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.

Download current and past fee schedules