the Schedule it implies the various processes (cementation,bonding, adhesion, curing, attaching) employed to achieve enduring retention of a restoration orprosthesisinthemouth.
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Notes for Guidance
Immediate Dentures
Immediatedenturesrequiremultipleitemisation.
For exampleA full upper immediatedenture inwhich six teethare replaced immediately following their extractionshouldbeitemisedwiththefollowingitems:
Removalofatoothorpart(s)thereof 6x311Completemaxillarydenture 711Immediatetoothreplacementpertooth 6x736
Thesameprincipleappliestopartialdentureimmediatetoothreplacement[s]
Partial Dentures
Partialdentureitems721,722,727and728areusedtodescribethebaseonly(resinorcastmetal)ofthepartialdenture.
Item733(tooth/teeth)shouldbeusedtodescribethenumberofteethbornebythedenturebase.
When retainers (clasps) (731), overlays (734), occlusal rests (732), precisionormagnetic attachments(735)ormetalbackings(739)areusedtheyshouldbeappropriatelyitemised.
Item730:AcodingusedonlybytheDepartmentofVeteransAffairstoidentifytheactualcostofthecastalloyframeworkofapartialdenture.Itsuseisusuallysupportedbytheprovisionofaninvoiceorcopythereof.
ExampleProvisionofafive-toothmandibularacrylicpartialdenturewherethesaddlesareconnectedbyawroughtbarandwheretherearetwoclaspsandtwoocclusalrestswouldbeitemisedas:
Partialmandibulardentureresinbase 722Wroughtbar 738Fiveteethontheresindenturebase 5x733Tworetainers 2x731Twoocclusalrests 2x732
Provisionofafive-toothcastmetalframeworkmaxillarydenturewithtwoocclusalrestsandtworetainerswouldbeitemisedas:
Partialmaxillarydenturemetalframework 727Fiveteeth 5x733Tworetainers 2x731Twoocclusalrests 2x732
Item 281 Course of Non-Surgical Periodontal Treatment
Thisisanall-inclusiveitemisationofadefinitivecourseofcomplexnon-surgicalperiodontaltreatment.Itmaybeutilisedinconjunctionwiththeperiodontaltreatmentform(seepage12).Whilethisisamultifacetedsinglecourseoftreatment,theaccountingmaybesequentiallypresentedtoenableprogressivebilling.
Radiographsandothermeasuresappropriatetothetreatmentplanningshouldbeseparatelyitemised.
ixThe Australian Schedule of Dental Services and Glossary
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Notes for Guidance
Item 881 Complete Course of Orthodontic Treatment
This is an all-inclusive itemisationof adefinitive courseof complexorthodontic treatment. Itmaybeutilised inconjunctionwith theorthodontic treatment form (seepage42).While this isamultifacetedsinglecourseoftreatment,theaccountingmaybesequentiallypresentedtoenableprogressivebilling.
Radiographsandothermeasuresappropriatetothetreatmentplanningshouldbeseparatelyitemised.
Dental Health Insurance and Other Third Parties
TheTenthEditionoftheSchedulecontainsthedefinitiveandauthoritativedescriptionsofdentalservicesrenderedwithinAustralia.Assuch,thirdpartiesandallotherbodiesthatusetheSchedulearenotentitledtoplacetheirowndefinitionsorinterpretationsonitemnumberslistedwithinthisSchedule.
Commercialdecisionsbyhealthfundsandotherthirdpartiestoplacelimitsorutilisationrulesoncertainprocedures,whether they are annual or per procedure, do not imply that the continued provision ofthose servicesby theprovider is inappropriate.Wherehealth fundsorother thirdpartiesmakesuchclaims,appropriateevidenceshouldbeprovidedtotheChiefExecutiveOfficeroftheAustralianDentalAssociationInc.
Tooth Identification
If it isnecessaryorusefultoidentifyatooth,theFDITwo-digitToothIdentificationnumbershouldbeemployed.PleasenotethattoothIDisnotapplicabletoimplants.
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Notes for Guidance
Itemisation of Accounts
Theoriginal itemisationofdental servicesshouldbeprovided ina formconsistentwith the followingguidelineswhich,althoughnotmandatory,arerecommendedbytheAssociation:
(a) Nameandprovidernumberofthedentistprovidingtheservice.
(b) Entitytowhichpaymentistobemade.
(c) Specialistdescriptionifappropriate.
(d) Addressoftheplaceofpractice.
(e) Telephonenumberoftheplaceofpractice.
(f) Nameandaddressofthepartyresponsibleforthedebt.
(g) Nameofpatient.
(h) Dateonwhichtheaccountwasrendered.
(i) Dateonwhichservicewasprovided.
(j) Identificationofserviceby theSchedulenumberand/ordescriptionofservicesufficient toidentifytheprocedure.
(k) Feechargedforeachitemofservice.
(I) Detailsofpaymentmade.
(m) Balanceowing.
(n) Whenasubsequentaccountisissued,itshouldbeendorsedduplicatecopy.
(o) GST,whereappropriate,shouldbeitemised.
xiThe Australian Schedule of Dental Services and Glossary
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Illustrated Definitions
Tooth Terminology
PulpThe organ at the centre of a tooth containing blood vessels, nerve tissue and cells that produce dentine.
FissureA naturally occurring crevice in the enamel.
EnamelThe hard, calcified substance that is the surface of a crown of a tooth.
CrownThe crown of the tooth is the part of the tooth that is visible and is above the gum margin or gingiva.
Periodontal ligamentThe ligament which connects a tooth, by its root, to the supporting bone.
DentineThe calcified tissue that forms the major part of a tooth. In the crown of the tooth, the dentine is covered by enamel. The pulp chamber of the tooth is enclosed by dentine.
RootThe root is the part of the tooth below the gum margin and is connected through cementum on its surface and the fibres of the periodontal ligament to the supporting bone.
MucosaThe name given to the lining of epithelium inside the mouth, and its immediate substructures.
CementumThe calcified tissue which is on the surface of the root of a tooth and which provides attachment for the periodontal ligament.
GingivaThe marginal part of the gum that surrounds the tooth where it emerges from the deeper, supporting tissues.
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Illustrated Definitions
Dental Arch
Molar teethThe teeth behind the bicuspid teeth. There are three molar teeth in each quadrant of the dental arch. They are the very back teeth; the wisdom tooth is the last molar in each dental arch.
Posterior teethThe teeth at the back of the mouth including premolars and molars.
LingualAn adjective to describe the aspect or surface of the teeth or other object or structure in the mouth which is in proximity to the tongue.
BuccalAn adjective to describe the aspect or surface of the teeth or other object or structure in the mouth which is in proximity to the cheek.
PalatalAn adjective to describe the aspect or surface of the teeth or other object or structure in the mouth which is adjacent to the palate.
LabialAn adjective to describe the aspect or surface of teeth or other object or structure in the mouth which is in proximity to the lips; for instance, the front surface of the incisor teeth.
Incisor teethThe front teeth usually in the centre of the upper or lower dental arch.
Premolar (bicuspid) teethThe teeth in each quadrant of the dental arch usually immediately behind the canine teeth.
Canine (cuspid) toothThe tooth usually immediately behind the incisor teeth; usually the third tooth from the centre of the dental arch.
Anterior teethThe teeth in the upper or lower arch usually comprising the central and lateral incisors and the canine (or cuspid) teeth.
xiiiThe Australian Schedule of Dental Services and Glossary
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Illustrated Definitions
Mandible Showing Anatomical Features
Mandibleorlowerjaw(leftsideview)showinganatomicalfeatures.
Body of mandible
Angle of mandible
Ramus of mandible
Left condyle
Right condyle
Third Molar Impactions of Upper and Lower Jaw
Maxillaryandmandibular(upperandlower)teethshowingthirdmolar(wisdomteeth)impactions,rightsideview.
Unerupted third molar (maxillary)
Impaction against second molar
Unerupted third molar (mandibular)
Third molar impacted against erupted second molar
Wheresurgicalremovalofmolarsisperformed,seeSurgicalExtractions.
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Illustrated Definitions
Casting Technique
Irrespectiveofthemetalemployed,castingsusedindentistryareusuallymadebythewaxeliminationprocess,whichpermitsaccurateandverycomplexshapestobecastinmetalandusedasinlays,crowns,bridgesorpartialdentures.
Figure 1
Inthisexample,thetoothispreparedbycuttingtoadesignedshape.Awaxpattern ismadetoformandcontourthatwouldreplacethemissingtooth structure. Sometimes, wax patterns aremadedirectly in themouth;atother timestheyaremadeonareplica(die)ofthetoothorteeth.
Thewaxpatternisthenliftedawayfromthetooth(ordie)bymeansofapin(sprue)meltedontoitsexternalsurface.
Figure 2
Thewaxpatternwith its sprue isembedded inheatresistantplaster.Whenthesprueisremovedand thewaxmeltedawaybyheating,ahollowmouldremainsintowhichmoltenmetalmaybeforcedorcast.
