Glosario en Ingles de Odontologia

The Australian Scheduleof Dental Services andGlossaryTenth Edition

The Australian Schedule of Dental Services and Glossary Australian Dental Association Incorporated Tenth Edition

Published by the Australian Dental Association Inc. 12-14 Chandos St, St Leonards, NSW 2065 Australia

Australian Dental Association Inc., 2013

First published 1986 An Australian Glossary of Dental Terms Second Edition 1990 An Australian Glossary of Dental Terms Third Edition 1992 An Australian Glossary of Dental Terms Fourth Edition 1994 An Australian Glossary of Dental Terms Fifth Edition 1996 An Australian Schedule of Dental Services and Glossary Sixth Edition 2000 An Australian Schedule of Dental Services and Glossary Seventh Edition 2002 The Australian Schedule of Dental Services and Glossary Eighth Edition 2004 The Australian Schedule of Dental Services and Glossary Ninth Edition 2009 The Australian Schedule of Dental Services and Glossary Tenth Edition 2013 The Australian Schedule of Dental Services and Glossary

All rights reserved. No part of this work covered by copyright may be reproduced or copied in any form or by any means (graphic, electronic or mechanical, including photocopying, recording, taping, or information and retrieval systems) without the written permission of the publisher.

ISBN 0 909961 31 X

Table of Contents

Tenth Edition Updates iii

Introduction iv

General iv

PurposeandPrinciples iv

Clarification v

GuidelinesforSubmissionstotheScheduleandThirdPartyCommittee v

Notes for Guidance vi

MultipleAppointmentProcedures vi

DentalMaterials vi

Linings vi

StandardisationofSurfaceDescriptionsofDentalRestorations vi

RestorativeProcedures vii

Endodontics vii

ProvisionalRestorationorProsthesis vii

DefinitiveRestorationorProsthesis vii

DirectandIndirectRestorations,CrownsandBridges vii

Direct,Indirect viii

Cementation viii

ImmediateDentures ix

PartialDentures ix

Item281CourseofNon-SurgicalPeriodontalTreatment ix

Item881CompleteCourseofOrthodonticTreatment x

DentalHealthInsuranceandOtherThirdParties x

ToothIdentification x

ItemisationofAccounts xi

Illustrated Definitions xiixviii

Goods and Services Tax xix

SCHEDULE OF DENTAL SERVICES AND GLOSSARY 1

Diagnostic Services (items 011-086) 1

Examinations 1

RadiologicalExaminationandInterpretation 2

OtherDiagnosticServices 4

Preventive, Prophylactic and Bleaching Services (items 111-171) 7

DentalProphylaxisandBleaching 7

RemineralisationAgents 8

OtherPreventiveServices 8

Periodontics (items 213-282) 10

PeriodontalTreatmentFormforusewithItems281and282 12

HowtoClaimBenefits 13

Oral Surgery (items 311-399) 14

Extractions 14

SurgicalExtractions 14

iThe Australian Schedule of Dental Services and Glossary

Table of Contents

SurgeryforProstheses 15

TreatmentofMaxillofacialInjuries 16

Dislocations 16

Osteotomies 17

GeneralSurgical 17

OtherSurgicalProcedures 18

Endodontics (items 411-458) 20

PulpandRootCanalTreatments 20

PeriradicularSurgery 21

OtherEndodonticServices 22

Restorative Services (items 511-597) 23

MetallicRestorationsDirect 23

AdhesiveRestorationsAnteriorTeethDirect 23

AdhesiveRestorationsPosteriorTeethDirect 24

MetallicRestorationsIndirect 25

Tooth-colouredRestorationsIndirect 25

OtherRestorativeServices 26

Prosthodontics (items 611-779) 28

Crowns 28

ProvisionalCrownandBridge 29

Bridges 30

CrownandBridgeRepairsandOtherServices 31

ProceduresforImplantProstheses 32

DenturesandDentureComponents 34

DentureMaintenance 36

DentureRepairs 37

OtherProsthodonticServices 38

Orthodontics (items 811-881) 39

RemovableAppliances 39

FixedAppliances 39

ExtraoralAppliances 40

Attachments 40

OtherOrthodonticServices 41

CompleteCourseofOrthodonticTreatment 41

OrthodonticTreatmentFormforusewithItem881 42

HowToClaimBenefits 43

General Services (items 911-972) 44

Emergencies 44

DrugTherapy 44

Anaesthesia,SedationandRelaxationTherapy 44

OcclusalTherapy 45

Miscellaneous (items 981-999) 47

Alphabetical Index of Procedures 49

ii Australian DentalAssociation Incorporated

Tenth Edition Updates

New items, changes and additions since the Ninth Edition

Newitems,changesandadditionssincetheNinthEditionareannotatedbelow.

