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
| Item number DT011G | Service description Initial examination and report | Maximum payment rate $99.20 |
| Item number DT012G | Service description Periodical oral examination | Maximum payment rate $50.33 |
| Item number DT014G | Service description Consultation and report for a second opinion | Maximum payment rate $160.70 |
| Item number DT022G | Service description Single Intral oral radiograph | Maximum payment rate $41.91 |
| Item number DT036G | Service description Cephalometric radiograph | Maximum payment rate $109.01 |
| Item number DT037G | Service description Panoramic radiograph (e.g. OPG) | Maximum payment rate $118.77 |
| Item number DT061G | Service description Pulp vitality testing - Per visit (Maximum 3 visits per year) | Maximum payment rate $19.61 |
| Item number DT071G | Service description Diagnostic model - Per model | Maximum payment rate $78.32 |
| Item number DT072G | Service description Photographic records (for WorkSafe) | Maximum payment rate $27.96 |
Preventative services
| Item number DT114G | Service description Scaling and cleaning | Maximum payment rate $90.79 |
| Item number DT117G | Service description Non-vital bleaching - Per tooth (if separate appointments are made) | Maximum payment rate $174.65 |
| Item number DT121G | Service description Topical fluoride treatment | Maximum payment rate $49.06 |
| Item number DT141G | Service description Oral hygiene instruction where appropriate time is allocated | Maximum payment rate $18.20 |
Adjunctive services
| Item number DT165G | Service description Desensitising procedure - Per visit | Maximum payment rate $35.08 |
| Item number DT171G | Service description Odontoplasty for fractured tooth - Per tooth | Maximum payment rate $35.08 |
Oral surgery
| Item number DT311G | Service description Extraction of tooth - Per tooth - Multiple operation rule applies | Maximum payment rate $125.66 |
| Item number DT323G | Service description Surgical extraction requiring bone removal - Per tooth - Multiple operation rule applies | Maximum payment rate $242.97 |
| Item number DT377G | Service description Removal of soft tissue | Maximum payment rate $49.06 |
| Item number DT387G | Service description Replanting avulsed tooth and splinting | Maximum payment rate $283.50 |
NB: Multiple operation rule applies to items DT311 and DT323.
Endodontics
| Item number DT411G | Service description Pulp capping | Maximum payment rate $15.47 |
| Item number DT414G | Service description Cvek pulpotomy | Maximum payment rate $124.38 |
| Item number DT415G | Service description Extirpation of pulp or debridement of root canal 1 canal | Maximum payment rate $234.62 |
| Item number DT416G | Service description Extirpation of pulp or debridement of root canal each additional canal | Maximum payment rate $99.20 |
| Item number DT417G | Service description Root canal obturation 1 canal | Maximum payment rate $244.39 |
| Item number DT418G | Service description Root canal obturation each additional canal | Maximum payment rate $99.20 |
| Item number DT419G | Service description Emergency endodontic procedure not exceeding 15 minutes | Maximum payment rate $55.94 |
| Item number DT432G | Service description Apicectomy and apical seal | Maximum payment rate $247.19 |
| Item number DT451G | Service description Removal of root filling per canal | Maximum payment rate $95.00 |
| Item number DT455G | Service description Additional visit for irrigation and/or dressing of the root canal system | Maximum payment rate $90.79 |
| Item number DT458G | Service description Apexification - Fee additional to routine endodontic treatment | Maximum payment rate $141.14 |
NB: Items for endodontic treatment are inclusive of radiographs taken in the course of treatment.