Figure 3
Excess metal is cut away and the casting istrimmed,fittedtothetoothordieandpolished.
Figure 4
The casting is attached to the prepared toothwith a special adhesive cement. It replacesexactlythemissingtoothstructure.
xvThe Australian Schedule of Dental Services and Glossary
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Illustrated Definitions
Crowns and Bridges
Crown
Crown
Bridge
Retainer
Abutment tooth
Post crown
Crown of naturaltooth reduced toaccept the crown
Retainer(full crown)
Abutment tooth
Root filling
Prepared root of tooth
Post cast, wroughtor preformed
Artificial new crown
Pontic (artificialreplacement tooth)
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Illustrated Definitions
Implants
Healing screw (removed whensecond stage head section is attached)
Oral mucosa healed overimplant after insertion of firststage
Oral mucosal epithelium(oral mucosa)
Outer bone plate
Cancellous bone
Endosseous implant
Abutment sectioninserted after removalof healing screw
Endosseous implant
Crown inserted overabutment section
Abutment head sectiondesigned to receive acrown
Oral mucosal epithelium
Outer bone plate
Cancellous bone
xviiThe Australian Schedule of Dental Services and Glossary
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Illustrated Definitions
Partial Mandibular Denture
Retainer clasp
Framework for attachmentof acrylic and teeth
Figure 1Figureshowingcastalloyframeworkonmodelofmandibularteethmadefromanimpression.
Cast alloyframework
Retainer clasp
Denture saddle withthree teeth
Occlusal rest
Denture tooth
Figure 2Castalloyframeworkwithsixteeth.
Veneer
Prepared labial face
Veneer
Figure 1Incisor tooth prepared for veneerand veneer before attachment.
Figure 2Incisor tooth with veneerattached.
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Goods and Services Tax
Goods and Services Tax: goods and services supplied by dentists
Adraftofthis10thEditionofThe Australian Schedule of Dental Services and Glossary wasprovidedtotheAustralianTaxationOffice(ATO)witharequestthat,fortheassistanceofmembers,itprovideanadviceontheapplicationofGSTlegislationtotheScheduleitems.
AcopyofthecompleteRulingfromtheATOisreproducedontheADAmemberwebsiteathttp://www.ada.org.au/members/publications/schedulemem.aspx
TheessentialpartsoftheRulingarere-producedbelow.ThisincludestheRulingitselfandAppendix1whichprovidesanExplanationoftheRuling.AnAppendix2Detailedcontentslistisnotre-producedbelow.ThisAppendixatAttachmentAidentifiesthetaxstatusofeachitemintheSchedule.
TheADAhasinthe10thEditionofThe Australian Schedule of Dental Services and Glossary identifiedthoseitemstowhichGSTdoesormayapply.ThetaxstatusofanitemispresumedtobetaxfreeunlesstheitemnumberintheSchedulehasasymbolnexttoit.
Thelegendforthesymbolsis:
T Referstoservicesthatareconsideredtobetaxableastheyarenotfortheappropriatetreatmentofthepatient.
# Indicatesservices thatmaynotbeGST-freeas theymaynotbe necessary for theappropriatetreatment of the patient, for example, services for medico-legal or cosmetic purposes (seeparagraphs44and45ofthisClassRuling).
$ These are item numbers where the description of the item covers both taxable and GST-freesupplies.RefertothediscussiononSupplyofsparepartswithlabourservicesatparagraphs87to97ofClassRuling.
@ TheMedicareBenefitsScheduleprovidesthataMedicarebenefitispayableforsomedentalservicesprovidedinthecommunitytopeoplewithchronicmedicalconditionsandcomplexcareneeds.TheMedicareBenefitsScheduleofDentalServicesprovidesdetailsofservicesthatarecoveredbytheMedicareitems;whichdentalpractitionersareeligibletousethedentalitemsandwhichpatientsareeligibleforthesedentalservices.WhereaMedicarebenefitispayable,theserviceisGST-freeundersection38-7.
WhatappearsonthefollowingpagesisanextractoftheATORuling.ItisdesignedtoprovideuserswiththeessentialadviceregardingtheRuling.TheinclusionofthisadviceisfortheinformationofmembersandinnowayimpliesendorsementbytheAustralianDentalAssociation(ADA).YoushouldnotethatintheextractsprovidedtheparagraphnumbersprovidedbytheATOinthecompleteRuling(accessiblethroughtheADAwebsite)havebeenretainedforsimplicityandcompleteness.
IfinreadingtheextractspublishedbelowmembersrequirefurtherclarificationoftheimpactoftheRulingtheyareadvisedtovisitthecompletecopyoftheRulingonthewebsitehttp://www.ada.org.au/members/publications/schedulemem.aspx
TheADAwishestothanktheATOforthepromptprovisionofthisadvice.
xixThe Australian Schedule of Dental Services and Glossary
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Goods and Services Tax
Explanatory Notes
Thispublication(excludingappendixes)isapublicrulingforthepurposesoftheTaxation Administration Act 1953.
ApublicrulingisanexpressionoftheCommissionersopinionaboutthewayinwhicharelevantprovisionapplies,orwouldapply,toentitiesgenerallyortoaclassofentitiesinrelationtoaparticularschemeoraclassofschemes.
IfyourelyonthisRuling,theCommissionermustapplythelawtoyouinthewaysetoutintheruling(unlesstheCommissionerissatisfiedthattherulingisincorrectanddisadvantagesyou,inwhichcasethelawmaybeappliedtoyouinawaythatismorefavourableforyouprovidedtheCommissionerisnotpreventedfromdoingsobyatimelimitimposedbythelaw).Youwillbeprotectedfromhavingtopayanyunderpaidtax,penaltyorinterestinrespectofthematterscoveredbythisrulingifitturnsoutthatitdoesnotcorrectlystatehowtherelevantprovisionappliestoyou.
[PLEASENOTETHEPARAGRAPHNUMBERSFROMTHEATORULINGHAVEBEENADOPTEDINTHEFOLLOWINGEXTRACT]
8. Thisworkiscopyright.ApartfromanyuseaspermittedundertheCopyright Act 1968,nopartmaybereproducedbyanyprocesswithoutpriorwrittenpermissionfromtheCommonwealth.Requestsandinquiriesconcerningreproductionandrightsshouldbeaddressedto:
CommonwealthCopyrightAdministrationCopyrightandClassificationPolicyBranchAttorney-GeneralsDepartment3-5NationalCircuitBartonACT2600
orpostedat:http://www.ag.gov.au/cca
Date of effect
9. ThisRulingappliesonorafter1April2013.However,thisRulingwillnotapplytotaxpayerstotheextentthatitconflictswiththetermsofasettlementofadisputeagreedtobeforethedateofissueofthisRuling(seeparagraphs75and76ofTaxationRulingTR2006/10).
Ruling
15. This Ruling addresses the goods and services tax (GST) treatment of the supply of goods andservicesbydentists.This Ruling includes Attachment A at page 22.
Supplies made by dentists under section 38-7
Supplies of services
16. Suppliesofdentalservicesandrepairsofdentalgoodsbyadentisttoapatientforwhichamedicarebenefit ispayableunderPart II of theHealth Insurance Act 1973 areGST-freeunder subsection38-7(1)(seeparagraphs31to34ofthisClassRuling).
Supplies of goods to patients (goods other than medical aids and appliances covered by section 38-45)
17. SuppliesofgoodstoapatientinthecourseofsupplyingthatpatientwithaGST-freeserviceundersubsection38-7(1)arealsoGST-freeundersubsection38-7(3)ifthesupplyismadetothepatientatthepremisesatwhichtheGST-freeserviceissupplied(seeparagraphs68to69ofthisClassRuling).
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Goods and Services Tax
Supplies made by dentists under section 38-10
Supplies of services
18. Suppliesofdentalservicesbyadentisttoapatientthataregenerallyacceptedinthedentalprofessionas being necessary for the appropriate treatment of that patient are GST-free under subsection38-10(1)(seeparagraphs35to67ofthisClassRuling).
Supplies of goods to patients (goods other than medical aids and appliances covered by section 38-45)
19. SuppliesofgoodstoapatientinthecourseofsupplyingthatpatientwithaGST-freedentalserviceundersubsection38-10(1)arealsoGST-freeundersubsection38-10(3)ifthesupplyismadetothatpatientatthepremisesatwhichtheGST-freeserviceissupplied(seeparagraphs68to69ofthisClassRuling).
Supplies of medical aids and appliances under section 38-45
Supplies of medical aids and appliances used in the dental industry
20. Supplies of customised toothbrushes for people with disabilities, dentures and artificial teeth,andmandibularadvancementsplintsareGST-freeundersubsection38-45(1)atallpoints in thesupplychain.ThingsmadeorconsumedintheprocessofconstructingandsupplyingoneoftheseitemsformpartoftheoneoverallGST-freesupplyofthatitem,evenifthecomponentsareitemisedseparatelyonthebill(seeparagraphs70to81ofthisClassRuling).