Amended items

025,031,033,035,036,039,061,081,111,113,115,116,121,151,153,161,222,231,232,242,243,314,322,323,324,371,373,412,572,576,595,596,632,663,664,666,727,728,735,761,762,765

Renumbered items

662now633

Deleted items

225

New items

054,633,634,665,667,690,766

iiiThe Australian Schedule of Dental Services and Glossary

Introduction

AnAustralian Glossary of Dental Terms was first published by theAustralianDental Association Inc.in1986.TheFifthEditionwasexpanded toThe Australian Schedule of Dental Services and Glossary (Schedule)in1996.Sinceitsinception,ithasbeenuniversallyacceptedasthedefinitivecodingsystemofdentaltreatmentandisendorsedbytheNationalCodingCentre.

TheScheduleandThirdPartyCommittee,indevelopingtheTenthEdition,hasconsideredsubmissionsfromwithinthemembership,specialistaffiliateddentalgroups,healthfunds,theDepartmentofVeteransAffairs and other interested groups. The contributions of theChief ExecutiveOfficer, secretarial andpublicationsstaffoftheAustralianDentalAssociationInc.andmembersoftheScheduleandThirdPartyCommitteearegratefullyacknowledged.

CurrentinformationontheGSTisincludedonpagexixandisavailableonthemembersonlysectionoftheAssociationswebsite(www.ada.org.au)underInformationResources.

KarinAlexanderPresidentAustralianDentalAssociationInc.April2013

General

Purpose and Principles

TheScheduleandThirdPartyCommitteeassignsathree-digitcodenumbertoitemsorclinicalproceduresitconsiderstobepartofcurrentdentalpractice.InreviewingtheSchedule,thefollowingprinciplesareapplied:

1. AScheduleentrydescribes,asageneralrule,atreatmentoutcome.Itdoesnotaccommodateminorvariationsinclinicaltechniques.

2. ConsiderationforalistingintheSchedulewillonlybegiventoacceptedformsoftherapy.

3. Itisnotpossibletodescribeeverysingledentalserviceoutcome,andassuch,theprincipleofthemostappropriateitemnumbershouldbeutilised.Wherenosuitableitemnumbercanbeidentified,itemnumber990istobeallocatedfordescribingsuchservices.

4. Noitemnumbersarereservedexclusivelyforusebyspecialists.

5. Thereisnodifferentiationbetweenservicesonprimaryorsecondaryteethunlesstheprocedureisuniquewithinthatgroup.

6. Changestomaterialswithinagenericgrouporchangesinlaboratorytechniquesareunlikelytobeallocatednewitemnumbers.

iv Australian DentalAssociation Incorporated

General

Clarification

Any dentist or third party requiring clarification or interpretation of the Schedule should contact theAustralian Dental Association Inc. In the event of a dispute regarding interpretation or clarificationbetweenadentistandathirdparty,theChiefExecutiveOfficer(CEO)shouldbeinformedofthenamesandaddressesofbothpartiestogetherwithdetailsofthedispute.TheCEOwillthenreferthatinformationontotheAssociationsScheduleandThirdPartyCommitteeChairmanforevaluationanddecision.TheCEOwilltheninformbothpartiesofthedecision.Confidentialitywillbemaintained.

Federaland/orStateandTerritoryspecialistgroupsandAustralianDentalAssociationInc.affiliatedbodiesmustnotoffer interpretationorguidelinesfortheuseof ItemnumberswithinThe Australian Schedule of Dental Services and Glossary withouttheexplicitwrittenendorsementoftheFederalExecutiveoftheAustralianDentalAssociationInc.

Guidelines for Submissions to the Schedule and Third Party Committee

The Schedule and Third Party Committee welcomes submissions and comments on the Schedule.SuggestionsfornewandamendeditemnumbersshouldbeaccompaniedbyasuggesteddraftfortheSchedulethatis,itemnumber,headingandbriefdescription.

An organisation submitting on behalf of a particular discipline of dentistry should first consult withbranchesofequivalentorganisations inotherStatesandTerritories inorder toarriveataconsensus.Thirdpartiesshouldsubmitthroughtheirumbrellaorganisations.

CorrespondenceshouldbedirectedtotheChiefExecutiveOfficer,AustralianDentalAssociation Inc.,POBox520,StLeonards1590.Fax:0299064676oremail:[email protected]

vThe Australian Schedule of Dental Services and Glossary

Notes for Guidance

Multiple Appointment Procedures

Wheremultiple appointments are required to complete a procedure or course of treatment (such asdentures,crowns,orthodontics,periodontics,etc.),itisentirelyappropriatetorenderanaccountinpartorinfullatanyappointmentduringtheprocedureincludingthefirstappointment.Theitemnumberfortheprocedurecanonlybeusedonce.

Dental Materials

TheTenthEditionoftheSchedulehascontinuedtoclassifydentalmaterialsintobasicgenericgroups.Examplesaregiveninthefollowingtable.

