Dental services fee schedule
View current and past dental service fee schedules.
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GST information for fee schedules
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.
Item number  | Service description | Maximum payment rate |
|---|---|---|
DT011G | Initial Examination And Report | $118.45 |
DT012G | Periodical Oral Examination | $60.11 |
DT014G | Consultation And Report for a second opinion | $191.89 |
DT022G | Single Intral Oral Radiograph | $50.06 |
DT036G | Cephalometric Radiograph | $130.17 |
DT037G | Panoramic Radiograph (e.g. OPG) | $141.83 |
DT061G | Pulp Vitality Testing - Per Visit (Maximum 3 Visits Per Year) | $23.44 |
DT071G | Diagnostic Model - Per Model | $93.51 |
DT072G | Photographic Records (for WorkSafe) | $33.40 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT114G | Scaling And Cleaning | $108.42 |
DT117G | Non-Vital Bleaching - Per Tooth (if separate appointments are made) | $208.54 |
DT121G | Topical Fluoride Treatment | $58.59 |
DT141G | Oral Hygiene Instruction Where Appropriate Time Is Allocated | $21.74 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT165G | Desensitising Procedure - Per Visit | $41.89 |
DT171G | Odontoplasty For Fractured Tooth - Per Tooth | $41.89 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT311G | Extraction Of Tooth (Per Tooth) | $150.04 |
DT323G | Surgical Extraction Requiring Bone Removal (Per Tooth) | $290.12 |
DT377G | Removal Of Soft Tissue | $58.59 |
DT387G | Replanting Avulsed Tooth And Splinting | $338.51 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT411G | Pulp Capping | $18.48 |
DT414G | Cvek Pulpotomy | $148.52 |
DT415G | Extirpation Of Pulp Or Debridement Of Root Canal 1 Canal | $280.14 |
DT416G | Extirpation Of Pulp Or Debridement Of Root Canal Each Additional Canal | $118.45 |
DT417G | Root Canal Obturation 1 Canal | $291.82 |
DT418G | Root Canal Obturation Each Additional Canal | $118.45 |
DT419G | Emergency Endodontic Procedure Not Exceeding 15 Minutes | $66.81 |
DT432G | Apicectomy And Apical Seal | $295.16 |
DT451G | Removal Of Root Filling Per Canal | $113.43 |
DT455G | Additional Visit For Irrigation And/Or Dressing Of The Root Canal System | $108.42 |
DT458G | Apexification - Fee Additional To Routine Endodontic Treatment | $168.52 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT511G | Metallic Restoration 1 Surface | $116.87 |
DT512G | Metallic Restoration 2 Surface | $148.52 |
DT513G | Metallic Restoration 3 Surface | $181.91 |
DT514G | Metallic Restoration 4 Surface | $216.79 |
DT515G | Metallic Restoration 5 Surface | $241.77 |
DT521G | Adhesive Resin Restoration Anterior Tooth - 1 Surfaces - Direct | $133.51 |
DT522G | Adhesive Resin Restoration Anterior Tooth - 2 Surfaces - Direct | $158.48 |
DT523G | Adhesive Resin Restoration Anterior Tooth - 3 Surfaces - Direct | $191.89 |
DT524G | Adhesive Resin Restoration Anterior Tooth - 4 Surfaces - Direct | $225.09 |
DT525G | Adhesive Resin Restoration Anterior Tooth - 5 Surfaces - Direct | $325.20 |
DT526G | Bonded Veneer - Direct | $296.90 |
DT531G | Adhesive Resin Restoration Posterior Tooth 1 Surfaces - Direct | $150.04 |
DT532G | Adhesive Resin Restoration Posterior Tooth 2 Surfaces - Direct | $176.74 |
DT533G | Adhesive Resin Restoration Posterior Tooth 3 Surfaces - Direct | $216.79 |
DT534G | Adhesive Resin Restoration Posterior Tooth 4 Surfaces - Direct | $250.17 |
DT535G | Adhesive Resin Restoration Posterior Tooth 5 Surfaces - Direct | $325.20 |
DT542G | Metallic Inlay Or Onlay Two Surface Cavity | $770.32 |
DT543G | Metallic Inlay Or Onlay Three Surface Cavity | $905.20 |
DT556G | Bonded Veneer - Indirect | $1,000.16 |
