Dental service fees effective from 1 July 2018
WorkSafe will pay up to a maximum amount for the following categories of the service.
| Item number | Service description | Maximum payment rate |
|---|---|---|
| General Dentist | ||
| Diagnostic services | ||
| DT011G | Initial examination and report | $97.20 |
| DT012G | Periodical oral examination | $49.32 |
| DT014G | Consultation and report for a second opinion | $157.47 |
| DT022G | Single Intral oral radiograph | $41.07 |
| DT036G | Cephalometric radiograph | $106.82 |
| DT037G | Panoramic radiograph (e.g. OPG) | $116.38 |
| DT061G | Pulp vitality testing - Per visit (Maximum 3 visits per year) | $19.22 |
| DT071G | Diagnostic model - Per model | $76.75 |
| DT072G | Photographic records (for WorkSafe) | $27.39 |
| Preventative services | ||
| DT114G | Scaling and cleaning | $88.97 |
| DT117G | Non-vital bleaching - Per tooth (if separate appointments are made) | $171.14 |
| DT121G | Topical fluoride treatment | $48.08 |
| DT141G | Oral hygiene instruction where appropriate time is allocated | $17.83 |
| Adjunctive services | ||
| DT165G | Desensitising procedure - Per visit | $34.37 |
| DT171G | Odontoplasty for fractured tooth - Per tooth | $34.37 |
| Oral surgery | ||
| DT311G | Extraction of tooth - Per tooth - Multiple operation rule applies |
$123.14 |
| DT323G | Surgical extraction requiring bone removal - Per tooth - Multiple operation rule applies |
$238.09 |
| DT377G | Removal of soft tissue | $48.08 |
| DT387G | Replanting avulsed tooth and splinting | $277.81 |
| Endodontics | ||
| DT411G | Pulp capping | $15.16 |
| DT414G | Cvek pulpotomy | $121.88 |
| DT415G | Extirpation of pulp or debridement of root canal 1 canal | $229.91 |
| DT416G | Extirpation of pulp or debridement of root canal each additional canal | $97.20 |
| DT417G | Root canal obturation 1 canal | $239.48 |
| DT418G | Root canal obturation each additional canal | $97.20 |
| DT419G | Emergency endodontic procedure not exceeding 15 minutes | $54.82 |
| DT432G | Apicectomy and apical seal | $242.23 |
| DT451G | Removal of root filling per canal | $93.10 |
| DT455G | Additional visit for irrigation and/or dressing of the root canal system | $88.97 |
| DT458G | Apexification - Fee additional to routine endodontic treatment | $138.30 |
| NB: Items for endodontic treatment are inclusive of radiographs taken in the course of treatment. | ||
| Restorative services | ||
| DT511G | Metallic restoration 1 surface | $95.90 |
| DT512G | Metallic restoration 2 surface | $121.88 |
| DT513G | Metallic restoration 3 surface | $149.28 |
| DT514G | Metallic restoration 4 surface | $177.92 |
| DT515G | Metallic restoration 5 surface | $198.42 |
| DT521G | Adhesive resin restoration anterior tooth - 1 surfaces - direct | $109.57 |
| DT522G | Adhesive resin restoration anterior tooth - 2 surfaces - direct | $130.05 |
| DT523G | AAdhesive resin restoration anterior tooth - 3 surfaces - direct | $157.47 |
| DT524G | Adhesive resin restoration anterior tooth - 4 surfaces - direct | $184.71 |
| DT525G | Adhesive resin restoration anterior tooth - 5 surfaces - direct | $266.87 |
| DT526G | Bonded veneer - direct | $243.65 |
| DT531G | Adhesive resin restoration posterior tooth 1 surfaces - direct | $123.14 |
| DT532G | Adhesive resin restoration posterior tooth 2 surfaces - direct | $145.04 |
| DT533G | Adhesive resin restoration posterior tooth 3 surfaces - direct | $177.92 |
| DT534G | Adhesive resin restoration posterior tooth 4 surfaces - direct | $205.29 |
| DT535G | Adhesive resin restoration posterior tooth 5 surfaces - direct | $266.87 |
| DT542G | Metallic inlay or onlay two surface cavity | $632.18 |
| DT543G | Metallic inlay or onlay three surface cavity | $742.85 |
| DT556G | Bonded veneer - indirect | $820.79 |
| DT572G | Temporary restoration emergency or interim treatment only | $98.58 |
| DT575G | Pin retention (per unit - Pin) | $30.28 |