Example Generic Grouping

amalgam metallicrestorationdirect

gold metallicrestorationindirect

non-preciousmetal metallicrestorationindirect

Ketacsilver adhesiverestoration

compomer tooth-colouredadhesiverestoration

compositeresin tooth-colouredadhesiverestoration

glassionomer tooth-colouredadhesiverestoration

polymerglass tooth-colouredadhesiverestoration

porcelain ceramic(fused,castormilled)

acrylic resin

Linings

Liningsusedbeneathrestorations,asinterposingmaterial,formanintegralpartofarestorationandarenottobeitemisedseparately.

Standardisation of Surface Descriptions of Dental Restorations

Auniformsystemisrecommendedinordertoquantifythecomplexityofarestorativeprocedure.

Asurfaceisdefinedbythelineangles,withtheincisaledgeregardedasaseparatesurface.

Whereseparateonesurfacerestorationsinthesamematerialareplacedonthesamesurfaceofthesametoothatthesamevisit,theyshallbeitemisedasasingleone-surfacerestoration.

Whereseparateonesurfacerestorationsareplacedondifferentsurfacesofthesametoothatthesamevisit,theyshallbeitemisedasseparateonesurfacerestorationsirrespectiveofthematerialused.

Similarprinciplesapplytomultiplesurfacerestorationsonthesametooth.

vi Australian DentalAssociation Incorporated

Notes for Guidance

Restorative Procedures

Whentwomaterialsareusedinthesamerestoration,thepredominantmaterialtypeshouldbeusedtoitemisethatrestoration.Wherearestorationincludesafissuresealantonthesametooth,thenonlyoneitemnumbershallbeusedtodescribethatrestoration.

Endodontics

Itemnumbersdescribingchemo-mechanicalpreparation,obturationandotherproceduresassociatedwithrootcanaltreatmentsshouldbeutilisedastheservicestheyrepresentarecompleted,whetherinasinglevisitormultipleappointments.

Ifanadditionalvisitisnecessarytoirrigateandredresstherootcanalsystem,item455shouldbeused.

Chancefillingofanaccessorycanalwhileobturatingamaincanalisnottobedeemedanadditionalcanalobturation.

Theprovisional(temporary)closureoftheaccesscavitybetweenvisitsshouldnotbeseparatelyitemised.

Provisional Restoration or Prosthesis

Provisional refers to a restoration or prosthesis which is intended to be of diagnostic or short-termfunctionaloraestheticvalue.

Definitive Restoration or Prosthesis

Definitivereferstoarestorationorprosthesisplacedafteradequatediagnosticprocedureshavebeencompletedwiththeintentionthattherestorationorprosthesiswillhavelong-termfunctionaloraestheticvalue.

Direct and Indirect Restorations, Crowns and Bridges

Non-specificterminologyhasbeenadoptedtodescribethecomponentsofdirectandindirectrestorations,crownsandbridges.Theonlydistinctionsarebetweenmetallicandtooth-colouredmaterialsanddirectorindirectfabrication.

Bridgesconsistofretainers,suchascrowns,directandindirectrestorations,bondedwingsorfacings,whichattachpontics (replacements formissing teeth) to theabutment teethor implants towhich theretainersarefixed.

Correct itemisation requires description of abutment retainers togetherwith the type and number ofpontics.Thisitemisationisalsoapplicabletoprovisionalcrownsandbridges.Similarprinciplesapplytoimplantsupportedcrownsandbridges.

ExampleAtoothsupportedbridgecarryingtwoindirectponticssupportedbyaveneeredjacketcrownateachend(commonlyknownasafour-unitbridge)wouldbeitemisedas:2x615,2x643

viiThe Australian Schedule of Dental Services and Glossary

Notes for Guidance

Animplantsupportedbridgecarryingoneindirectponticsupportedbyaveneeredjacketcrownateachend incorporating an abutment attached to the underlying implant (commonly knownas a three unitimplantsupportedbridge)wouldbeitemisedas:2x661,2x672,1x643

Bondedbridgesaresimilarlyitemised.Forinstance,athree-unitindirectbondedbridgewhichhastworetainersandasingleindirectponticisitemisedas:2x649,1x643

Atoothsupportedprovisionalbridgecarryingtwoindirectponticssupportedbyprovisionalcrownsateachend(commonlyknownasaprovisionalfour-unitbridge)wouldbeitemisedas:2x631,2x632

An implant supportedprovisionalbridgecarryingone indirectponticsupportedbyaveneered jacketcrownateachendincorporatingaprovisionalabutmentattachmenttotheunderlyingimplant(commonlyknownasaprovisionalthreeunitimplantsupportedbridge)wouldbeitemisedas:2x633,2x634,1x632

Infrastructures (such as core for crown including post), stress-breakers and precision or magneticattachmentsshouldbeappropriatelyitemised.

Direct, Indirect

Thetermsdirectand indirectareusedtodistinguishbetweenrestorations/servicesfabricateddirectlyinthemouth(direct)andthosefabricatedoutsidethemouthusingmodels,copingsordigitisedimages(indirect).Adentaltechnicianmayassistinthefabricationofindirectrestorations.

Certainrestorationsusebothintraoralandextraoralproceduresbutaretobeitemisedbythepredominantelementoffabrication.