Supplies of specifically designed spare parts for medical aids and appliances
21. ThesupplyofaspecificallydesignedsparepartforaGST-freemedicalaidorappliance(customisedtoothbrushesforpeoplewithdisabilities,denturesandartificialteeth,andmandibularadvancementsplints)isGST-freeundersubsection38-45(2).
22. GenericsparepartsthatarenotspecificallydesignedforaGST-freemedicalaidorappliancearenotGST-free(seeparagraphs82to85ofthisClassRuling).
Supplies of specifically designed spare parts with labour services
23. WhereaspecificallydesignedsparepartissuppliedtogetherwithalabourcomponentthatisnotGST-freebyitself,theGSTtreatmentwilldependonhowthesupplyischaracterised(seeparagraphs87to97ofthisClassRuling).
24. AsupplyisGST-freeifthedominantpartofthesupplyisthespecificallydesignedsparepartandthelabourismerelyintegral,ancillaryorincidentaltothesupplyofthesparepart.However,thesupplyistaxable1ifthedominantpartisthelabourandthesparepartismerelyintegral,ancillaryorincidentaltothelabour.
25. Ifthespecificallydesignedsparepartorthelabourisneitherintegral,ancillaryorincidentaltotheother,thesupply isamixedsupplythat ispartlyGST-free(thesparepart)andpartlytaxable(thelabour).
Appendix 1 Explanation
This Appendix is provided as information to help you understand how the Commissioners view has been reached. It does not form part of the binding public ruling.
26. Under the GST Act, some goods and services supplied by dentists are GST-free where certainrequirementsaresatisfied.
1 InthisClassRuling,whenasupplyisindicatedasbeingtaxableorpartlytaxable,itisassumedthatalltherequirementsforataxablesupplyundersection9-5aremet.
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27. GSTispayableonsuppliesthataretaxablesuppliesbutnotonthosethatareGST-free.AdentistmayclaiminputtaxcreditsfortheGSTincludedinthepriceofthingsacquiredformakingtaxableorGST-freesuppliesorboth.
Taxable supplies section 9-5
28. Undersection9-5,anentitymakesataxablesupplyif:
itismadeforconsideration
itismadeinthecourseorfurtheranceofanenterprisethattheentitycarrieson
thesupplyisconnectedwithAustralia,and
theentityisregisteredorrequiredtoberegisteredforGST.
29. However,section9-5alsoprovidesthatasupplyisnottaxabletotheextentthatitisGST-freeorinputtaxed.
30. Forthepurposesofthisruling,theprovisionsoftheGSTActdealingwithinputtaxedsuppliesarenotrelevanttoanysuppliesmadeinthedentalindustry.TherelevantGST-freeprovisionsoftheGSTActareconsideredbelow.
GST- free supplies under section 38-7
Medical services subsection 38-7(1)
31. Subsection38-7(1)states:
Asupplyofa*medicalserviceisGST-free.
32. Medicalserviceisdefinedinsection195-1tomean:
(a)aserviceforwhichamedicarebenefitispayableunderPartIIoftheHealth Insurance Act 1973; or
(b)...(thispartofthedefinitionisnotrelevanttodentalservices)
33. Somedentalservices(includingrepairsofdentalgoods)arelistedintheMedicareBenefitsSchedule.ForadentalservicetobeGST-freeundersubsection38-7(1),amedicarebenefitmustbepayableforthatservice2.
34. Whereadental service is listed in theMedicareBenefitsSchedulebutamedicarebenefit isnotpayablebecausecertainothercriteriaarenotmet,thedefinitionofmedicalserviceisnotsatisfied.Forexample,amedicarebenefitisnotpayableforasupplyofadentalservicetoanon-residenteventhoughthatserviceislistedintheMedicareBenefitsSchedule.Inthesecircumstances,whetherthedentalserviceisGST-freeornotneedstobeconsideredundersection38-10.
GST-free supplies under section 38-10
Dental services subsection 38-10(1)
35. Subsection38-10(1)states:
AsupplyisGST-free if:
(a)it is a service of a kind specified in the table in this subsection, or of a kind specified in theregulations;and
(b)thesupplierisa*recognisedprofessionalinrelationtothesupplyofservicesofthatkind;and
2 Theexceptioninsubsection38-7(2)doesnotapplytotheitemsreferredtointheScheduleinAttachmentAtothisClassruling.Subsection38-7(2)providesthatasupplyofamedicalserviceisnotGST-freeundersubsection38-7(1)ifitisasupplyofaprofessionalservicerenderedinprescribedcircumstanceswithinthemeaningofregulation14oftheHealthInsuranceRegulationsthataremadeundertheHealthInsuranceAct1973(otherthantheprescribedcircumstancessetoutinregulations14(2)(ea),(f)and(g).
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(c)thesupplywouldgenerallybeaccepted,intheprofessionassociatedwithsupplyingservicesofthatkind,asbeingnecessaryfortheappropriatetreatmentofthe*recipientofthesupply.
36. AllthreeoftherequirementsmustbesatisfiedforasupplyofdentalservicestobeGST-freeunderthiscategory.
Paragraph 38-10(1)(a)
Are dental services specified in the table or the regulations?
37. Dentalisaservicespecifiedatitem6inthetableinsubsection38-10(1).
Paragraph 38-10(1)(b)
Who is a recognised professional in relation to the supply of dental services?
38. Section195-1definesrecognisedprofessionaltomeanthefollowing:
Apersonisarecognisedprofessional,inrelationtothesupplyofaserviceofkindspecifiedinthetableinsubsection38-10(1),if:
(a)theserviceissuppliedinaStateorTerritoryinwhichthepersonhasapermissionorapproval,orisregistered,undera*Statelawora*Territorylawprohibitingthesupplyofservicesofthatkindwithoutsuchpermission,approvalorregistration;or
(b)theservice is supplied inaStateorTerritory inwhich there isnoState laworTerritory lawrequiringsuchpermission,approvalorregistration,andthepersonisamemberofaprofessionalassociationthathasuniformnationalregistrationrequirementsrelatingtothesupplyofservicesofthatkind;or
(c)inthecaseofservicescoveredbyitem3inthetabletheserviceissuppliedbyanaccreditedserviceproviderwithin themeaningof section4of theHearing Services Administration Act 1977.
39. InallStatesandTerritories,dentistsarerequiredtoberegisteredpursuanttotherelevantStateorTerritoryAct.Accordingly,apersonwhoisregisteredpursuanttotheStateorTerritoryActwillbeconsideredtobearecognisedprofessionalindentalservicespursuanttoparagraph195-1(a).
Paragraph 38-10(1)(c)
40. To satisfy this requirement, the servicemust generally be accepted in theprofession associatedwithsupplyingservicesofthatkind(inthiscase,thedentalprofession)asbeingnecessaryfortheappropriatetreatmentoftherecipientofthesupply.
What is appropriate treatment?
41. Adentistwillprovideappropriatetreatmenttothepatientifthedentistassessesthepatientsstateofhealthanddeterminesaprocessforpreserving,restoringorimprovingthephysicalorpsychologicalwellbeingofthatpatient.Appropriatetreatmentincludesanysubsequentservicesprovidedtothepatientaspartofthatprocess.
42. Appropriate treatment also includesmedical treatment of a preventative nature, for example, aperiodicoralexaminationwherethereisnoevidenceofanailmentpriortoattendance.However,thisdoesnotextendtothesupplyofservicesandgoodsinrelationtocustomisedmouthguards.Whilstacustomisedmouthguardisadevicethatmaypreventorreducedamagesustainedtothemouthandteethintheeventofaninjury,itisnotconsideredtobetreatmentthatisperformedonapatient.
43. TobeGST-free, thedentalprofessionmustaccept that theservice isnecessaryandacceptabletreatment,takingintoaccountthepatientsindividualcircumstances.
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44. Servicesprovidedinassessingapatientfor insuranceor litigationpurposes,that is,medico-legalservices,arenotnecessaryfortheappropriatetreatmentofthepatientandarenotGST-free.
45. Serviceswhicharepredominantlyfortheimprovementoftheappearanceofthepatientarealsonotnecessaryfortheappropriatetreatmentofthepatientandtherefore,arenotGST-free.
46. Servicesthatareintendedtoimprovethehealthofthepatientbutwhichalsocompriseacosmeticcomponent,forexample,reconstructionofabadlydamagedtooth,arenecessaryfortheappropriatetreatmentofthepatientandaretherefore,GST-free.
47. Amodificationtoadentureorotherapplianceundertakenforthechangingconditionofthepatientisappropriate treatmentof thatpatientand isGST-free if suppliedbyadentist toapatient.Thechangingconditionofthepatientwillincludesituationssuchas:
anadditiontothedenturewherethepatienthashadatoothextracted;or
amodificationoradjustmenttoadentureduetoachangeintheshapeorstructureofapatientsmouth,palate,gumsorjaw.