DT572G | Temporary Restoration Emergency Or Interim Treatment Only | $120.13 |
DT575G | Pin Retention (Per Unit - Pin) | $36.89 |
DT597G | Post - Direct Preformed | $120.13 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT613G | Full Crown - Indirect - Non Metallic | $1,540.26 |
DT615G | Full Crown - Indirect - Metal Base Veneered | $1,652.04 |
DT618G | Full Crown - Indirect - Metallic | $1,540.26 |
DT625G | Cast Core For Crown Including Post | $383.51 |
DT627G | Preliminary Restoration For Crown | $238.50 |
DT632G | Provisional Bridge Pontic - Per Pontic | $248.49 |
DT643G | Bridge Pontic - Indirect - Per Pontic | $1,602.83 |
DT649G | Bridge - Indirect - Bonded To Abutment - Per Pontic | $1,652.12 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT661AG | Expendable Implant Hardware | As at retail |
DT661G | Implant Based Crown - Veneered - Includes Abutment | $2,467.06 |
DT666G | Prosthesis With Metal Frame Attached To Implants - Per Implant | $1,788.70 |
DT669G | Removal And Reattachment Of Prosthesis Fixed To Implants - Per Implant | $198.42 |
DT672G | Implant Based Crown - Veneered - Includes Abutment | $2,467.06 |
DT679G | Surgical Implant Guide | $275.13 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT711G | Full Upper Denture | $1,177.70 |
DT712G | Full Lower Denture | $1,177.70 |
DT719G | Full Upper & Lower Denture | $2,083.81 |
DT721AG | One Tooth - Partial Denture - Acrylic Base - Upper | $391.79 |
DT721BG | Two Teeth | $453.55 |
DT721CG | Three Teeth | $538.49 |
DT721DG | Four Teeth | $615.35 |
DT721EG | Five To Nine Teeth | $758.65 |
DT721FG | Ten Or More Teeth | $873.61 |
DT722AG | One Tooth - Partial Denture - Acrylic Base - Lower | $391.79 |
DT722BG | Two Teeth | $453.55 |
DT722CG | Three Teeth | $538.49 |
DT722DG | Four Teeth | $615.35 |
DT722EG | Five To Nine Teeth | $758.65 |
DT722FG | Ten Or More Teeth | $873.61 |
DT727AG | One Tooth Or Two Teeth - Partial Denture - Chrome Cobalt Including Rests & Retainers - Upper | $1,466.97 |
DT727BG | Three Or Four Teeth | $1,500.30 |
DT727CG | Five To Nine Teeth | $1,550.35 |
DT727DG | Ten Or More Teeth | $1,600.30 |
DT728AG | One Tooth Or Two Teeth - Partial Denture - Chrome Cobalt Including Rests & Retainers - Lower | $1,466.97 |
DT728BG | Three Or Four Teeth | $1,500.30 |
DT728CG | Five To Nine Teeth | $1,550.35 |
DT728DG | Ten Or More Teeth | $1,600.30 |
DT731G | Each Retainer | $50.06 |
DT732G | Occlusal Rest (Not Part Of Retainer) | $20.15 |
DT736G | Immediate Tooth Replacement | $10.19 |
DT743G | Relining - Full Denture - Processed | $376.86 |
DT744G | Relining - Partial Denture - Processed | $276.89 |
DT768G | Adding Tooth To Partial Denture To Replace Extracted Tooth | $191.89 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT821G | Active Removable Appliance Therapy - One Arch | $900.25 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT963G | Full Clinical Assessment Of Case Including Joint And Muscle Palpation, Occlusal Analysis With Study Models And Report. | $286.87 |
DT965G | Occlusal Splint Including Initial Programming | $646.91 |
DT966G | Routine Adjustment Of Splint - Per Visit (Maximum Of Six Visits) | $108.42 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT011S | Initial Examination And Report | $148.52 |
DT012S | Periodical Oral Examination | $86.74 |
DT014S | Consultation And Report for a second opinion | $275.13 |
DT022S | Single Intral Oral Radiograph | $50.06 |
DT036S | Cephalometric Radiograph | $130.17 |
DT037S | Panoramic Radiograph (e.g. OPG) | $141.83 |
DT061S | Pulp Vitality Testing - Per Visit - Maximum 3 Visits Per Year | $23.44 |
DT071S | Diagnostic Model - Per Model | $93.51 |