For exampleSomeresin-basedrestorationmaterialsareformedinthemouthbutareremovedforextraoralcuringandfinishingbeforecementation/insertion.Thesearetobeitemisedasdirectrestorations.

Somerestorationsaremilledextraorallybeforecementation/insertion.Thesearetobeitemisedasindirectrestorations

Some cast restorationswill have the casting pattern prepared in themouth before being completedextraorally.Thesearetobeitemisedasindirect.

Cementation

Where the term cementation is used in the Schedule it implies the various processes (cementation,bonding, adhesion, curing, attaching) employed to achieve enduring retention of a restoration orprosthesisinthemouth.

viii Australian DentalAssociation Incorporated

Notes for Guidance

Immediate Dentures

Immediatedenturesrequiremultipleitemisation.

For exampleA full upper immediatedenture inwhich six teethare replaced immediately following their extractionshouldbeitemisedwiththefollowingitems:

Removalofatoothorpart(s)thereof 6x311Completemaxillarydenture 711Immediatetoothreplacementpertooth 6x736

Thesameprincipleappliestopartialdentureimmediatetoothreplacement[s]

Partial Dentures

Partialdentureitems721,722,727and728areusedtodescribethebaseonly(resinorcastmetal)ofthepartialdenture.

Item733(tooth/teeth)shouldbeusedtodescribethenumberofteethbornebythedenturebase.

When retainers (clasps) (731), overlays (734), occlusal rests (732), precisionormagnetic attachments(735)ormetalbackings(739)areusedtheyshouldbeappropriatelyitemised.

Item730:AcodingusedonlybytheDepartmentofVeteransAffairstoidentifytheactualcostofthecastalloyframeworkofapartialdenture.Itsuseisusuallysupportedbytheprovisionofaninvoiceorcopythereof.

ExampleProvisionofafive-toothmandibularacrylicpartialdenturewherethesaddlesareconnectedbyawroughtbarandwheretherearetwoclaspsandtwoocclusalrestswouldbeitemisedas:

Partialmandibulardentureresinbase 722Wroughtbar 738Fiveteethontheresindenturebase 5x733Tworetainers 2x731Twoocclusalrests 2x732

Provisionofafive-toothcastmetalframeworkmaxillarydenturewithtwoocclusalrestsandtworetainerswouldbeitemisedas:

Partialmaxillarydenturemetalframework 727Fiveteeth 5x733Tworetainers 2x731Twoocclusalrests 2x732

Item 281 Course of Non-Surgical Periodontal Treatment

Thisisanall-inclusiveitemisationofadefinitivecourseofcomplexnon-surgicalperiodontaltreatment.Itmaybeutilisedinconjunctionwiththeperiodontaltreatmentform(seepage12).Whilethisisamultifacetedsinglecourseoftreatment,theaccountingmaybesequentiallypresentedtoenableprogressivebilling.

Radiographsandothermeasuresappropriatetothetreatmentplanningshouldbeseparatelyitemised.

ixThe Australian Schedule of Dental Services and Glossary

Notes for Guidance

Item 881 Complete Course of Orthodontic Treatment

This is an all-inclusive itemisationof adefinitive courseof complexorthodontic treatment. Itmaybeutilised inconjunctionwith theorthodontic treatment form (seepage42).While this isamultifacetedsinglecourseoftreatment,theaccountingmaybesequentiallypresentedtoenableprogressivebilling.

Radiographsandothermeasuresappropriatetothetreatmentplanningshouldbeseparatelyitemised.

Dental Health Insurance and Other Third Parties

TheTenthEditionoftheSchedulecontainsthedefinitiveandauthoritativedescriptionsofdentalservicesrenderedwithinAustralia.Assuch,thirdpartiesandallotherbodiesthatusetheSchedulearenotentitledtoplacetheirowndefinitionsorinterpretationsonitemnumberslistedwithinthisSchedule.

Commercialdecisionsbyhealthfundsandotherthirdpartiestoplacelimitsorutilisationrulesoncertainprocedures,whether they are annual or per procedure, do not imply that the continued provision ofthose servicesby theprovider is inappropriate.Wherehealth fundsorother thirdpartiesmakesuchclaims,appropriateevidenceshouldbeprovidedtotheChiefExecutiveOfficeroftheAustralianDentalAssociationInc.

Tooth Identification

If it isnecessaryorusefultoidentifyatooth,theFDITwo-digitToothIdentificationnumbershouldbeemployed.PleasenotethattoothIDisnotapplicabletoimplants.

x Australian DentalAssociation Incorporated

Notes for Guidance

Itemisation of Accounts

Theoriginal itemisationofdental servicesshouldbeprovided ina formconsistentwith the followingguidelineswhich,althoughnotmandatory,arerecommendedbytheAssociation:

(a) Nameandprovidernumberofthedentistprovidingtheservice.

(b) Entitytowhichpaymentistobemade.

(c) Specialistdescriptionifappropriate.

(d) Addressoftheplaceofpractice.