| DT597G | Post - Direct preformed | $98.58 |
| Crown and bridgework | ||
| DT613G | Full crown - Indirect - non Metallic | $1,264.02 |
| DT615G | Full crown - Indirect - Metal base veneered | $1,355.74 |
| DT618G | Full crown - Indirect - Metallic | $1,264.02 |
| DT625G | Cast core for crown including post | $314.72 |
| DT627G | Preliminary restoration for crown | $195.74 |
| DT632G | Provisional bridge pontic - Per pontic | $203.93 |
| DT643G | Bridge pontic - Indirect - Per pontic | $1,315.36 |
| DT649G | Bridge - Indirect - bonded to abutment - Per pontic | $1,355.81 |
| Implant procedures | ||
| DT661G | Implant based crown - Veneered - Includes abutment | $2,024.59 |
| DT661AG | Expendable implant hardware | As at retail |
| DT666G | Prosthesis with metal frame attached to implants - Per implant | $1,467.89 |
| DT669G | Removal and reattachment of prosthesis fixed to implants - Per implant | $162.84 |
| DT672G | Implant based crown - Veneered - Includes abutment | $2,024.59 |
| DT679G | Surgical implant guide | $225.78 |
| NB: Multiple operation rule applies to items DT684, DT688 and DT691. | ||
| Prosthodontics | ||
| DT711G | Full upper denture | $966.48 |
| DT712G | Full lower denture | $966.48 |
| DT719G | Full upper and lower denture | $1,710.06 |
| DT721AG | One tooth - Partial denture - Acrylic base - upper | $321.52 |
| DT721BG | Two teeth | $372.20 |
| DT721CG | Three teeth | $441.91 |
| DT721DG | Four teeth | $504.98 |
| DT721EG | Five to nine teeth | $622.57 |
| DT721FG | Ten or more teeth | $716.93 |
| DT722AG | One tooth - Partial denture - Acrylic base - lower | $321.52 |
| DT722BG | Two teeth | $372.20 |
| DT722CG | Three teeth | $441.91 |
| DT722DG | Four teeth | $504.98 |
| DT722EG | Five to nine teeth | $622.57 |
| DT722FG | Ten or more teeth | $716.93 |
| DT727AG | One tooth or two teeth - Partial denture - chrome cobalt including rests and retainers - upper | $1,203.87 |
| DT727BG | Three or four teeth | $1,231.22 |
| DT727CG | Five to nine teeth | $1,272.30 |
| DT727DG | Ten or more teeth | $1,313.29 |
| DT728AG | One tooth or two teeth - Partial denture - chrome cobalt including rests and retainers - lower | $1,203.87 |
| DT728BG | Three or four teeth | $1,231.22 |
| DT728CG | Five to nine teeth | $1,272.30 |
| DT728DG | Ten or more teeth | $1,313.29 |
| DT731G | Each retainer | $41.07 |
| DT732G | Occlusal rest (not part of retainer) | $16.53 |
| DT736G | Immediate tooth replacement | $8.36 |
| DT743G | Relining - Full denture - Processed | $309.27 |
| DT744G | Relining - Partial denture - Processed | $227.22 |
| DT768G | Adding tooth to partial denture to replace extracted tooth | $157.47 |
| Orthodontics | ||
| DT821G | Active removable appliance therapy - One arch | $738.79 |
| Temporomandibular joint therapy | ||
| DT963G | Full clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report. | $235.41 |
| DT964G | Full clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report. | $235.41 |
| DT965G | Occlusal splint including initial programming | $530.90 |
| DT966G | Routine adjustment of splint - Per visit (maximum of six visits) | $88.97 |
| Specialist Dentist | ||
| Diagnostic services | ||
| DT011S | Initial examination and report | $121.88 |
| DT012S | Periodical oral examination | $71.18 |
| DT014S | Consultation and report for a second opinion | $225.78 |
| DT022S | Single intral oral radiograph | $41.07 |
| DT036S | Cephalometric radiograph | $106.82 |
| DT037S | Panoramic radiograph (e.g. OPG) | $116.38 |
| DT061S | Pulp vitality testing - Per visit - Maximum 3 visits per year | $19.22 |
| DT071S | Diagnostic model - Per model | $76.75 |
| DT072S | Photographic Records (for WorkSafe) | $27.39 |
| Preventative services | ||
| DT114S | Scaling and cleaning | $88.97 |
| DT117S | Non-vital bleaching - Per tooth (if separate appointments are made) | $213.54 |
| DT121S | Topical fluoride treatment | $48.08 |
| DT141S | Oral hygiene instruction where appropriate time is allocated | $17.83 |