Restorative services
| Item number DT511G | Service description Metallic restoration 1 surface | Maximum payment rate $97.86 |
| Item number DT512G | Service description Metallic restoration 2 surface | Maximum payment rate $124.38 |
| Item number DT513G | Service description Metallic restoration 3 surface | Maximum payment rate $152.35 |
| Item number DT514G | Service description Metallic restoration 4 surface | Maximum payment rate $181.56 |
| Item number DT515G | Service description Metallic restoration 5 surface | Maximum payment rate $202.49 |
| Item number DT521G | Service description Adhesive resin restoration anterior tooth - 1 surfaces - direct | Maximum payment rate $111.81 |
| Item number DT522G | Service description Adhesive resin restoration anterior tooth - 2 surfaces - direct | Maximum payment rate $132.72 |
| Item number DT523G | Service description Adhesive resin restoration anterior tooth - 3 surfaces - direct | Maximum payment rate $160.70 |
| Item number DT524G | Service description Adhesive resin restoration anterior tooth - 4 surfaces - direct | Maximum payment rate $188.50 |
| Item number DT525G | Service description Adhesive resin restoration anterior tooth - 5 surfaces - direct | Maximum payment rate $272.34 |
| Item number DT526G | Service description Bonded veneer - direct | Maximum payment rate $248.64 |
| Item number DT531G | Service description Adhesive resin restoration posterior tooth 1 surfaces - direct | Maximum payment rate $125.66 |
| Item number DT532G | Service description Adhesive resin restoration posterior tooth 2 surfaces - direct | Maximum payment rate $148.02 |
| Item number DT533G | Service description Adhesive resin restoration posterior tooth 3 surfaces - direct | Maximum payment rate $181.56 |
| Item number DT534G | Service description Adhesive resin restoration posterior tooth 4 surfaces - direct | Maximum payment rate $209.50 |
| Item number DT535G | Service description Adhesive resin restoration posterior tooth 5 surfaces - direct | Maximum payment rate $272.34 |
| Item number DT542G | Service description Metallic inlay or onlay two surface cavity | Maximum payment rate $645.14 |
| Item number DT543G | Service description Metallic inlay or onlay three surface cavity | Maximum payment rate $758.08 |
| Item number DT556G | Service description Bonded veneer - indirect | Maximum payment rate $837.62 |
| Item number DT572G | Service description Temporary restoration emergency or interim treatment only | Maximum payment rate $100.60 |
| Item number DT575G | Service description Pin retention (per unit - Pin) | Maximum payment rate $30.90 |
| Item number DT597G | Service description Post - Direct preformed | Maximum payment rate $100.60 |
Crown and bridgework
| Item number DT613G | Service description Full Crown - Indirect - Non Metallic | Maximum payment rate $1,289.93 |
| Item number DT615G | Service description Full Crown - Indirect - Metal Base Veneered | Maximum payment rate $1,383.54 |
| Item number DT618G | Service description Full Crown - Indirect - Metallic | Maximum payment rate $1,289.93 |
| Item number DT625G | Service description Cast Core For Crown Including Post | Maximum payment rate $321.18 |
| Item number DT627G | Service description Preliminary Restoration For Crown | Maximum payment rate $199.75 |
| Item number DT632G | Service description Provisional Bridge Pontic - Per Pontic | Maximum payment rate $208.11 |
| Item number DT643G | Service description Bridge Pontic - Indirect - Per Pontic | Maximum payment rate $1,342.33 |
| Item number DT649G | Service description Bridge - Indirect - Bonded To Abutment - Per Pontic | Maximum payment rate $1,383.60 |
Implant procedures
| Item number DT661AG | Service description Expendable implant hardware | Maximum payment rate As at retail |
| Item number DT661G | Service description Implant based crown - Veneered - Includes abutment | Maximum payment rate $2,066.10 |
| Item number DT666G | Service description Prosthesis with metal frame attached to implants - Per implant | Maximum payment rate $1,497.98 |
| Item number DT669G | Service description Removal and reattachment of prosthesis fixed to implants - Per implant | Maximum payment rate $166.18 |
| Item number DT672G | Service description Implant based crown - Veneered - Includes abutment | Maximum payment rate $2,066.10 |
