Dental service fees effective from 1 July 2019

WorkSafe will pay up to a maximum amount for the following categories of the service.

General Dentist

Diagnostic services

DT011GInitial examination and report$99.20
DT012GPeriodical oral examination$50.33
DT014GConsultation and report for a second opinion$160.70
DT022GSingle Intral oral radiograph$41.91
DT036GCephalometric radiograph$109.01
DT037GPanoramic radiograph (e.g. OPG)$118.77
DT061GPulp vitality testing - Per visit (Maximum 3 visits per year)$19.61
DT071GDiagnostic model - Per model$78.32
DT072GPhotographic records (for WorkSafe)$27.96

Preventative services

DT114GScaling and cleaning$90.79
DT117GNon-vital bleaching - Per tooth (if separate appointments are made)$174.65
DT121GTopical fluoride treatment$49.06
DT141GOral hygiene instruction where appropriate time is allocated$18.20

Adjunctive services

DT165GDesensitising procedure - Per visit$35.08
DT171GOdontoplasty for fractured tooth - Per tooth$35.08

Oral surgery

DT311GExtraction of tooth - Per tooth - Multiple operation rule applies$125.66
DT323GSurgical extraction requiring bone removal - Per tooth - Multiple operation rule applies$242.97
DT377GRemoval of soft tissue$49.06
DT387GReplanting avulsed tooth and splinting$283.50

NB: Multiple operation rule applies to items DT311 and DT323.

Endodontics

DT411GPulp capping$15.47
DT414GCvek pulpotomy$124.38
DT415GExtirpation of pulp or debridement of root canal 1 canal$234.62
DT416GExtirpation of pulp or debridement of root canal each additional canal$99.20
DT417GRoot canal obturation 1 canal$244.39
DT418GRoot canal obturation each additional canal $99.20
DT419GEmergency endodontic procedure not exceeding 15 minutes$55.94
DT432GApicectomy and apical seal$247.19
DT451GRemoval of root filling per canal$95.00
DT455GAdditional visit for irrigation and/or dressing of the root canal system$90.79
DT458GApexification - Fee additional to routine endodontic treatment$141.14

NB: Items for endodontic treatment are inclusive of radiographs taken in the course of treatment.

Restorative services

DT511GMetallic restoration 1 surface$97.86
DT512GMetallic restoration 2 surface$124.38
DT513GMetallic restoration 3 surface$152.35
DT514GMetallic restoration 4 surface$181.56
DT515GMetallic restoration 5 surface$202.49
DT521G Adhesive resin restoration anterior tooth - 1 surfaces - direct$111.81
DT522G Adhesive resin restoration anterior tooth - 2 surfaces - direct$132.72
DT523GAdhesive resin restoration anterior tooth - 3 surfaces - direct$160.70
DT524GAdhesive resin restoration anterior tooth - 4 surfaces - direct$188.50
DT525GAdhesive resin restoration anterior tooth - 5 surfaces - direct$272.34
DT526GBonded veneer - direct$248.64
DT531GAdhesive resin restoration posterior tooth 1 surfaces - direct$125.66
DT532GAdhesive resin restoration posterior tooth 2 surfaces - direct$148.02
DT533GAdhesive resin restoration posterior tooth 3 surfaces - direct$181.56
DT534GAdhesive resin restoration posterior tooth 4 surfaces - direct$209.50
DT535GAdhesive resin restoration posterior tooth 5 surfaces - direct$272.34
DT542GMetallic inlay or onlay two surface cavity$645.14
DT543GMetallic inlay or onlay three surface cavity$758.08
DT556GBonded veneer - indirect$837.62
DT572GTemporary restoration emergency or interim treatment only$100.60
DT575GPin retention (per unit - Pin)$30.90
DT597GPost - Direct preformed$100.60

Crown and bridgework

DT613GFull Crown - Indirect - Non Metallic$1,289.93
DT615GFull Crown - Indirect - Metal Base Veneered$1,383.54
DT618GFull Crown - Indirect - Metallic$1,289.93
DT625GCast Core For Crown Including Post$321.18
DT627GPreliminary Restoration For Crown$199.75
DT632GProvisional Bridge Pontic - Per Pontic$208.11
DT643GBridge Pontic - Indirect - Per Pontic$1,342.33
DT649GBridge - Indirect - Bonded To Abutment - Per Pontic$1,383.60

Implant procedures

DT661AGExpendable implant hardwareAs at retail
DT661GImplant based crown - Veneered - Includes abutment$2,066.10
DT666GProsthesis with metal frame attached to implants - Per implant$1,497.98
DT669GRemoval and reattachment of prosthesis fixed to implants - Per implant$166.18
DT672GImplant based crown - Veneered - Includes abutment$2,066.10
DT679GSurgical implant guide$230.41