(e) Telephonenumberoftheplaceofpractice.

(f) Nameandaddressofthepartyresponsibleforthedebt.

(g) Nameofpatient.

(h) Dateonwhichtheaccountwasrendered.

(i) Dateonwhichservicewasprovided.

(j) Identificationofserviceby theSchedulenumberand/ordescriptionofservicesufficient toidentifytheprocedure.

(k) Feechargedforeachitemofservice.

(I) Detailsofpaymentmade.

(m) Balanceowing.

(n) Whenasubsequentaccountisissued,itshouldbeendorsedduplicatecopy.

(o) GST,whereappropriate,shouldbeitemised.

xiThe Australian Schedule of Dental Services and Glossary

Illustrated Definitions

Tooth Terminology

PulpThe organ at the centre of a tooth containing blood vessels, nerve tissue and cells that produce dentine.

FissureA naturally occurring crevice in the enamel.

EnamelThe hard, calcified substance that is the surface of a crown of a tooth.

CrownThe crown of the tooth is the part of the tooth that is visible and is above the gum margin or gingiva.

Periodontal ligamentThe ligament which connects a tooth, by its root, to the supporting bone.

DentineThe calcified tissue that forms the major part of a tooth. In the crown of the tooth, the dentine is covered by enamel. The pulp chamber of the tooth is enclosed by dentine.

RootThe root is the part of the tooth below the gum margin and is connected through cementum on its surface and the fibres of the periodontal ligament to the supporting bone.

MucosaThe name given to the lining of epithelium inside the mouth, and its immediate substructures.

CementumThe calcified tissue which is on the surface of the root of a tooth and which provides attachment for the periodontal ligament.

GingivaThe marginal part of the gum that surrounds the tooth where it emerges from the deeper, supporting tissues.

xii Australian DentalAssociation Incorporated


Dental Arch

Molar teethThe teeth behind the bicuspid teeth. There are three molar teeth in each quadrant of the dental arch. They are the very back teeth; the wisdom tooth is the last molar in each dental arch.

Posterior teethThe teeth at the back of the mouth including premolars and molars.

LingualAn adjective to describe the aspect or surface of the teeth or other object or structure in the mouth which is in proximity to the tongue.

BuccalAn adjective to describe the aspect or surface of the teeth or other object or structure in the mouth which is in proximity to the cheek.

PalatalAn adjective to describe the aspect or surface of the teeth or other object or structure in the mouth which is adjacent to the palate.

LabialAn adjective to describe the aspect or surface of teeth or other object or structure in the mouth which is in proximity to the lips; for instance, the front surface of the incisor teeth.

Incisor teethThe front teeth usually in the centre of the upper or lower dental arch.

Premolar (bicuspid) teethThe teeth in each quadrant of the dental arch usually immediately behind the canine teeth.

Canine (cuspid) toothThe tooth usually immediately behind the incisor teeth; usually the third tooth from the centre of the dental arch.

Anterior teethThe teeth in the upper or lower arch usually comprising the central and lateral incisors and the canine (or cuspid) teeth.

xiiiThe Australian Schedule of Dental Services and Glossary


Mandible Showing Anatomical Features

Mandibleorlowerjaw(leftsideview)showinganatomicalfeatures.

Body of mandible

Angle of mandible

Ramus of mandible

Left condyle

Right condyle

Third Molar Impactions of Upper and Lower Jaw

Maxillaryandmandibular(upperandlower)teethshowingthirdmolar(wisdomteeth)impactions,rightsideview.

Unerupted third molar (maxillary)

Impaction against second molar

Unerupted third molar (mandibular)

Third molar impacted against erupted second molar

Wheresurgicalremovalofmolarsisperformed,seeSurgicalExtractions.

xiv Australian DentalAssociation Incorporated


Casting Technique

Irrespectiveofthemetalemployed,castingsusedindentistryareusuallymadebythewaxeliminationprocess,whichpermitsaccurateandverycomplexshapestobecastinmetalandusedasinlays,crowns,bridgesorpartialdentures.

Figure 1

Inthisexample,thetoothispreparedbycuttingtoadesignedshape.Awaxpattern ismadetoformandcontourthatwouldreplacethemissingtooth structure. Sometimes, wax patterns aremadedirectly in themouth;atother timestheyaremadeonareplica(die)ofthetoothorteeth.

Thewaxpatternisthenliftedawayfromthetooth(ordie)bymeansofapin(sprue)meltedontoitsexternalsurface.

Figure 2

Thewaxpatternwith its sprue isembedded inheatresistantplaster.Whenthesprueisremovedand thewaxmeltedawaybyheating,ahollowmouldremainsintowhichmoltenmetalmaybeforcedorcast.

Figure 3

Excess metal is cut away and the casting istrimmed,fittedtothetoothordieandpolished.