DT072S | Photographic Records (for WorkSafe) | $33.40 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT114S | Scaling and Cleaning | $108.42 |
DT117S | Non-Vital Bleaching - Per Tooth (if separate appointments are made) | $260.21 |
DT121S | Topical Fluoride Treatment | $58.59 |
DT141S | Oral Hygiene Instruction Where Appropriate Time Is Allocated | $21.74 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT165S | Desensitising Procedure - Per Visit | $41.89 |
DT171S | Odontoplasty For Fractured Tooth - Per Tooth | $41.89 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT222S | Root Planing And Subgingival Curettage (Per Segment) | $331.55 |
DT232S | Periodontal Flap Surgery (Per Tooth or Implant) | $406.77 |
DT235S | Gingival Connective Tissue Graft | $903.65 |
DT236A | Expendable GTR Material | $918.71 |
DT236S | Guided Tissue Regeneration (Per Tooth Or Implant) | $903.65 |
DT238S | Crown Lengthening - Including Alveolar Bone Removal (Per Tooth) | $666.86 |
DT242S | Osseous Surgery (Per Tooth or Implant) | $406.77 |
DT243S | Osseous Graft (Per Tooth or Implant) | $903.65 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT311S | Extraction Of Tooth (Per Tooth) | $191.89 |
DT323S | Surgical Extraction Requiring Bone Removal (Per Tooth) | $353.43 |
DT377S | Removal Of Soft Tissue | $58.59 |
DT387S | Replanting Avulsed Tooth And Splinting | $488.49 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT411S | Pulp Capping | $23.44 |
DT414S | Cvek Pulpotomy | $221.86 |
DT415S | Extirpation Of Pulp Or Debridement Of Root Canal 1 Canal | $408.53 |
DT416S | Extirpation Of Pulp Or Debridement Of Root Canal Each Additional Canal | $168.52 |
DT417S | Root Canal Obturation 1 Canal | $418.47 |
DT418S | Root Canal Obturation Each Additional Canal | $168.52 |
DT419S | Emergency Endodontic Procedure Not Exceeding 15 Minutes | $83.47 |
DT432S | Apicectomy And Apical Seal | $408.53 |
DT451S | Removal Of Root Filling Per Canal | $161.76 |
DT455S | Additional Visit For Irrigation And/Or Dressing Of The Root Canal System | $130.17 |
DT458S | Apexification - Fee Additional To Routine Endodontic Treatment | $270.16 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT511S | Metallic Restoration 1 Surface | $165.26 |
DT512S | Metallic Restoration 2 Surface | $213.60 |
DT513S | Metallic Restoration 3 Surface | $270.16 |
DT514S | Metallic Restoration 4 Surface | $300.12 |
DT515S | Metallic Restoration 5 Surface | $325.20 |
DT521S | Adhesive Resin Restoration Anterior Tooth - 1 Surfaces - Direct | $175.16 |
DT522S | Adhesive Resin Restoration Anterior Tooth - 2 Surfaces - Direct | $225.09 |
DT523S | Adhesive Resin Restoration Anterior Tooth - 3 Surfaces - Direct | $275.13 |
DT524S | Adhesive Resin Restoration Anterior Tooth - 4 Surfaces - Direct | $308.55 |
DT525S | Adhesive Resin Restoration Anterior Tooth - 5 Surfaces - Direct | $383.51 |
DT526S | Bonded Veneer - Direct | $395.01 |
DT531S | Adhesive Resin Restoration Posterior Tooth 1 Surfaces - Direct | $183.47 |
DT532S | Adhesive Resin Restoration Posterior Tooth 2 Surfaces - Direct | $216.79 |
DT533S | Adhesive Resin Restoration Posterior Tooth 3 Surfaces - Direct | $283.58 |
DT534S | Adhesive Resin Restoration Posterior Tooth 4 Surfaces - Direct | $316.75 |
DT535S | Adhesive Resin Restoration Posterior Tooth 5 Surfaces - Direct | $383.51 |
DT542S | Metallic Inlay Or Onlay Two Surface Cavity | $930.29 |
DT543S | Metallic Inlay Or Onlay Three Surface Cavity | $1,140.24 |
DT556S | Bonded Veneer - Indirect | $1,366.23 |
DT572S | Temporary Restoration Emergency Or Interim Treatment Only | $148.52 |
DT575S | Pin Retention (Per Unit - Pin) | $36.89 |