48. ServicesfordeterminingthatamodificationisrequiredandanysubsequentservicestoensurethatthedenturefitscorrectlyarealsoGST-freeiftheelementsofsection38-10aresatisfied.
Who is the recipient of the supply?
49. Paragraph 38-10(1)(c) requires that the supply must be generally accepted in the professionassociatedwithsupplyingservicesofthatkindasbeingnecessaryfortheappropriatetreatmentoftherecipientofthesupply.
50. Asonlyan individualcan receive treatmentasapatient, the recipientof thesupplymustbeanindividualforthesupplytobeGST-freeundersection38-10.
Supply of dental services under arrangements with third parties
51. In some cases, dentists will have agreements with third parties under which there is a bindingobligationonthedentisttoprovidesomethingtothepatientforwhichthethirdpartyisliabletopay.Inthesecases,thethirdpartyistherecipientofthesupply.Dependingontheparticularagreement,thedentistmaybemakingsuppliestothepatientaswellasthethirdparty3.
52. Intheabsenceofabindingobligation,theremaystillbeasupplybythedentisttothethirdpartywherethefollowingfactors4arepresent:
(a)thereisapre-existingframeworkoragreementbetweenthethirdpartyandthedentistwhichcontemplatesthatthepartiesactinaparticularmannerinrespectofsuppliesbythedentisttoparticularpatientsoraclassofpatients;
(b)thepre-existingframeworkoragreement:
(i) identifiesamechanismbywhichtheparticularpatientsor theclassofpatientsare tobeidentifiedsuchthatthesuppliesmadetothemcomewithinthescopeoftheframeworkoragreement;and
(ii) specifiesthatthethirdpartyisunderanobligationtopaythedentistifthereisarelevantsupplybythedentisttoapatientandalsosetsoutamechanismbywhichsuchpaymentisauthorised;
3 Seeforexample,thecaseofFederal Commissioner of Taxation v Secretary to the Department of Transport (Vic) [2010] FCAFC84;2102ATC20-196.
4 Seeparagraph221BofGSTR2006/9butnotethedifferenceinterminology.Here,thirdpartyisusedinsteadofpayer,dentistisusedinsteadofsupplierandpatientisusedinsteadofthirdparty.
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(c)theframeworkoragreementandthemechanismforauthorisingthepaymentareinexistencebeforethesupplybythedentisttothepatient(thatis,thedentistknowsinadvancethatthethirdpartyisobligedtopaysomeoralloftheconsiderationintheeventofthesupplytothepatient);
(d)thedentistmakesthesupply to thepatient inconformitywith thepre-existing frameworkoragreementbetweentheparties;and
(e)the obligationof the thirdparty tomakepayment pursuant to thepre-existing frameworkoragreementisnotanadministrativearrangementtopayonbehalfofthepatientforaliabilityowedbythepatienttothedentist.Rather,oncethesupplybecomesasupplytowhichtheframeworkoragreementapplies,theframeworkoragreementestablishesaliabilityowedbythethirdparty(notthepatient)tothedentistintheeventthatthereisasupplybythedentisttothepatient.
53. Undersection38-60,wherethethirdparty isan insurer,anoperatorofastatutorycompensationschemeorcompulsorythirdpartyscheme(schemeoperator),oranAustraliangovernmentagency,thesupplytothethirdpartybythedentistisGST-freetotheextentthattheunderlyingsupplyofthedentalservicetothepatientisaGST-freesupplyundersection38-10or38-7.
54. Undersubsection38-60(4),thedentistandthethirdpartycanagreethatthesupplynotbetreatedasGST-free.ThedentistandthirdpartymaychoosetonottreatsuppliesasGST-freewhere,forexample,thereisacombinationofGST-freeandtaxablesuppliesanddeterminingtheamountsforeachsupplymaybecomplex.TheoptionofnottreatinganyofthesuppliesasGST-freemaybeadministrativelyeasierfortheparties.
55. Whereathirdpartyisnotaninsurer,aschemeoperatororanAustraliangovernmentagency,thesupplytothethirdpartyisnotaGST-freesupplyundersection38-60.
Example 1 Supply of health services by a dentist to an insurer
56. ABC Health Fund has a pre-existing agreement with a dentist for the supply of goods and services to settle claims made under their insurance policies.
57. The agreement outlines what both parties need to do when the dentist treats an ABC Health Fund member. Under the agreement, the payment to the dentist from ABC Health Fund is for the supply made by the dentist to ABC Health Fund for supplying dental treatment to the ABC Health Fund member.
58. As the supply of the dental treatment to the ABC Health Fund member is a GST-free supply under section 38-10, the supply by the dentist to ABC Health Fund is GST-free under section 38-60.
Example 2 Supply of health services by a dentist to a third party not being an insurer, a scheme operator or an Australian government agency
59. XYZ Company contracts with a dentist to provide dental treatment to its employees. XYZ Company is not an insurer, a scheme operator or an Australian government agency.
60. XYZ Company is the recipient of the supply of professional services from the dentist. If the dentist is registered for GST, the supply of the services is a taxable supply.
61. Section 38-60 does not apply in this scenario to make the supply to the third party GST-free because XYZ Company is not an insurer, a scheme operator or an Australian government agency.
Supplies paid for by someone other than the patient
62. Underothertypesofarrangements,athirdpartymeetsthepatients liabilitytothedentistwithoutasupplybeingmadetothethirdpartybythedentist.Afeatureofthesearrangementsisthattheagreementforthesupplyofgoodsorservicesisbetweenthedentistandthepatientandtheobligationtopayforthatsupplyremainswiththepatient.Thethirdpartymerelypaysforthesupplyonbehalfofthepatient.
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63. Whopays for a supplyof services is not relevantwhenworkingout if the supply isGST-free. Iftherecipientofthesupplyisthepatient,itdoesnotmatterthatthesupplyisbeingpaidforonthepatientsbehalfbyathirdparty5.
Example 3 The third party merely pays for the supply of dental treatment on a patients behalf
64. Jenny is a dentist who is a recognised professional for GST purposes. Adam makes an appointment to see Jenny. At the initial consultation, Adam tells Jenny that he sustained damage to his tooth whilst at work and that she can bill his employer for the costs. Jenny confirms with Adams employer that she can send the bill to them.
65. Jenny does not have a pre-existing agreement or a binding obligation with Adams employer to provide the treatment to Adam.
66. Jenny is making a GST-free supply to Adam which is paid for by Adams employer. Jenny is not making any supply to Adams employer they are merely paying the bill on Adams behalf. The fact that another entity pays for the service does not alter its GST-free status.
67. GoodsandServicesTaxRulingGSTR2006/9(Supplies),atparagraphs114-246,providesdetailedguidanceinanalysingthirdpartyarrangementsfordeterminingwhotherecipientofasupplyis.
Dental goods subsections 38-7(3) and 38-10(3)
68. If a dentist supplies goods as part of aGST-free service, those goods are alsoGST-free undersubsection38-7(3)or38-10(3)iftheyaresuppliedtothepatientinthecourseofsupplyingadentalserviceandthesupplyismadeatthepremisesatwhichtheserviceissupplied.
69. Thephraseinthecourseofsupplyingmeansthatthegoodsaresuppliedatthesametimeasthedentalserviceandtheyare:
individuallycustomisedormanipulatedforthetreatmentoftheillnessordisabilityofthatparticularpatient;or
essentialfortreatingthatpatientduringthatparticularconsultation.
Supplies of medical aids and appliances under section 38-45
Medical aids and appliances subsection 38-45(1)
70. Subsection38-45(1)states:
AsupplyisGST-free if:
(a)itiscoveredbySchedule3(medicalaidsandappliances),orspecifiedintheregulations;and
(b)thethingsuppliedisspecificallydesignedforpeoplewithanillnessordisability,andisnotwidelyusedbypeoplewithoutanillnessordisability.
71. Asupplythatsatisfiesalltherequirementsinsubsection38-45(1)isGST-free.ThesupplyisGST-freenomatterwhomakesthesupplyorwhothesupplyismadeto.
72. Indeterminingwhetheramedicalaidorapplianceisspecificallydesignedforpeoplewithanillnessordisability,referenceshouldbemadetoitsfeaturesandthedesignersormanufacturersintentionofhowthegoodistobeused.Indicatorsofthedesignersormanufacturersintentionofhowthegoodistobeusedincludehowthegoodismarketedandthetypeofretailoutletsatwhichthegoodscanbepurchased.
5 Subsection9-15(2).
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73. Indeterminingwhether amedical aidor appliance iswidely usedbypeoplewithout an illnessordisability, reference shouldbemade to how thewider community uses thesegoods. That is, thecommon purpose for which the goods are purchased. Subsection 38-45(1) does not require themedicalaidorappliancetobeusedinaparticularwaybutratherfocusesonthepurposeforwhichthewidercommunitypurchasestheseproducts.IrregularoruncommonuseofamedicalaidorapplianceinawaycontrarytoitsmanufacturedpurposedoesnotpreventthegoodfrombeingGST-free.