Figure 4

The casting is attached to the prepared toothwith a special adhesive cement. It replacesexactlythemissingtoothstructure.

xvThe Australian Schedule of Dental Services and Glossary


Crowns and Bridges

Crown

Crown

Bridge

Retainer

Abutment tooth

Post crown

Crown of naturaltooth reduced toaccept the crown

Retainer(full crown)

Abutment tooth

Root filling

Prepared root of tooth

Post cast, wroughtor preformed

Artificial new crown

Pontic (artificialreplacement tooth)

xvi Australian DentalAssociation Incorporated


Implants

Healing screw (removed whensecond stage head section is attached)

Oral mucosa healed overimplant after insertion of firststage

Oral mucosal epithelium(oral mucosa)

Outer bone plate

Cancellous bone

Endosseous implant

Abutment sectioninserted after removalof healing screw

Endosseous implant

Crown inserted overabutment section

Abutment head sectiondesigned to receive acrown

Oral mucosal epithelium

Outer bone plate

Cancellous bone

xviiThe Australian Schedule of Dental Services and Glossary


Partial Mandibular Denture

Retainer clasp

Framework for attachmentof acrylic and teeth

Figure 1Figureshowingcastalloyframeworkonmodelofmandibularteethmadefromanimpression.

Cast alloyframework

Retainer clasp

Denture saddle withthree teeth

Occlusal rest

Denture tooth

Figure 2Castalloyframeworkwithsixteeth.

Veneer

Prepared labial face

Veneer

Figure 1Incisor tooth prepared for veneerand veneer before attachment.

Figure 2Incisor tooth with veneerattached.

xviii Australian DentalAssociation Incorporated

Goods and Services Tax

Goods and Services Tax: goods and services supplied by dentists

Adraftofthis10thEditionofThe Australian Schedule of Dental Services and Glossary wasprovidedtotheAustralianTaxationOffice(ATO)witharequestthat,fortheassistanceofmembers,itprovideanadviceontheapplicationofGSTlegislationtotheScheduleitems.

AcopyofthecompleteRulingfromtheATOisreproducedontheADAmemberwebsiteathttp://www.ada.org.au/members/publications/schedulemem.aspx

TheessentialpartsoftheRulingarere-producedbelow.ThisincludestheRulingitselfandAppendix1whichprovidesanExplanationoftheRuling.AnAppendix2Detailedcontentslistisnotre-producedbelow.ThisAppendixatAttachmentAidentifiesthetaxstatusofeachitemintheSchedule.

TheADAhasinthe10thEditionofThe Australian Schedule of Dental Services and Glossary identifiedthoseitemstowhichGSTdoesormayapply.ThetaxstatusofanitemispresumedtobetaxfreeunlesstheitemnumberintheSchedulehasasymbolnexttoit.

Thelegendforthesymbolsis:

T Referstoservicesthatareconsideredtobetaxableastheyarenotfortheappropriatetreatmentofthepatient.

# Indicatesservices thatmaynotbeGST-freeas theymaynotbe necessary for theappropriatetreatment of the patient, for example, services for medico-legal or cosmetic purposes (seeparagraphs44and45ofthisClassRuling).

$ These are item numbers where the description of the item covers both taxable and GST-freesupplies.RefertothediscussiononSupplyofsparepartswithlabourservicesatparagraphs87to97ofClassRuling.

@ TheMedicareBenefitsScheduleprovidesthataMedicarebenefitispayableforsomedentalservicesprovidedinthecommunitytopeoplewithchronicmedicalconditionsandcomplexcareneeds.TheMedicareBenefitsScheduleofDentalServicesprovidesdetailsofservicesthatarecoveredbytheMedicareitems;whichdentalpractitionersareeligibletousethedentalitemsandwhichpatientsareeligibleforthesedentalservices.WhereaMedicarebenefitispayable,theserviceisGST-freeundersection38-7.

WhatappearsonthefollowingpagesisanextractoftheATORuling.ItisdesignedtoprovideuserswiththeessentialadviceregardingtheRuling.TheinclusionofthisadviceisfortheinformationofmembersandinnowayimpliesendorsementbytheAustralianDentalAssociation(ADA).YoushouldnotethatintheextractsprovidedtheparagraphnumbersprovidedbytheATOinthecompleteRuling(accessiblethroughtheADAwebsite)havebeenretainedforsimplicityandcompleteness.

IfinreadingtheextractspublishedbelowmembersrequirefurtherclarificationoftheimpactoftheRulingtheyareadvisedtovisitthecompletecopyoftheRulingonthewebsitehttp://www.ada.org.au/members/publications/schedulemem.aspx

TheADAwishestothanktheATOforthepromptprovisionofthisadvice.

xixThe Australian Schedule of Dental Services and Glossary


Explanatory Notes

Thispublication(excludingappendixes)isapublicrulingforthepurposesoftheTaxation Administration Act 1953.

ApublicrulingisanexpressionoftheCommissionersopinionaboutthewayinwhicharelevantprovisionapplies,orwouldapply,toentitiesgenerallyortoaclassofentitiesinrelationtoaparticularschemeoraclassofschemes.