| Item number DT679G | Service description Surgical implant guide | Maximum payment rate $230.41 |
Prosthodontics
| Item number DT711G | Service description Full upper denture | Maximum payment rate $986.29 |
| Item number DT712G | Service description Full lower denture | Maximum payment rate $986.29 |
| Item number DT719G | Service description Full upper and lower denture | Maximum payment rate $1,745.12 |
| Item number DT721AG | Service description One tooth - Partial denture - Acrylic base - upper | Maximum payment rate $328.11 |
| Item number DT721BG | Service description Two teeth | Maximum payment rate $379.83 |
| Item number DT721CG | Service description Three teeth | Maximum payment rate $450.97 |
| Item number DT721DG | Service description Four teeth | Maximum payment rate $515.34 |
| Item number DT721EG | Service description Five to nine teeth | Maximum payment rate $635.34 |
| Item number DT721FG | Service description Ten or more teeth | Maximum payment rate $731.62 |
| Item number DT722AG | Service description One tooth - Partial denture - Acrylic base - lower | Maximum payment rate $328.11 |
| Item number DT722BG | Service description Two teeth | Maximum payment rate $379.83 |
| Item number DT722CG | Service description Three teeth | Maximum payment rate $450.97 |
| Item number DT722DG | Service description Four teeth | Maximum payment rate $515.34 |
| Item number DT722EG | Service description Five to nine teeth | Maximum payment rate $635.34 |
| Item number DT722FG | Service description Ten or more teeth | Maximum payment rate $731.62 |
| Item number DT727AG | Service description One tooth or two teeth - Partial denture - chrome cobalt including rests and retainers - upper | Maximum payment rate $1,228.55 |
| Item number DT727BG | Service description Three or four teeth | Maximum payment rate $1,256.46 |
| Item number DT727CG | Service description Five to nine teeth | Maximum payment rate $1,298.39 |
| Item number DT727DG | Service description Ten or more teeth | Maximum payment rate $1,340.21 |
| Item number DT728AG | Service description One tooth or two teeth - Partial denture - chrome cobalt including rests and retainers - lower | Maximum payment rate $1,228.55 |
| Item number DT728BG | Service description Three or four teeth | Maximum payment rate $1,256.46 |
| Item number DT728CG | Service description Five to nine teeth | Maximum payment rate $1,298.39 |
| Item number DT728DG | Service description Ten or more teeth | Maximum payment rate $1,340.21 |
| Item number DT731G | Service description Each retainer | Maximum payment rate $41.91 |
| Item number DT732G | Service description Occlusal rest (not part of retainer) | Maximum payment rate $16.87 |
| Item number DT736G | Service description Immediate tooth replacement | Maximum payment rate $8.53 |
| Item number DT743G | Service description Relining - Full denture - Processed | Maximum payment rate $315.61 |
| Item number DT744G | Service description Relining - Partial denture - Processed | Maximum payment rate $231.88 |
| Item number DT768G | Service description Adding tooth to partial denture to replace extracted tooth | Maximum payment rate $160.70 |
Orthodontics
| Item number DT821G | Service description Active removable appliance therapy - One arch | Maximum payment rate $753.94 |
Temporomandibular joint therapy
| Item number DT963G | Service description Full clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report. | Maximum payment rate $240.24 |
| Item number DT964G | Service description Full clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report. | Maximum payment rate $240.24 |
| Item number DT965G | Service description Occlusal splint including initial programming | Maximum payment rate $541.78 |
| Item number DT966G | Service description Routine adjustment of splint - Per visit (maximum of six visits) | Maximum payment rate $90.79 |
Dentist Specialist
Diagnostic services
| Item number DT011S | Service description Initial examination and report | Maximum payment rate $124.38 |
| Item number DT012S | Service description Periodical oral examination | Maximum payment rate $72.64 |
| Item number DT014S | Service description Consultation and report for a second opinion | Maximum payment rate $230.41 |
| Item number DT022S | Service description Single intral oral radiograph | Maximum payment rate $41.91 |