74. TheitemsinthetableinSchedule3totheGSTActthatareofrelevancetothedentalindustryare:
item29customisedtoothbrushesforpeoplewithdisabilities
item30denturesandartificialteeth,and
item75mandibularadvancementsplints.
75. For GST purposes, customised toothbrushes for people with disabilities are considered to betoothbrushesthathavebeenadapted,forexample,contoured,tosuittheneedsofaclassofdisabledpersons.
76. Dentures forGSTpurposes,areconsideredtobeanartificial restorationofseveral teeth (partialdenture)oralloftheteethofeitherjaw(fulldenture).Artificialteethareconsideredtobethosewhicharefabricatedandreplacenaturalteethinformandfunction.Thephraseartificialteethincludesasingletoothaswellasmultipleteeth.Fullcrownsandbridgesareartificialteeth.
77. Amandibularadvancementsplintisasmalldevicemadeofplasticorsimilarmaterialthatisworninthemouthwhilstsleeping(similarinappearancetoamouthguard).Itisdesignedtohelpstopsometypesofsnoring.Thesplint isdesignedtopushthemandible(lower jaw)forwardhelpingtokeepthetongueclearofthepharynx(thebackofthethroat).Thesplintsarealsosometimesusedforthetreatmentoftemporomandibularjointdisorder(TMJ).
Consumables
78. Where,inthecourseofsupplyingoneoftheproductslistedatitem28,item30oritem75inthetableinSchedule3,adentistconsumesvariousthings,thereisonlyoneoverallsupplyofthelisteditem.ThingsmadeandconsumedintheprocessofconstructingandsupplyingalisteditemformpartoftheoneoverallGST-freesupplyofthatproduct,evenifthecomponentsareseparatelyitemisedinthebill.
79. ExamplesofthingsconsumedintheprocessofconstructingandsupplyingaGST-freemedicalaidorapplianceincludeoil,lubricant,glueandgenericpartslikescrewsandwires.Consumableitemsareacquiredwith the intention that theywillbedestroyed,consumedorexpended.Theydonotretaintheirindividualcharacterornaturewhenanewmedicalaidorapplianceissuppliedorwhenarepairedmedicalaidorapplianceisreturnedtoitsowner.
80. However,wherethesethingsaresuppliedseparatelytothemedicalaidorappliance,theyareonlyGST-freeiftheyarespecificallydesignedsparepartsofthatmedicalaidorappliance(seeparagraphs82to84ofthisClassRuling).
Example 4 Goods used or consumed in the process of constructing and supplying a GST-free medical aid or appliance
81. Steve (a dentist) contracts Mike (a dental technician) to make a crown for Steves patient. In order to make the crown, Mike must first create a plaster model. Mike itemises the crown and plaster model separately on his bill to Steve. The plaster model is integral to the manufacturing process and is not used for any other purpose. The plaster model forms part of the overall supply of the crown, all of which is GST-free. Goods made and consumed in the process of constructing and supplying a GST-free medical aid or appliance form part of the overall GST-free supply of that item.
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Spare parts for GST-free medical aids and appliances subsection 38-45(2)
82. Undersubsection38-45(2),asparepartforaGST-freemedicalaidorapplianceisalsoGST-freeifisspecificallydesignedasasparepartforthatGST-freemedicalaidorapplianceandissuppliedforthatpurpose.
83. ForGSTpurposes,asparepartisapartthatcanbeusedtoreplaceafaulty,wornorbrokenpartofanotherthing.Thepartneedonlybecapableofreplacingthefaulty,wornorbrokenpart.Itdoesnotactuallyhavetobeusedforthatpurpose.
84. Sparepartsthatarenotspecificallydesignedtoreplaceafaulty,wornorbrokenpartofaGST-freemedicalaidorappliancearenotGST-free.Thismeans that things likegenericscrewswhicharenot specifically designed for aGST-freemedical aid or appliance are notGST-free spare parts.However,asexplainedinparagraphs78to80ofthisClassRuling,thingsusedandorconsumedintheconstructionandoverallsupplyofaGST-freemedicalaidorappliancearepartofthatoverallGST-freesupply.Therefore,whilstagenericscrewwhensuppliedonitsownisnotaGST-freesparepartforadenturebecauseitisnotspecificallydesignedforthatpurpose,itwouldbeGST-freeifthatscrewformedpartofthesupplyofthedenture.
Example 5 A part that cannot be used as a spare part for a GST-free medical aid or appliance
85. A chrome/cobalt casting frame is the internal framework for a denture. Dentures are covered by item 30 in the table in Schedule 3 and are GST-free. Whilst the framework is a component for a denture, it is not a spare part for a denture. This is because if the framework is broken, it is either repaired or a completely new denture is supplied. A new framework is never actually supplied to replace a faulty, worn or broken framework of the denture. Therefore, it is not a GST-free spare part.
Repair services
86. OtherthanrepairsofdentalgoodswhichmaybeGST-freeundersection38-7(seeparagraphs31to34above),thereisnospecificexemptionintheGSTActforthesupplyofrepairsofmedicalaidsorappliancesortheirspareparts.
Supply of spare parts with labour services
87. Where the specifically designed spare parts are supplied togetherwith a labour component (forexample,installationorfittingservice)thatisnotGST-free,theGSTtreatmentwilldependonhowthesupplyischaracterised.Thetablebelowprovidesasummaryofhowthesupplymaybecharacterised.
What is the character of the supply?
Type Dominant component
Integral, ancillary or incidental component
GST outcome
A Specificallydesignedspareparts
Labour AsinglecompositeGST-freesupplyofspecificallydesignedspareparts
B Labour(notGST-free)
Specificallydesignedspareparts
Asinglecompositetaxablesupplyoflabour
C Separatelyidentifiablesuppliesofsparepartsandlabour
Neitherisintegral,ancillaryorincidentaltotheother
ApartlytaxableandpartlyGST-freesupply(amixedsupply).ThetaxablecomponentisthelabourandtheGST-freecomponentisthespecificallydesignedsparepart.Areasonablebasismustbeusedforapportionment
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What does integral, ancillary or incidental mean?
88. Indicators6thatapartofasupplyisintegral,ancillaryorincidentaltothedominantpartofthesupplyincludethefollowing:
itrepresentsamarginalproportionofthetotalvalueofthepackagecomparedtothedominantpart
itisnecessaryorcontributestothesupplyasawholebutcannotbeidentifiedasthedominantpartofthesupply
itcontributestotheproperperformanceofthecontracttosupplythedominantpart,and
asupplierwouldreasonablyconcludethatitdoesnotconstituteforcustomersanaiminitselfbutisameansofbetterenjoyingthedominantthingsupplied.
Example 6 GST-free supply of spare parts to which labour is integral, ancillary or incidental
89. A tooth is fitted to a denture to replace a broken or missing tooth under a supply and fit contract. The supply of the tooth itself is GST-free under section 38-7 or section 38-10. The fitting of the tooth is merely integral, ancillary or incidental to the supply of the tooth. The fitting of the tooth and the supply of the tooth is a single composite GST-free supply of an artificial tooth. SeeTypeAinthetableinparagraph87ofthisClassRuling.
Example 7 Taxable supply of labour to which the spare parts are integral, ancillary or incidental
90. A denture is in poor condition and is sent to be restored which involves a significant amount of labour. The restoration service is not GST-free under section 38-7 as no medicare benefit is payable for the service. As part of that restoration, a clasp is replaced. Of itself, the clasp is a GST-free spare part for a denture under subsection 38-45(2). However, in this case, the supply of the clasp is integral, ancillary or incidental to the supply of the restoration service which is not GST-free. The supply of the clasp merely contributes to the proper performance of the contract to restore the denture, takes up a marginal proportion of the total value of the service package, and the customer does not seek the supply of the clasp as an aim in itself, but merely as part of the supply of the restoration service. The supply of the restoration service and the spare part is a single composite taxable supply. SeeTypeBinthetableinparagraph87ofthisClassRuling.
Example 8 Partly taxable and partly GST-free supply of spare parts and labour as neither component is integral, ancillary or incidental to each other
91. A tooth is added to a denture to replace a broken or missing tooth under a supply and fit contract. At the same time, a small crack which is discovered in the denture base is repaired. This repair service is not GST-free under section 38-7 as no medicare benefit is payable for the service. An extra charge is made for the repair of the crack. Neither the repair of the crack nor the fitted tooth is integral, incidental or ancillary to each other. The fitted tooth part of the supply is GST-free under section 38-10 and the repair part is taxable. The supply is partly taxable and partly GST-free. SeeTypeCinthetableinparagraph87ofthisClassRuling.
Apportionment
A supply that is partly taxable and partly GST-free
92. WhereadentistmakesasupplywhichispartlytaxableandpartlyGST-free(amixedsupply),thedentistwillneedtoapportiontheconsiderationchargedforthesupplybetweentheGST-freeandtaxablepartspursuanttosection9-80.