| Adjunctive services | ||
| DT165S | Desensitising procedure - Per visit | $34.37 |
| DT171S | Odontoplasty for fractured tooth - Per tooth | $34.37 |
| DT222S | Root planing and subgingival curettage (Per segment) | $272.08 |
| DT232S | Periodontal flap surgery (Per tooth or implant) | $333.82 |
| DT235S | Gingival connective tissue graft | $741.58 |
| DT236S | Guided tissue regeneration (Per tooth or implant) | $741.58 |
| DT237S | Guided tissue regeneration (Per tooth or implant) | $741.58 |
| DT236A | Expendable GTR material | $753.94 |
| DT238S | Crown lengthening - Including alveolar bone removal (Per tooth) | $547.26 |
| DT242S | Osseous surgery (Per tooth or implant) | $333.82 |
| DT243S | Osseous graft (Per tooth or implant) | $741.58 |
| NB: Multiple operation rule applies | ||
| Oral surgery | ||
| DT311S | Extraction of tooth (Per tooth) | $157.47 |
| DT323S | Surgical extraction requiring bone removal (Per tooth) | $290.05 |
| DT377S | Removal of soft tissue | $48.08 |
| DT387S | Replanting avulsed tooth and splinting | $400.89 |
| NB: Multiple operation rule applies to items DT311S and DT323S. | ||
| Endodontics | ||
| DT411S | Pulp capping | $19.22 |
| DT414S | Cvek pulpotomy | $182.06 |
| DT415S | Extirpation of pulp or debridement of root canal 1 canal | $335.26 |
| DT416S | Extirpation of pulp or debridement of root canal each additional canal | $138.30 |
| DT417S | Root canal obturation 1 Canal | $343.42 |
| DT418S | Root canal obturation each additional canal | $138.30 |
| DT419S | Emergency endodontic procedure not exceeding 15 minutes | $68.50 |
| DT432S | Apicectomy and apical seal | $335.26 |
| DT451S | Removal of root filling per canal | $132.74 |
| DT455S | Additional visit for irrigation and/or dressing of the root canal system | $106.82 |
| DT458S | Apexification - Fee additional to routine endodontic treatment | $221.72 |
| NB: Items for endodontic treatment are Inclusive of radiographs taken in the course of treatment. | ||
| Restorative services | ||
| DT511S | Metallic restoration 1 surface | $135.61 |
| DT512S | Metallic restoration 2 surface | $175.27 |
| DT513S | Metallic restoration 3 surface | $221.72 |
| DT514S | Metallic restoration 4 surface | $246.28 |
| DT515S | Metallic restoration 5 surface | $266.87 |
| DT521S | Adhesive resin restoration anterior tooth - 1 surfaces - Direct | $143.75 |
| DT522S | Adhesive resin restoration anterior tooth - 2 surfaces - Direct | $184.71 |
| DT523S | Adhesive resin restoration anterior tooth - 3 surfaces - Direct | $225.78 |
| DT524S | Adhesive resin restoration anterior tooth - 4 surfaces - Direct | $253.21 |
| DT525S | Adhesive resin restoration anterior tooth - 5 surfaces - Direct | $314.72 |
| DT526S | Bonded veneer - Direct | $324.16 |
| DT531S | Adhesive resin restoration posterior tooth 1 surfaces - Direct | $150.55 |
| DT532S | Adhesive resin restoration posterior tooth 2 surfaces - Direct | $177.92 |
| DT533S | Adhesive resin restoration posterior tooth 3 surfaces - Direct | $232.71 |
| DT534S | Adhesive resin restoration posterior tooth 4 surfaces - Direct | $259.95 |
| DT535S | Adhesive resin restoration posterior tooth 5 surfaces - Direct | $314.72 |
| DT542S | Metallic inlay or onlay two surface cavity | $763.45 |
| DT543S | Metallic inlay or onlay three surface cavity | $935.73 |
| DT556S | Bonded veneer - Indirect | $1,121.20 |
| DT572S | Temporary restoration emergency or interim treatment only | $121.88 |
| DT575S | Pin retention (Per unit - Pin) | $30.28 |
| DT597S | Post - direct preformed | $121.88 |
| Crown and bridgework | ||
| DT613S | Full crown - Indirect - Non metallic | $1,684.09 |
| DT615S | Full crown - Indirect - Metal base veneered | $1,773.03 |
| DT618S | Full crown - Indirect - Metallic | $1,684.09 |
| DT625S | Cast core for crown including post | $506.24 |
| DT627S | Preliminary restoration for crown | $279.18 |