| Item number DT036S | Service description Cephalometric radiograph | Maximum payment rate $109.01 |
| Item number DT037S | Service description Panoramic radiograph (e.g. OPG) | Maximum payment rate $118.77 |
| Item number DT061S | Service description Pulp vitality testing - Per visit - Maximum 3 visits per year | Maximum payment rate $19.61 |
| Item number DT071S | Service description Diagnostic model - Per model | Maximum payment rate $78.32 |
| Item number DT072S | Service description Photographic Records (for WorkSafe) | Maximum payment rate $27.96 |
Preventative services
| Item number DT114S | Service description Scaling and cleaning | Maximum payment rate $90.79 |
| Item number DT117S | Service description Non-vital bleaching - Per tooth (if separate appointments are made) | Maximum payment rate $217.91 |
| Item number DT121S | Service description Topical fluoride treatment | Maximum payment rate $49.06 |
| Item number DT141S | Service description Oral hygiene instruction where appropriate time is allocated | Maximum payment rate $18.20 |
Adjunctive services
| Item number DT165S | Service description Desensitising procedure - Per visit | Maximum payment rate $35.08 |
| Item number DT171S | Service description Odontoplasty for fractured tooth - Per tooth | Maximum payment rate $35.08 |
Periodontics
| Item number DT222S | Service description Root planing and subgingival curettage (Per segment) | Maximum payment rate $277.66 |
| Item number DT232S | Service description Periodontal flap surgery (Per tooth or implant) | Maximum payment rate $340.67 |
| Item number DT235S | Service description Gingival connective tissue graft | Maximum payment rate $756.78 |
| Item number DT236A | Service description Expendable GTR material | Maximum payment rate $769.39 |
| Item number DT236S | Service description Guided tissue regeneration (Per tooth or implant) | Maximum payment rate $756.78 |
| Item number DT237S | Service description Guided tissue regeneration (Per tooth or implant) | Maximum payment rate $756.78 |
| Item number DT238S | Service description Crown lengthening - Including alveolar bone removal (Per tooth) | Maximum payment rate $558.47 |
| Item number DT242S | Service description Osseous surgery (Per tooth or implant) | Maximum payment rate $340.67 |
| Item number DT243S | Service description Osseous graft (Per tooth or implant) | Maximum payment rate $756.78 |
NB: Multiple operation rule applies.
Oral surgery
| Item number DT311S | Service description Extraction of tooth (Per tooth) | Maximum payment rate $160.70 |
| Item number DT323S | Service description Surgical extraction requiring bone removal (Per tooth) | Maximum payment rate $295.99 |
| Item number DT377S | Service description Removal of soft tissue | Maximum payment rate $49.06 |
| Item number DT387S | Service description Replanting avulsed tooth and splinting | Maximum payment rate $409.11 |
NB: Multiple operation rule applies to items DT311S and DT323S.
Endodontics
| Item number DT411S | Service description Pulp capping | Maximum payment rate $19.61 |
| Item number DT414S | Service description Cvek pulpotomy | Maximum payment rate $185.80 |
| Item number DT415S | Service description Extirpation of pulp or debridement of root canal 1 canal | Maximum payment rate $342.14 |
| Item number DT416S | Service description Extirpation of pulp or debridement of root canal each additional canal | Maximum payment rate $141.14 |
| Item number DT417S | Service description Root canal obturation 1 Canal | Maximum payment rate $350.46 |
| Item number DT418S | Service description Root canal obturation each additional canal | Maximum payment rate $141.14 |
| Item number DT419S | Service description Emergency endodontic procedure not exceeding 15 minutes | Maximum payment rate $69.91 |
| Item number DT432S | Service description Apicectomy and apical seal | Maximum payment rate $342.14 |
| Item number DT451S | Service description Removal of root filling per canal | Maximum payment rate $135.46 |
| Item number DT455S | Service description Additional visit for irrigation and/or dressing of the root canal system | Maximum payment rate $109.01 |
| Item number DT458S | Service description Apexification - Fee additional to routine endodontic treatment | Maximum payment rate $226.27 |
NB: Items for endodontic treatment are Inclusive of radiographs taken in the course of treatment.