IfyourelyonthisRuling,theCommissionermustapplythelawtoyouinthewaysetoutintheruling(unlesstheCommissionerissatisfiedthattherulingisincorrectanddisadvantagesyou,inwhichcasethelawmaybeappliedtoyouinawaythatismorefavourableforyouprovidedtheCommissionerisnotpreventedfromdoingsobyatimelimitimposedbythelaw).Youwillbeprotectedfromhavingtopayanyunderpaidtax,penaltyorinterestinrespectofthematterscoveredbythisrulingifitturnsoutthatitdoesnotcorrectlystatehowtherelevantprovisionappliestoyou.

[PLEASENOTETHEPARAGRAPHNUMBERSFROMTHEATORULINGHAVEBEENADOPTEDINTHEFOLLOWINGEXTRACT]

8. Thisworkiscopyright.ApartfromanyuseaspermittedundertheCopyright Act 1968,nopartmaybereproducedbyanyprocesswithoutpriorwrittenpermissionfromtheCommonwealth.Requestsandinquiriesconcerningreproductionandrightsshouldbeaddressedto:

CommonwealthCopyrightAdministrationCopyrightandClassificationPolicyBranchAttorney-GeneralsDepartment3-5NationalCircuitBartonACT2600

orpostedat:http://www.ag.gov.au/cca

Date of effect

9. ThisRulingappliesonorafter1April2013.However,thisRulingwillnotapplytotaxpayerstotheextentthatitconflictswiththetermsofasettlementofadisputeagreedtobeforethedateofissueofthisRuling(seeparagraphs75and76ofTaxationRulingTR2006/10).

Ruling

15. This Ruling addresses the goods and services tax (GST) treatment of the supply of goods andservicesbydentists.This Ruling includes Attachment A at page 22.

Supplies made by dentists under section 38-7

Supplies of services

16. Suppliesofdentalservicesandrepairsofdentalgoodsbyadentisttoapatientforwhichamedicarebenefit ispayableunderPart II of theHealth Insurance Act 1973 areGST-freeunder subsection38-7(1)(seeparagraphs31to34ofthisClassRuling).

Supplies of goods to patients (goods other than medical aids and appliances covered by section 38-45)

17. SuppliesofgoodstoapatientinthecourseofsupplyingthatpatientwithaGST-freeserviceundersubsection38-7(1)arealsoGST-freeundersubsection38-7(3)ifthesupplyismadetothepatientatthepremisesatwhichtheGST-freeserviceissupplied(seeparagraphs68to69ofthisClassRuling).

Australian DentalAssociation Incorporated

xx


Supplies made by dentists under section 38-10

Supplies of services

18. Suppliesofdentalservicesbyadentisttoapatientthataregenerallyacceptedinthedentalprofessionas being necessary for the appropriate treatment of that patient are GST-free under subsection38-10(1)(seeparagraphs35to67ofthisClassRuling).

Supplies of goods to patients (goods other than medical aids and appliances covered by section 38-45)

19. SuppliesofgoodstoapatientinthecourseofsupplyingthatpatientwithaGST-freedentalserviceundersubsection38-10(1)arealsoGST-freeundersubsection38-10(3)ifthesupplyismadetothatpatientatthepremisesatwhichtheGST-freeserviceissupplied(seeparagraphs68to69ofthisClassRuling).

Supplies of medical aids and appliances under section 38-45

Supplies of medical aids and appliances used in the dental industry

20. Supplies of customised toothbrushes for people with disabilities, dentures and artificial teeth,andmandibularadvancementsplintsareGST-freeundersubsection38-45(1)atallpoints in thesupplychain.ThingsmadeorconsumedintheprocessofconstructingandsupplyingoneoftheseitemsformpartoftheoneoverallGST-freesupplyofthatitem,evenifthecomponentsareitemisedseparatelyonthebill(seeparagraphs70to81ofthisClassRuling).

Supplies of specifically designed spare parts for medical aids and appliances

21. ThesupplyofaspecificallydesignedsparepartforaGST-freemedicalaidorappliance(customisedtoothbrushesforpeoplewithdisabilities,denturesandartificialteeth,andmandibularadvancementsplints)isGST-freeundersubsection38-45(2).

22. GenericsparepartsthatarenotspecificallydesignedforaGST-freemedicalaidorappliancearenotGST-free(seeparagraphs82to85ofthisClassRuling).

Supplies of specifically designed spare parts with labour services

23. WhereaspecificallydesignedsparepartissuppliedtogetherwithalabourcomponentthatisnotGST-freebyitself,theGSTtreatmentwilldependonhowthesupplyischaracterised(seeparagraphs87to97ofthisClassRuling).

24. AsupplyisGST-freeifthedominantpartofthesupplyisthespecificallydesignedsparepartandthelabourismerelyintegral,ancillaryorincidentaltothesupplyofthesparepart.However,thesupplyistaxable1ifthedominantpartisthelabourandthesparepartismerelyintegral,ancillaryorincidentaltothelabour.