Prosthodontics

DT711GFull upper denture$986.29
DT712GFull lower denture$986.29
DT719GFull upper and lower denture$1,745.12
DT721AGOne tooth - Partial denture - Acrylic base - upper$328.11
DT721BGTwo teeth$379.83
DT721CGThree teeth$450.97
DT721DGFour teeth$515.34
DT721EGFive to nine teeth$635.34
DT721FGTen or more teeth$731.62
DT722AGOne tooth - Partial denture - Acrylic base - lower$328.11
DT722BGTwo teeth$379.83
DT722CGThree teeth$450.97
DT722DGFour teeth$515.34
DT722EGFive to nine teeth$635.34
DT722FGTen or more teeth$731.62
DT727AGOne tooth or two teeth - Partial denture - chrome cobalt including rests and retainers - upper$1,228.55
DT727BGThree or four teeth$1,256.46
DT727CGFive to nine teeth$1,298.39
DT727DGTen or more teeth$1,340.21
DT728AGOne tooth or two teeth - Partial denture - chrome cobalt including rests and retainers - lower$1,228.55
DT728BGThree or four teeth$1,256.46
DT728CGFive to nine teeth$1,298.39
DT728DGTen or more teeth$1,340.21
DT731GEach retainer$41.91
DT732GOcclusal rest (not part of retainer)$16.87
DT736GImmediate tooth replacement$8.53
DT743GRelining - Full denture - Processed$315.61
DT744GRelining - Partial denture - Processed$231.88
DT768GAdding tooth to partial denture to replace extracted tooth$160.70

Orthodontics

DT821GActive removable appliance therapy - One arch$753.94

Temporomandibular joint therapy

DT963GFull clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report.$240.24
DT964GFull clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report.$240.24
DT965GOcclusal splint including initial programming$541.78
DT966GRoutine adjustment of splint - Per visit (maximum of six visits)$90.79

Dentist Specialist

Diagnostic services

DT011SInitial examination and report$124.38
DT012SPeriodical oral examination$72.64
DT014SConsultation and report for a second opinion$230.41
DT022SSingle intral oral radiograph$41.91
DT036SCephalometric radiograph$109.01
DT037SPanoramic radiograph (e.g. OPG)$118.77
DT061SPulp vitality testing - Per visit - Maximum 3 visits per year$19.61
DT071SDiagnostic model - Per model$78.32
DT072SPhotographic Records (for WorkSafe)$27.96

Preventative services

DT114SScaling and cleaning$90.79
DT117SNon-vital bleaching - Per tooth (if separate appointments are made)$217.91
DT121STopical fluoride treatment$49.06
DT141SOral hygiene instruction where appropriate time is allocated$18.20

Adjunctive services

DT165SDesensitising procedure - Per visit$35.08
DT171SOdontoplasty for fractured tooth - Per tooth$35.08

Periodontics

DT222SRoot planing and subgingival curettage (Per segment)$277.66
DT232SPeriodontal flap surgery (Per tooth or implant)$340.67
DT235SGingival connective tissue graft$756.78
DT236AExpendable GTR material$769.39
DT236SGuided tissue regeneration (Per tooth or implant)$756.78
DT237SGuided tissue regeneration (Per tooth or implant)$756.78
DT238SCrown lengthening - Including alveolar bone removal (Per tooth)$558.47
DT242SOsseous surgery (Per tooth or implant)$340.67
DT243SOsseous graft (Per tooth or implant)$756.78

NB: Multiple operation rule applies.

Oral surgery

DT311SExtraction of tooth (Per tooth)$160.70
DT323SSurgical extraction requiring bone removal (Per tooth)$295.99
DT377SRemoval of soft tissue$49.06
DT387SReplanting avulsed tooth and splinting$409.11

NB: Multiple operation rule applies to items DT311S and DT323S.

Endodontics

DT411SPulp capping$19.61
DT414SCvek pulpotomy$185.80
DT415SExtirpation of pulp or debridement of root canal 1 canal$342.14
DT416SExtirpation of pulp or debridement of root canal each additional canal$141.14
DT417SRoot canal obturation 1 Canal$350.46
DT418SRoot canal obturation each additional canal$141.14
DT419SEmergency endodontic procedure not exceeding 15 minutes$69.91
DT432SApicectomy and apical seal$342.14
DT451SRemoval of root filling per canal$135.46
DT455SAdditional visit for irrigation and/or dressing of the root canal system$109.01
DT458SApexification - Fee additional to routine endodontic treatment$226.27

NB: Items for endodontic treatment are Inclusive of radiographs taken in the course of treatment.