Restorative services
| Item number DT511S | Service description Metallic restoration 1 surface | Maximum payment rate $138.39 |
| Item number DT512S | Service description Metallic restoration 2 surface | Maximum payment rate $178.86 |
| Item number DT513S | Service description Metallic restoration 3 surface | Maximum payment rate $226.27 |
| Item number DT514S | Service description Metallic restoration 4 surface | Maximum payment rate $251.33 |
| Item number DT515S | Service description Metallic restoration 5 surface | Maximum payment rate $272.34 |
| Item number DT521S | Service description Adhesive resin restoration anterior tooth - 1 surfaces - Direct | Maximum payment rate $146.69 |
| Item number DT522S | Service description Adhesive resin restoration anterior tooth - 2 surfaces - Direct | Maximum payment rate $188.50 |
| Item number DT523S | Service description Adhesive resin restoration anterior tooth - 3 surfaces - Direct | Maximum payment rate $230.41 |
| Item number DT524S | Service description Adhesive resin restoration anterior tooth - 4 surfaces - Direct | Maximum payment rate $258.40 |
| Item number DT525S | Service description Adhesive resin restoration anterior tooth - 5 surfaces - Direct | Maximum payment rate $321.18 |
| Item number DT526S | Service description Bonded veneer - Direct | Maximum payment rate $330.80 |
| Item number DT531S | Service description Adhesive resin restoration posterior tooth 1 surfaces - Direct | Maximum payment rate $153.64 |
| Item number DT532S | Service description Adhesive resin restoration posterior tooth 2 surfaces - Direct | Maximum payment rate $181.56 |
| Item number DT533S | Service description Adhesive resin restoration posterior tooth 3 surfaces - Direct | Maximum payment rate $237.49 |
| Item number DT534S | Service description Adhesive resin restoration posterior tooth 4 surfaces - Direct | Maximum payment rate $265.27 |
| Item number DT535S | Service description Adhesive resin restoration posterior tooth 5 surfaces - Direct | Maximum payment rate $321.18 |
| Item number DT542S | Service description Metallic inlay or onlay two surface cavity | Maximum payment rate $779.10 |
| Item number DT543S | Service description Metallic inlay or onlay three surface cavity | Maximum payment rate $954.92 |
| Item number DT556S | Service description Bonded veneer - Indirect | Maximum payment rate $1,144.19 |
| Item number DT572S | Service description Temporary restoration emergency or interim treatment only | Maximum payment rate $124.38 |
| Item number DT575S | Service description Pin retention (Per unit - Pin) | Maximum payment rate $30.90 |
| Item number DT597S | Service description Post - direct preformed | Maximum payment rate $124.38 |
Crown and bridgework
| Item number DT613S | Service description Full crown - Indirect - Non metallic | Maximum payment rate $1,718.61 |
| Item number DT615S | Service description Full crown - Indirect - Metal base veneered | Maximum payment rate $1,809.37 |
| Item number DT618S | Service description Full crown - Indirect - Metallic | Maximum payment rate $1,718.61 |
| Item number DT625S | Service description Cast core for crown including post | Maximum payment rate $516.62 |
| Item number DT627S | Service description Preliminary restoration for crown | Maximum payment rate $284.90 |
| Item number DT632S | Service description Provisional bridge pontic - Per pontic | Maximum payment rate $261.15 |
| Item number DT643S | Service description Bridge pontic - Indirect - Per pontic | Maximum payment rate $1,625.25 |
| Item number DT649S | Service description Bridge - Indirect - Bonded to abutment - Per pontic | Maximum payment rate $1,675.21 |
Implant procedures
NB: Multiple operation rule applies to Items DT684S, DT688S and DT691S.