| DT632S | Provisional bridge pontic - Per pontic | $255.90 |
| DT643S | Bridge pontic - Indirect - Per pontic | $1,592.60 |
| DT649S | Bridge - Indirect - Bonded to abutment - Per pontic | $1,641.56 |
| Implant procedures | ||
| DT661S | Implant based crown - Veneered - Includes abutment | $2,476.03 |
| DT661AS | Expendable implant hardware | As at retail |
| DT666S | Prosthesis with metal frame attached to implants - Per implant | $1,723.74 |
| DT669S | Removal and reattachment of prosthesis fixed to implants - Per implant | $162.84 |
| DT672S | Implant based crown - Veneered - Includes abutment | $2,476.03 |
| DT679S | Surgical implant guide | $225.78 |
| DT684S | Osseo-Integration procedure - Intraoral implantation of titanium fixture | $985.02 |
| DT688S | Osseo-Integration procedure - One stage | $1,098.54 |
| DT691S | Osseo-Integration procedure - Fixation of transcutaneous abutment | $372.20 |
| NB: Multiple operation rule applies to Items DT684S, DT688S and DT691S. | ||
| Prosthodontics | ||
| DT711S | Full upper denture | $1,350.31 |
| DT712S | Full lower denture | $1,350.31 |
| DT719S | Full upper and lower denture | $2,512.99 |
| DT721AS | One tooth - Partial denture - Acrylic base - upper | $396.76 |
| DT721BS | Two teeth | $515.86 |
| DT721CS | Three teeth | $618.44 |
| DT721DS | Four teeth | $686.80 |
| DT721ES | Five to nine teeth | $825.02 |
| DT721FS | Ten or more teeth | $943.89 |
| DT722AS | One tooth - Partial denture - Acrylic base - lower | $396.76 |
| DT722BS | Two teeth | $515.80 |
| DT722CS | Three teeth | $618.46 |
| DT722DS | Four teeth | $686.80 |
| DT722ES | Five to nine teeth | $825.02 |
| DT722FS | Ten or more teeth | $943.92 |
| DT727AS | One tooth or two teeth - Partial denture - Chrome cobalt including rests and retainers - upper | $1,388.54 |
| DT727BS | Three or four teeth | $1,496.62 |
| DT727CS | Five to nine teeth | $1,552.71 |
| DT727DS | Ten or more teeth | $1,614.34 |
| DT728AS | One tooth or two teeth - Partial denture - Chrome cobalt including rests and retainers - lower | $1,388.54 |
| DT728BS | Three or four teeth | $1,496.62 |
| DT728CS | Five to nine teeth | $1,552.71 |
| DT728DS | Ten or more teeth | $1,614.34 |
| DT731S | Each retainer | $41.07 |
| DT732S | Occlusal rest (Not part of retainer) | $16.53 |
| DT736S | Immediate tooth replacement | $8.36 |
| DT743S | Relining - Full denture - Processed | $383.08 |
| DT744S | Relining - Partial denture - Processed | $279.18 |
| DT768S | Adding tooth to partial denture to replace extracted tooth | $157.47 |
| Orthodontics | ||
| DT821S | Active removable appliance therapy - One arch | $1,053.45 |
| DT831S | Full arch banding - One Arch | $3,839.83 |
| DT846S | Orthodontic extrusion of tooth | $871.48 |
| DT881S | Full course of fixed appliance orthodontic treatment | $5,986.06 |
| Temporomandibular joint therapy | ||
| DT963S | Full clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report. | $290.05 |
| DT964S | Full clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report. | $290.05 |
| DT965S | Occlusal splint including initial programming | $626.63 |
| DT966S | Routine adjustment of splint - Per visit (maximum of six visits) | $113.71 |
Multiple operations
WorkSafe will apply the multiple-operation rule where two or more procedures are performed on the one occassion. In accordance with this rule WorkSafe will pay100% of the WorkSafe fee for the most expensive item, 50% of the WorkSafe fee for the second most expensive item, and 25% of the WorkSafe fee thereafter.
GST
Maximum fees listed in this fee schedule are exclusive of GST. If GST is applicable, WorkSafe Victoria will pay the GST component in addition to the maximum fee. Providers should provide a tax invoice where amounts are subject to GST. For queries regarding whether the services you provide to an injured worker are taxable (that is, subject to GST) please contact the Australian Taxation Office and/or your tax advisor.