Restorative services

DT511SMetallic restoration 1 surface$138.39
DT512SMetallic restoration 2 surface$178.86
DT513SMetallic restoration 3 surface$226.27
DT514SMetallic restoration 4 surface$251.33
DT515SMetallic restoration 5 surface$272.34
DT521SAdhesive resin restoration anterior tooth - 1 surfaces - Direct$146.69
DT522SAdhesive resin restoration anterior tooth - 2 surfaces - Direct$188.50
DT523SAdhesive resin restoration anterior tooth - 3 surfaces - Direct$230.41
DT524SAdhesive resin restoration anterior tooth - 4 surfaces - Direct$258.40
DT525SAdhesive resin restoration anterior tooth - 5 surfaces - Direct$321.18
DT526SBonded veneer - Direct$330.80
DT531SAdhesive resin restoration posterior tooth 1 surfaces - Direct$153.64
DT532SAdhesive resin restoration posterior tooth 2 surfaces - Direct$181.56
DT533SAdhesive resin restoration posterior tooth 3 surfaces - Direct$237.49
DT534SAdhesive resin restoration posterior tooth 4 surfaces - Direct$265.27
DT535SAdhesive resin restoration posterior tooth 5 surfaces - Direct$321.18
DT542SMetallic inlay or onlay two surface cavity$779.10
DT543SMetallic inlay or onlay three surface cavity$954.92
DT556SBonded veneer - Indirect$1,144.19
DT572STemporary restoration emergency or interim treatment only$124.38
DT575SPin retention (Per unit - Pin)$30.90
DT597SPost - direct preformed$124.38

Crown and bridgework

DT613SFull crown - Indirect - Non metallic$1,718.61
DT615SFull crown - Indirect - Metal base veneered$1,809.37
DT618SFull crown - Indirect - Metallic$1,718.61
DT625SCast core for crown including post$516.62
DT627SPreliminary restoration for crown$284.90
DT632SProvisional bridge pontic - Per pontic$261.15
DT643SBridge pontic - Indirect - Per pontic$1,625.25
DT649SBridge - Indirect - Bonded to abutment - Per pontic$1,675.21

Implant procedures

NB: Multiple operation rule applies to Items DT684S, DT688S and DT691S.

DT661ASExpendable implant hardwareAs at retail
DT661SImplant based crown - Veneered - Includes abutment$2,526.78
DT666SProsthesis with metal frame attached to implants - Per implant$1,759.07
DT669SRemoval and reattachment of prosthesis fixed to implants - Per implant$166.18
DT672SImplant based crown - Veneered - Includes abutment$2,526.78
DT679SSurgical implant guide$230.41
DT684SOsseo-Integration procedure - Intraoral implantation of titanium fixture$1,005.21
DT688SOsseo-Integration procedure - One stage$1,121.06
DT691SOsseo-Integration procedure - Fixation of transcutaneous abutment$379.83

Prosthodontics

DT711SFull upper denture$1,377.99
DT712SFull lower denture$1,377.99
DT719SFull upper and lower denture$2,564.51
DT721ASOne tooth - Partial denture - Acrylic base - upper$404.90
DT721BTwo teeth$526.43
DT721CSThree teeth$631.12
DT721DSFour teeth$700.88
DT721ESFive to nine teeth$841.93
DT721FSTen or more teeth$963.24
DT722ASOne tooth - Partial denture - Acrylic base - lower$404.90
DT722BSTwo teeth$526.43
DT722CSThree teeth$631.12
DT722DSFour teeth$700.88
DT722ESFive to nine teeth$841.93
DT722FSTen or more teeth$963.24
DT727ASOne tooth or two teeth - Partial denture - Chrome cobalt including rests and retainers - upper$1,417.01
DT727BSThree or four teeth$1,527.30
DT727CSFive to nine teeth$1,584.54
DT727DSTen or more teeth$1,647.44
DT728ASOne tooth or two teeth - Partial denture - Chrome cobalt including rests and retainers - lower$1,417.01
DT728BSThree or four teeth$1,527.30
DT728CSFive to nine teeth$1,584.54
DT728DSTen or more teeth$1,647.44
DT731SEach retainer$41.91
DT732SOcclusal rest (Not part of retainer)$16.87
DT736SImmediate tooth replacement$8.53
DT743SRelining - Full denture - Processed$390.94
DT744SRelining - Partial denture - Processed$284.90
DT768SAdding tooth to partial denture to replace extracted tooth$160.70

Orthodontics

DT821SActive removable appliance therapy - One arch$1,075.04
DT831SFull arch banding - One Arch$3,918.55
DT846SOrthodontic extrusion of tooth$889.35
DT881SFull course of fixed appliance orthodontic treatment$6,108.78

Temporomandibular joint therapy

DT963SFull clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report.$295.99
DT964SFull clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report.$295.99
DT965SOcclusal splint including initial programming$639.47
DT966SRoutine adjustment of splint - Per visit (maximum of six visits)$116.04

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