| Item number DT661AS | Service description Expendable implant hardware | Maximum payment rate As at retail |
| Item number DT661S | Service description Implant based crown - Veneered - Includes abutment | Maximum payment rate $2,526.78 |
| Item number DT666S | Service description Prosthesis with metal frame attached to implants - Per implant | Maximum payment rate $1,759.07 |
| Item number DT669S | Service description Removal and reattachment of prosthesis fixed to implants - Per implant | Maximum payment rate $166.18 |
| Item number DT672S | Service description Implant based crown - Veneered - Includes abutment | Maximum payment rate $2,526.78 |
| Item number DT679S | Service description Surgical implant guide | Maximum payment rate $230.41 |
| Item number DT684S | Service description Osseo-Integration procedure - Intraoral implantation of titanium fixture | Maximum payment rate $1,005.21 |
| Item number DT688S | Service description Osseo-Integration procedure - One stage | Maximum payment rate $1,121.06 |
| Item number DT691S | Service description Osseo-Integration procedure - Fixation of transcutaneous abutment | Maximum payment rate $379.83 |
Prosthodontics
| Item number DT711S | Service description Full upper denture | Maximum payment rate $1,377.99 |
| Item number DT712S | Service description Full lower denture | Maximum payment rate $1,377.99 |
| Item number DT719S | Service description Full upper and lower denture | Maximum payment rate $2,564.51 |
| Item number DT721AS | Service description One tooth - Partial denture - Acrylic base - upper | Maximum payment rate $404.90 |
| Item number DT721B | Service description Two teeth | Maximum payment rate $526.43 |
| Item number DT721CS | Service description Three teeth | Maximum payment rate $631.12 |
| Item number DT721DS | Service description Four teeth | Maximum payment rate $700.88 |
| Item number DT721ES | Service description Five to nine teeth | Maximum payment rate $841.93 |
| Item number DT721FS | Service description Ten or more teeth | Maximum payment rate $963.24 |
| Item number DT722AS | Service description One tooth - Partial denture - Acrylic base - lower | Maximum payment rate $404.90 |
| Item number DT722BS | Service description Two teeth | Maximum payment rate $526.43 |
| Item number DT722CS | Service description Three teeth | Maximum payment rate $631.12 |
| Item number DT722DS | Service description Four teeth | Maximum payment rate $700.88 |
| Item number DT722ES | Service description Five to nine teeth | Maximum payment rate $841.93 |
| Item number DT722FS | Service description Ten or more teeth | Maximum payment rate $963.24 |
| Item number DT727AS | Service description One tooth or two teeth - Partial denture - Chrome cobalt including rests and retainers - upper | Maximum payment rate $1,417.01 |
| Item number DT727BS | Service description Three or four teeth | Maximum payment rate $1,527.30 |
| Item number DT727CS | Service description Five to nine teeth | Maximum payment rate $1,584.54 |
| Item number DT727DS | Service description Ten or more teeth | Maximum payment rate $1,647.44 |
| Item number DT728AS | Service description One tooth or two teeth - Partial denture - Chrome cobalt including rests and retainers - lower | Maximum payment rate $1,417.01 |
| Item number DT728BS | Service description Three or four teeth | Maximum payment rate $1,527.30 |
| Item number DT728CS | Service description Five to nine teeth | Maximum payment rate $1,584.54 |
| Item number DT728DS | Service description Ten or more teeth | Maximum payment rate $1,647.44 |
| Item number DT731S | Service description Each retainer | Maximum payment rate $41.91 |
| Item number DT732S | Service description Occlusal rest (Not part of retainer) | Maximum payment rate $16.87 |
| Item number DT736S | Service description Immediate tooth replacement | Maximum payment rate $8.53 |
| Item number DT743S | Service description Relining - Full denture - Processed | Maximum payment rate $390.94 |
| Item number DT744S | Service description Relining - Partial denture - Processed | Maximum payment rate $284.90 |
| Item number DT768S | Service description Adding tooth to partial denture to replace extracted tooth | Maximum payment rate $160.70 |
Orthodontics
| Item number DT821S | Service description Active removable appliance therapy - One arch | Maximum payment rate $1,075.04 |
| Item number DT831S | Service description Full arch banding - One Arch | Maximum payment rate $3,918.55 |
| Item number DT846S | Service description Orthodontic extrusion of tooth | Maximum payment rate $889.35 |
| Item number DT881S | Service description Full course of fixed appliance orthodontic treatment | Maximum payment rate $6,108.78 |
Temporomandibular joint therapy
| Item number DT963S | Service description Full clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report. | Maximum payment rate $295.99 |
| Item number DT964S | Service description Full clinical assessment of case including joint and muscle palpation, occlusal analysis with study models and report. | Maximum payment rate $295.99 |
| Item number DT965S | Service description Occlusal splint including initial programming | Maximum payment rate $639.47 |
| Item number DT966S | Service description Routine adjustment of splint - Per visit (maximum of six visits) | Maximum payment rate $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.