6 SeeGoodsandServicesTaxRulingGSTR2001/8forfurtherguidanceindeterminingwhetherapartofasupplyisintegral,ancillaryorincidentaltothedominantpartofthesupply.
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93. Areasonablebasisforapportionmentmustbeusedandeachcasemustbedeterminedonitsownfacts.Recordsmustbekeptthatexplainthemethodofapportionmentused.GoodsandServicesTaxRulingGSTR2001/8givesfurtherguidanceonmixedsuppliesandapportionment.
94. As ameans ofminimising compliance costs, part of a supplymay be treated as being integral,ancillaryorincidentaltotheotherpartiftheconsiderationthatwouldbeapportionedtoit(ifitwerepartofamixedsupply)doesnotexceedthe lesser of:
$3.00;or
20%oftheconsiderationofthetotalsupply.
95. Thisapproachmaybeadoptedtotreatasupplyasacompositesupply(thatis,eitherwhollyGST-freeortaxable),althoughitmightotherwisebeconsideredasamixedsupply.However,iftheconsiderationforapartexceedsthelesserof$3.00or20%oftheconsiderationforthetotalsupply,itdoesnotnecessarilymeanthatthepartisnotintegral,ancillaryorincidental.
Charging GST on a GST-free medical aid or appliance or a specifically designed spare part
96. Insomecircumstances,itmaybedifficulttodeterminethosesuppliesthatareGST-freeandthosethataretaxable.
97. Subsection38-45(3)allowsasupplierand recipient toagreenot to treatsupplies,oraparticularsupply, asGST-free. For example, if a supply of amedical aid or appliance ismade to anotherbusiness,bothbusinessescanagreetotreatthesupplyastaxable.
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Diagnostic Services
Examinations
Onlyoneoftheitemnumbers011-017maybeusedatonevisit.
011 Comprehensive oral examination
012 Periodic oral examination
013 Oral examination limited
014 Consultation
015 Consultation extended (30 minutes or more)
016 Consultation by referral
017 Consultation by referral extended (30 minutes or more)
018 Written report (not elsewhere included)
019 Letter of referral
011 Comprehensive oral examination #
Evaluation of all teeth, their supporting tissues and the oral tissues in order to record theconditionofthesestructures.Thisevaluationincludesrecordinganappropriatemedicalhistoryandanyotherrelevantinformation.
012 Periodic oral examination
Anevaluationperformedonapatientofrecordtodetermineanychangesinthepatientsdentalandmedicalhealthstatussinceapreviouscomprehensiveorperiodicexamination.
013 Oral examination limited
Alimitedoralproblem-focussedevaluationcarriedoutimmediatelypriortorequiredtreatment.This evaluation includes recording an appropriate medical history and any other relevantinformation.
014 Consultation #
Aconsultationtoseekadviceordiscusstreatmentoptionsregardingaspecificdentalororalcondition.Thisconsultation includes recordinganappropriatemedicalhistoryandanyotherrelevantinformation.
015 Consultation extended (30 minutes or more) #
An extended consultation to seek advice or discuss treatment options regarding a specificdentalororalcomplaint.Thisconsultation includes recordinganappropriatemedicalhistoryandanyotherrelevantinformation.
016 Consultation by referral #
A consultation with a patient referred by a dental or medical practitioner for an opinionormanagement of a specific dental disorder. The consultationmay not necessarily bewitha specialist. The referringpractitioner shouldbeprovidedwitha report from theconsultant,includedwithintheitemnumber.
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Diagnostic Services
017 Consultation by referral extended (30 minutes or more) #
An extended consultation with a patient referred by a dental or medical practitioner for anopinionormanagementofaspecificdentaldisorder.Theconsultationmaynotnecessarilybewithaspecialist.Thereferringpractitionershouldbeprovidedwithareportfromtheconsultant,includedwithintheitemnumber.
018 Written report (not elsewhere included) T
Awrittenreportnotaddressedtoareferringpractitionerinvolvedinthepatientscare.
019 Letter of referral #
A letter from a dentist referring a patient to another practitioner and providing appropriateinformationtotheconsultant.
Radiological Examination and Interpretation
Radiographicitemisationalsoappliestodigitisedimagesperexposure.
022 Intraoral periapical or bitewing radiograph per exposure
025 Intraoral radiograph occlusal, maxillary, mandibular per exposure
031 Extraoral radiograph maxillary, mandibular per exposure
033 Lateral, antero-posterior, postero-anterior or submento-vertex radiograph of the skull per exposure
035 Radiograph of temporomandibular joint per exposure
036 Cephalometric radiograph lateral, antero-posterior, postero-anterior or submento-vertex per exposure
037 Panoramic radiograph per exposure
038 Hand-wrist radiograph for skeletal age assessment
039 Tomography of the skull or parts thereof
022 Intraoral periapical or bitewing radiograph per exposure #
Takingandinterpretingaradiographmadewiththefilminsidethemouth.
025 Intraoral radiograph occlusal, maxillary, mandibular per exposure #
Takingandinterpretinganocclusal,maxillaryormandibularintraoralradiograph.Thisradiographshowsamoreextensiveviewofteethandmaxillaryormandibularbone.
031 Extraoral radiograph maxillary, mandibular per exposure #
Takingandinterpretingaradiographoftheupperand/orlowerjawusingafilmplacedoutsidethemouth:forexample,obliquelateralradiograph.
033 Lateral, antero-posterior, postero-anterior or submento-vertex radiograph of the skull per exposure #
Takingandinterpretinganextraoralradiographoftheheadtakenfromtheside,thefront,thebackorthroughthevertexoftheskull.Nocephalostatisused.
035 Radiograph of temporomandibular joint per exposure #
Takingandinterpretingaradiographofthetemporomandibularjoint.
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Diagnostic Services
036 Cephalometric radiograph lateral, antero-posterior, postero-anterior or submento-vertex per exposure #
Takingand interpretinga radiographof thehead taken from theside, the front, thebackorthroughthevertexoftheskull,forthepurposeofmeasurementandanalysis.Acephalostatisusedtostandardisetheconditionsofimaging.
037 Panoramic radiograph per exposure #
Takingandinterpretinganextraoralradiographpresentingapanoramicviewofpartorallofthemandibleand/ormaxillaand/oradjacentstructures.
038 Hand-wrist radiograph for skeletal age assessment #
Takingandinterpretingaradiographofthewristbones,usedtoassessthedegreeofskeletaldevelopmentandmaturity.
039 Tomography of the skull or parts thereof #
AradiographismadeofaregionusingtomographicX-rayequipmentthatmayproduceaseriesofdiagnosticimagesAcephalostatmaybeusedtostandardisetheconditionsofimaging.
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Diagnostic Services
Other Diagnostic Services
041 Bacteriological examination
042 Culture examination and identification
043 Antibiotic sensitivity test
044 Collection of specimen for pathology examination
047 Saliva screening test
048 Bacteriological screening test
051 Biopsy of tissue
052 Histopathological examination of tissue
053 Cytological investigation
054 Mucosal screening
055 Blood sample
056 Haematological examination
061 Pulp testing per visit
071 Diagnostic model per model
072 Photographic records intraoral
073 Photographic records extraoral
074 Diagnostic wax-up
081 Cephalometric analysis excluding radiographs
082 Tooth-jaw size prediction analysis
083 Tomographic analysis
085 Electromyographic recording
086 Electromyographic analysis
041 Bacteriological examination
Anexaminationforbacteriaorothermicroorganismsinsamplesobtainedfromthepatient.
042 Culture examination and identification
Asample is takenfromoralmaterialand isculturedforexaminationand identificationof themicroorganismspresent.
043 Antibiotic sensitivity test
Alaboratoryprocedurewherealivecultureofasuspectedpathogenischallengedwithantibioticsamplestodeterminethesensitivityorresistanceofthemicroorganismstotheantibioticstested.
044 Collection of specimen for pathology examination
Thenon-surgicalcollectionandpreparation for transportofaspecimenforexaminationatapathologylaboratory.
047 Saliva screening test
Takingandtestingasalivasampletoassessitsphysiologicalproperties.
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Diagnostic Services
048 Bacteriological screening test
Takingandtestingasampletoassessitsphysiologicalproperties.
051 Biopsy of tissue
Asurgicalproceduretoobtainasectionoftissueforpathologicalexamination.
052 Histopathological examination of tissue
Ahistopathologicalexaminationtodeterminethediseasestatusofasectionoftissue.
053 Cytological investigation
Amicroscopicexaminationofcellsobtained fromasmearor in situ stainingofasuspectedlesion todetermineanyaberrant characteristics thatmaysuggest the lesion ismalignantorrelatedtosomeothercondition.
054 Mucosal screening
Anon-invasivetestforscreeningoforalmucosafororalcancerandorotherconditions.Mayinvolvestaining,specialisedlightorfluorescencetechniques.