DT597S | Post - Direct Preformed | $148.52 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT613S | Full Crown - Indirect - Non Metallic | $2,052.14 |
DT615S | Full Crown - Indirect - Metal Base Veneered | $2,160.51 |
DT618S | Full Crown - Indirect - Metallic | $2,052.14 |
DT625S | Cast Core For Crown Including Post | $616.87 |
DT627S | Preliminary Restoration For Crown | $340.20 |
DT632S | Provisional Bridge Pontic - Per Pontic | $311.83 |
DT643S | Bridge Pontic - Indirect - Per Pontic | $1,940.64 |
DT649S | Bridge - Indirect - Bonded To Abutment - Per Pontic | $2,000.32 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT661AS | Expendable Implant Hardware | As at retail |
DT661S | Implant Based Crown - Veneered - Includes Abutment | $3,017.15 |
DT666S | Prosthesis With Metal Frame Attached To Implants - Per Implant | $2,100.45 |
DT669S | Removal And Reattachment Of Prosthesis Fixed To Implants - Per Implant | $198.42 |
DT672S | Implant Based Crown - Veneered - Includes Abutment | $3,017.15 |
DT679S | Surgical Implant Guide | $275.13 |
DT684S | Osseo-Integration Procedure - Intraoral Implantation Of Titanium Fixture | $1,200.29 |
DT688S | Osseo-Integration Procedure - One Stage | $1,338.61 |
DT691S | Osseo-Integration Procedure - Fixation Of Transcutaneous Abutment | $453.55 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT711S | Full Upper Denture | $1,645.41 |
DT712S | Full Lower Denture | $1,645.41 |
DT719S | Full Upper & Lower Denture | $3,062.20 |
DT721AS | One Tooth - Partial Denture - Acrylic Base - Upper | $483.47 |
DT721BS | Two Teeth | $628.59 |
DT721CS | Three Teeth | $753.60 |
DT721DS | Four Teeth | $836.90 |
DT721ES | Five To Nine Teeth | $1,005.33 |
DT721FS | Ten Or More Teeth | $1,150.17 |
DT722AS | One Tooth - Partial Denture - Acrylic Base - Lower | $483.47 |
DT722BS | Two Teeth | $628.52 |
DT722CS | Three Teeth | $753.63 |
DT722DS | Four Teeth | $836.90 |
DT722ES | Five To Nine Teeth | $1,005.33 |
DT722FS | Ten Or More Teeth | $1,150.21 |
DT727AS | One Tooth Or Two Teeth - Partial Denture - Chrome Cobalt Including Rests & Retainers - Upper | $1,692.00 |
DT727BS | Three Or Four Teeth | $1,823.69 |
DT727CS | Five To Nine Teeth | $1,892.06 |
DT727DS | Ten Or More Teeth | $1,967.15 |
DT728AS | One Tooth Or Two Teeth - Partial Denture - Chrome Cobalt Including Rests & Retainers - Lower | $1,692.00 |
DT728BS | Three Or Four Teeth | $1,823.69 |
DT728CS | Five To Nine Teeth | $1,892.06 |
DT728DS | Ten Or More Teeth | $1,967.15 |
DT731S | Each Retainer | $50.06 |
DT732S | Occlusal Rest (Not Part Of Retainer) | $20.15 |
DT736S | Immediate Tooth Replacement | $10.19 |
DT743S | Relining - Full Denture - Processed | $466.80 |
DT744S | Relining - Partial Denture - Processed | $340.20 |
DT768S | Adding Tooth To Partial Denture To Replace Extracted Tooth | $191.89 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT821S | Active Removable Appliance Therapy - One Arch | $1,283.67 |
DT831S | Full Arch Banding - One Arch | $4,679.01 |
DT846S | Orthodontic Extrusion Of Tooth | $1,061.93 |
DT881S | Full Course Of Fixed Appliance Orthodontic Treatment | $7,294.28 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
DT963S | Full Clinical Assessment Of Case Including Joint And Muscle Palpation, Occlusal Analysis With Study Models And Report. | $353.43 |
DT965S | Occlusal Splint Including Initial Programming | $763.58 |
DT966S | Routine Adjustment Of Splint - Per Visit (Maximum Of Six Visits) | $138.56 |
| Item number | Service description | Maximum payment rate |
|---|---|---|
INS105 | 52 MLER Questionnaire - Treating Dentist - Medical & Like Entitlement Review (MLER) Questionnaire (estimated time to complete 20-40 mins) | $111.39 |