055 Blood sample
Thecollectionofasuitablesampleofbloodforhaematologicalexamination.
056 Haematological examination
Theexaminationandreportingofthestatusofabloodsample.
061 Pulp testing per visit
Anon-invasivetestusedtodeterminetheclinicalstatusofthepulp.Itinvolvestheapplicationofexternalstimulationtothepulptodetermineitsresponse.Otherteetharegenerallytestedforcomparison.Thisprocedureshouldonlybeitemisedonceforeachvisitwhenpulptestingisperformed.
071 Diagnostic model per model #
Thepreparationofamodel,fromanimpression.Themodelisusedforexaminationandtreatmentplanningprocedures.Thisitemshouldnotbeusedtodescribeaworkingmodel.
072 Photographic records intraoral #
Photographsand/orprinteddigitisedimagesshowingstructuresinsidethemouthassociatedwithdentaldiagnosisorclinicalprocedure.Theseimagesshouldnotbeconfusedwithdigitisedradiographicimages.
073 Photographic records extraoral #
Photographsand/orprinteddigitisedimagesshowingthefaceoraregionoftheheadandneckoutsidethemouth,associatedwithdentaldiagnosisorclinicalprocedure.Theseimagesshouldnotbeconfusedwithdigitisedradiographicimages.
074 Diagnostic wax-up #
Thepreparationandwaxingupofdiagnosticmodelstofacilitatethedevelopmentofatreatmentplan.
081 Cephalometric analysis excluding radiographs #
Theanalysisofacephalometric radiograph (item036)bymeasurementofspecificbiologicallandmarksinordertodetermineandpredictpatternsofdevelopmentofthecranio-maxillofacialgrowthcomplex.Theprocedureisoftenemployedinorthodonticdiagnosis.
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Diagnostic Services
082 Tooth-jaw size prediction analysis #
Theanalysisofrecords,includingradiographsandcasts,topredicttherelationshipbetweentheanticipatedsizeofthemandible,themaxillaandtheteeththeseboneshavetoaccommodate.
083 Tomographic analysis #
Theanalysisofatomograph(item039)bymeasurementofspecificbiologicallandmarks.Theprocedureisoftenemployedintreatmentplanningforimplantandothersurgicalprocedures.
085 Electromyographic recording #
Utilisationofelectronicapparatustodetectandrecordsensitivityoftheorofacialandassociatedmusculature.
086 Electromyographic analysis #
Theanalysisofelectromyographicrecordingsoftheorofacialandassociatedmusculature.
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Preventive, Prophylactic and Bleaching Services
Preventive, Prophylactic and Bleaching Services
Dental Prophylaxis and Bleaching
111 Removal of plaque and/or stain
113 Recontouring and polishing of pre-existing restoration(s)
114 Removal of calculus first visit
115 Removal of calculus subsequent visit
116 Enamel micro-abrasion per tooth
117 Bleaching, internal per tooth
118 Bleaching, external per tooth
119 Bleaching, home application per arch
111 Removal of plaque and/or stain #
Removalofdentalplaqueand/orstainfromthesurfacesofall teeth.This itemis includedinproceduresdescribedbyitems114,115,281and282.
113 Recontouring and polishing of pre-existing restoration(s)
Thereshapingandpolishingofpre-existingrestorations.
114 Removal of calculus first visit
Removalofcalculusfromthesurfacesofteeth.
115 Removal of calculus subsequent visit
Thisitemdescribesproceduresinitem114when,becauseoftheextentordegreeofcalculus,anadditionalvisit(s)isrequiredtoremovedepositsfromtheteeth.
116 Enamel micro-abrasion per tooth
Thechemo-physicalremovalofdiscolouredand/orothersurfaceenameldefectsresultingfromdevelopmentaldefects,alteredmineralisationordecalcificationofthesuperficialenamellayer.
117 Bleaching, internal per tooth
Themodification of the colour of the discoloured crown of an endodontically treated toothusingchemicaland/orphysicalmethodsappliedinternally.Thisisaclinicalcourseoftreatmentcarriedoutexclusivelyinthesurgery.
118 Bleaching, external per tooth #
The modification of the colour of a tooth using chemical and/or physical methods appliedexternally.Thisisaclinicalcourseoftreatmentcarriedoutexclusivelyinthesurgery.
119 Bleaching, home application per arch #
Theprescribeduse,byapatientathome,ofacustom-madetrayfortheapplicationofbleachingmedicaments to the patients dentition. This procedure describes the complete course oftreatmentperarch.Forprovisionofthetrayandmedicaments,seeitems926and927.
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Preventive, Prophylactic and Bleaching Services
Remineralisation Agents
121 Topical application of remineralisation and/or cariostatic agents, one treatment
122 Topical remineralisation and/or cariostatic agents, home application per arch
123 Concentrated remineralisation and/or cariostatic agents, application single tooth
121 Topical application of remineralisation and/or cariostatic agents, one treatment
Applicationofremineralisationand/orcariostaticagentstothesurfacesoftheteeth.Thismayincludeactivationoftheagent.Nottobeusedasanintrinsicpartoftherestoration.
122 Topical remineralisation and/or cariostatic agents, home application per arch
The prescribed use, by a patient at home, of a custom-made tray for the application ofremineralisationand/orcariostaticagentstothepatientsdentition.Thisproceduredescribesthecompletecourseoftreatmentperarch.Forprovisionofthetrayandmedicamentsorotherremineralisationagents,seeitems926and927.
123 Concentrated remineralisation and/or cariostatic agents, application single tooth
Aproceduretopromotecariesresistanceinaspecificsituation,involvingisolationandcontrolofthetargetareaandprolongedapplicationofaconcentratedfluorideorremineralisationand/or cariostatic agent. This includes necessary activation of the agent. Not to be used as anintrinsicpartoftherestoration.
Other Preventive Services
131 Dietary advice
141 Oral hygiene instruction
151 Provision of a mouthguard indirect
153 Bi-maxillary mouthguard indirect
161 Fissure and/or tooth surface sealing per tooth
165 Desensitising procedure per visit
171 Odontoplasty per tooth
131 Dietary advice
Analysisofandadviceonapatientsdiettocorrectanydietaryimbalancesordeficiencieswhichmaycontributetodentaldisease.
141 Oral hygiene instruction
Instructionintechniquesfortheremovalofbacterialplaque.Adviceofappropriatetoothpasteandmedicamentsmaybeincluded.
151 Provision of a mouthguard indirect T
Constructionofamouthguard,usingamodel(s)prepared froman impression(s)of the teethtakenbyorunderthesupervisionoftheclinicianandsubsequentlyinserted.
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Preventive, Prophylactic and Bleaching Services
153 Bi-maxillary mouthguard indirect T
Constructionofabi-maxillarymouthguardusingmodelspreparedfromimpressionsoftheteethtakenbyorunderthesupervisionoftheclinicianandsubsequentlyinserted.
161 Fissure and/or tooth surface sealing per tooth
Sealingofnon-cariouspits,fissures,smoothsurfacesorcracks ina toothwithanadhesivematerial.Anypreparationpriortoapplicationofthesealantisincludedinthisitemnumber.
165 Desensitising procedure per visit
Thisitemdescribesalldesensitisingundertakenatasinglevisitandmayincludeaproceduretodiminishorabolishthepainfulsensitivityanddiscomfortwhichcanoccurinexposeddentine.
171 Odontoplasty per tooth
Astand-aloneproceduretomodifythecontourofthecrownofatoothortheanatomyofthefissureofatooth.
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Periodontics
Periodontics
Proceduresdescribedinthissectionincludeinsertionofsutures,normalpost-operativecareandsutureremoval.
213 Treatment of acute periodontal infection per visit
221 Clinical periodontal analysis and recording
222 Root planing and subgingival curettage per tooth
231 Gingivectomy per tooth or implant
232 Periodontal flap surgery per tooth or implant
235 Gingival graft per tooth or implant
236 Guided tissue regeneration per tooth or implant
237 Guided tissue regeneration membrane removal
238 Periodontal flap surgery for crown lengthening per tooth
241 Root resection per root
242 Osseous surgery per tooth or implant
243 Osseous graft per tooth or implant
244 Osseous graft block
245 Periodontal surgery involving one tooth or implant
281 Course of non-surgical periodontal treatment
282 Continuation of periodontal treatment or maintenance subsequent to item 281
213 Treatment of acute periodontal infection per visit
Thisitemdescribesthetreatmentofacuteperiodontalinfection(s).Itmayincludeestablishingdrainageandtheremovalofcalculusfromtheaffectedtooth(teeth).
221 Clinical periodontal analysis and recording
Thisisaspecialexaminationperformedaspartofthediagnosisandmanagementofperiodontaldisease.Theprocedureconsistsofassessingandrecordingapatientsperiodontalcondition.
222 Root planing and subgingival curettage per tooth
Theprocessofplaningtherootsurfacetoremoveroughorcontaminatedcementumordentineandmayincluderemovalofcalculus,curettingthesofttissuesoftheperiodontalpocketandremovinggranulationtissue.Wherecalculusremovalisundertakenforotherteethatthesamevisit that do not require root planing it is appropriate to itemise 114/115 for these teeth inconjunctionwithbutseparatefromtheteeththathaveundergonerootplaning.
231 Gingivectomy per tooth or implant
Thesurgicalremovalofthesofttissuewalloftheperiodontalpocketortheremovalofswollen,excessgingivaltissue,Theprocedureincludestheremovalofcalculusandrootplaningofthetoothorimplant.
232 Periodontal flap surgery per tooth or implant
Incisionandraisingofaflapofgingivaltissuetoenableremovalofinflammatoryorgranulationtissue.Theprocedureincludestheremovalofcalculusandrootplaningofthetoothorimplant.
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Periodontics
235 Gingival graft per tooth or implant
Transferenceor transplantinggingivalorothersoft tissue fromadonorarea in thepatientsmouthtoanareaaroundatoothorimplanttoremedyagingivaldeficiency.
236 Guided tissue regeneration per tooth or implant
Asurgicaltechniqueinwhichamembraneisadaptedoverabonydefect,thetoothrootoranimplant.
237 Guided tissue regeneration membrane removal
Surgicalproceduretoremoveapreviouslypositionedmembrane.
238 Periodontal flap surgery for crown lengthening per tooth
Involvesaflapproceduretoestablishamoreapicalgingivalmarginforgreaterexposureoftoothstructure,includingreshapingofalveolarbonewhererequired.
241 Root resection per root
Removaloramputationofoneormorerootsofamulti-rootedtoothwithorwithoutaportionofthecrown.
242 Osseous surgery per tooth or implant
Reshapingandmodifyingdefectsanddeformitiesinthebonesupportingandsurroundingthetoothorimplant.Thisincludesproceduresdescribedinitem232.Theprocedureincludestheremovalofcalculusandrootplaningofthetoothorimplant.
243 Osseous graft per tooth or implant
Asurgicalprocedureinwhichparticulatebone,asyntheticsubstituteorothermatrix,isusedtoreplace,repairoraugmentalveolarbone.Itmaybeusedtorepairabonydefectaroundatoothordentalimplant.Thisisinadditiontoitemnumberssuchas232,245and684.
244 Osseous graft block
Asurgicalprocedureinwhichablockofboneisusedforaugmentationofabonyridge,securedbyscrewsorsimilardevices.
245 Periodontal surgery involving one tooth or an implant
Surgical intervention to aid the resolution of a localised periodontal inflammatory conditioninvolvingonetoothoranimplant.Theitemisalsousedtodescribepericision.
281 Course of non-surgical periodontal treatment
(SeeNotesforguidancepageix)
Analternativesystemofcodingencompassingallvisitssubsequent toperiodontaldiagnosisandtreatmentplanningforthenon-surgicalphaseofperiodontaltreatment.Thisitemincludesallformsofnon-surgicaltreatmentandprecludesreferencetootherperiodontaltechniquesorservices intheSchedule.Non-periodontal relatedproceduresshouldbeseparately itemised.Anassessmentandtreatmentformtobeusedwiththisitemmayberequestedinadvanceoftreatment.Seespecimenformonpage12.
282 Continuation of periodontal treatment or maintenance subsequent to item 281
Maintenance subsequent to item 281 for non-surgical periodontal treatment. Radiographs,periodontalchartingandotherdiagnosticprocedures,andnon-periodontalrelatedproceduresshouldbeseparatelyitemised.
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Periodontics
Periodontal Treatment Form for use with Items 281 and 282
Patientsname:.............................................................................................................................................
Address:.......................................................................................................................................................
.......................................................................................................................................................................
Practitionersname:.....................................................................................................................................
Address:.......................................................................................................................................................
.......................................................................................................................................................................
Contributorsname:.....................................................................................................................................
Address:.......................................................................................................................................................
.......................................................................................................................................................................
Datetreatmentcommenced:.......................................................................................................................
Anticipateddurationofactivetreatment:.....................................................................................................
Estimatedcostoftreatment:........................................................................................................................
Signed:.........................................................................................................................................................(Secretary)
.........................................................................................................................................................(Date)
Thisformmaybephotocopiedwhererequired.
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Periodontics
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13The Australian Schedule of Dental Services and Glossary
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Oral Surgery
Oral Surgery
Proceduresdescribedinthissectionincludeinsertionofsutures,normalpost-operativecareandsutureremoval.
SomeproceduresinthissectionmayattractaMedicarerebateforapproveddentalpractitioners.It isnotappropriatepracticetousebothADAandMedicareitemnumberstodescribethesameprocedure.
Onlyoneitemnumbershouldbeusedtodescribeeachoralsurgeryprocedureonthesamedaybythesameoperator.
Extractions
311 Removal of a tooth or part(s) thereof
314 Sectional removal of a tooth or part(s) thereof
311 Removal of a tooth or part(s) thereof
Aprocedureconsistingoftheremovalofatoothorpart(s)thereof.
314 Sectional removal of a tooth or part(s) thereof
Theremovalofatoothorpart(s)thereofinsections.Boneremovalmaybenecessary.
Surgical Extractions
322 Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division
323 Surgical removal of a tooth or tooth fragment requiring removal of bone
324 Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division
322 Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division
Removalofatoothortoothfragmentwhereanincisionandtheraisingofamucoperiostealflapisrequired,butwhereremovalofboneorsectioningofthetoothisnotnecessarytoremovethetooth.
323 Surgical removal of a tooth or tooth fragment requiring removal of bone
Removalofatoothortoothfragmentwhereremovalofboneisrequiredafteranincisionandamucoperiostealflapraised.
324 Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division
Removalofatoothortoothfragmentwherebothremovalofboneandsectioningofthetootharerequiredafteran incisionandamucoperiostealflapraised.Thetoothwillberemoved inportions.
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Oral Surgery
Surgery for Prostheses
331 Alveolectomy per segment
332 Ostectomy per jaw
337 Reduction of fibrous tuberosity
338 Reduction of flabby ridge per segment
341 Removal of hyperplastic tissue
343 Repositioning of muscle attachment
344 Vestibuloplasty
345 Skin or mucosal graft
331 Alveolectomy per segment
Thesurgicalmodificationoftheshapeofasegmentofthealveolarbone.
332 Ostectomy per jaw
Thesurgicalmodificationofthebonyarchitectureofthemaxillaormandible.
337 Reduction of fibrous tuberosity
Asurgicalprocedure involving removaloffibrous tissue fromtheposteriormaxillaryalveolarridgeinordertomodifytheridgecontour.
338 Reduction of flabby ridge per segment
Asurgicalprocedureinvolvingremovalofunsupportedsofttissuefromasegmentorquadrantofthemaxillaryormandibularalveolarridge.
341 Removal of hyperplastic tissue
Thesurgicalremovalofanareaofhyperplastictissuefromthemaxillaryormandibularalveolarridgeoradjacentmucosa.
343 Repositioning of muscle attachment
Thesurgicalrepositioningofamuscleattachmenttoplaceitinamorefavourableposition.
344 Vestibuloplasty
Thesurgicaldeepeningofthebuccalorlabialvestibuleinthemucosa.
345 Skin or mucosal graft
Asurgicalprocedureinvolvingaskinormucosalgraft.
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Oral Surgery
Treatment of Maxillofacial lnjuries
351 Repair of skin and subcutaneous tissue or mucous membrane
352 Fracture of maxilla or mandible not requiring splinting
353 Fracture of maxilla or mandible with wiring of teeth or intraoral fixation
354 Fracture of maxilla or mandible with external fixation
355 Fracture of zygoma
359 Fracture of the maxilla or mandible requiring open reduction
351 Repair of skin and subcutaneous tissue or mucous membrane
Thesurgicalcleaningandrepairofafacialskinwoundintheregionofthemouthorjaws,ortherepairoforalmucousmembrane,wherethewoundsinvolvethesubcutaneoustissues.
352 Fracture of maxilla or mandible not requiring splinting
Conservative treatment of a fracture of the maxilla or mandible where there is no markeddisplacementormobilityofthefragments.Nophysicalreductionorfixationisrequired.
353 Fracture of maxilla or mandible with wiring of teeth or intraoral fixation
Treatmentofafractureofthemaxillaormandiblewhereinterdentalwiringortheapplicationofadentalsplintisindicatedtoprovidereductionandfixationofthefragments.Whereasplintisrequireditshouldbeitemised.
354 Fracture of maxilla or mandible with external fixation
Treatmentofafractureofthemaxillaormandibleusingsetsofpinsinsertedthroughtheskinandintothemaxillaryormandibularbonetoreduceandfixthefracture.Thepinsarelockedintoafirmrelationshipusingclampsandasupportingapparatus.
355 Fracture of zygoma
Treatmentofafractureofthezygoma.