25. Ifthespecificallydesignedsparepartorthelabourisneitherintegral,ancillaryorincidentaltotheother,thesupply isamixedsupplythat ispartlyGST-free(thesparepart)andpartlytaxable(thelabour).

Appendix 1 Explanation

This Appendix is provided as information to help you understand how the Commissioners view has been reached. It does not form part of the binding public ruling.

26. Under the GST Act, some goods and services supplied by dentists are GST-free where certainrequirementsaresatisfied.

1 InthisClassRuling,whenasupplyisindicatedasbeingtaxableorpartlytaxable,itisassumedthatalltherequirementsforataxablesupplyundersection9-5aremet.

xxiThe Australian Schedule of Dental Services and Glossary


27. GSTispayableonsuppliesthataretaxablesuppliesbutnotonthosethatareGST-free.AdentistmayclaiminputtaxcreditsfortheGSTincludedinthepriceofthingsacquiredformakingtaxableorGST-freesuppliesorboth.

Taxable supplies section 9-5

28. Undersection9-5,anentitymakesataxablesupplyif:

itismadeforconsideration

itismadeinthecourseorfurtheranceofanenterprisethattheentitycarrieson

thesupplyisconnectedwithAustralia,and

theentityisregisteredorrequiredtoberegisteredforGST.

29. However,section9-5alsoprovidesthatasupplyisnottaxabletotheextentthatitisGST-freeorinputtaxed.

30. Forthepurposesofthisruling,theprovisionsoftheGSTActdealingwithinputtaxedsuppliesarenotrelevanttoanysuppliesmadeinthedentalindustry.TherelevantGST-freeprovisionsoftheGSTActareconsideredbelow.

GST- free supplies under section 38-7

Medical services subsection 38-7(1)

31. Subsection38-7(1)states:

Asupplyofa*medicalserviceisGST-free.

32. Medicalserviceisdefinedinsection195-1tomean:

(a)aserviceforwhichamedicarebenefitispayableunderPartIIoftheHealth Insurance Act 1973; or

(b)...(thispartofthedefinitionisnotrelevanttodentalservices)

33. Somedentalservices(includingrepairsofdentalgoods)arelistedintheMedicareBenefitsSchedule.ForadentalservicetobeGST-freeundersubsection38-7(1),amedicarebenefitmustbepayableforthatservice2.

34. Whereadental service is listed in theMedicareBenefitsSchedulebutamedicarebenefit isnotpayablebecausecertainothercriteriaarenotmet,thedefinitionofmedicalserviceisnotsatisfied.Forexample,amedicarebenefitisnotpayableforasupplyofadentalservicetoanon-residenteventhoughthatserviceislistedintheMedicareBenefitsSchedule.Inthesecircumstances,whetherthedentalserviceisGST-freeornotneedstobeconsideredundersection38-10.

GST-free supplies under section 38-10

Dental services subsection 38-10(1)


AsupplyisGST-free if:

(a)it is a service of a kind specified in the table in this subsection, or of a kind specified in theregulations;and

(b)thesupplierisa*recognisedprofessionalinrelationtothesupplyofservicesofthatkind;and

2 Theexceptioninsubsection38-7(2)doesnotapplytotheitemsreferredtointheScheduleinAttachmentAtothisClassruling.Subsection38-7(2)providesthatasupplyofamedicalserviceisnotGST-freeundersubsection38-7(1)ifitisasupplyofaprofessionalservicerenderedinprescribedcircumstanceswithinthemeaningofregulation14oftheHealthInsuranceRegulationsthataremadeundertheHealthInsuranceAct1973(otherthantheprescribedcircumstancessetoutinregulations14(2)(ea),(f)and(g).


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(c)thesupplywouldgenerallybeaccepted,intheprofessionassociatedwithsupplyingservicesofthatkind,asbeingnecessaryfortheappropriatetreatmentofthe*recipientofthesupply.

36. AllthreeoftherequirementsmustbesatisfiedforasupplyofdentalservicestobeGST-freeunderthiscategory.

Paragraph 38-10(1)(a)

Are dental services specified in the table or the regulations?

37. Dentalisaservicespecifiedatitem6inthetableinsubsection38-10(1).

Paragraph 38-10(1)(b)

Who is a recognised professional in relation to the supply of dental services?

38. Section195-1definesrecognisedprofessionaltomeanthefollowing:

Apersonisarecognisedprofessional,inrelationtothesupplyofaserviceofkindspecifiedinthetableinsubsection38-10(1),if:

(a)theserviceissuppliedinaStateorTerritoryinwhichthepersonhasapermissionorapproval,orisregistered,undera*Statelawora*Territorylawprohibitingthesupplyofservicesofthatkindwithoutsuchpermission,approvalorregistration;or

(b)theservice is supplied inaStateorTerritory inwhich there isnoState laworTerritory lawrequiringsuchpermission,approvalorregistration,andthepersonisamemberofaprofessionalassociationthathasuniformnationalregistrationrequirementsrelatingtothesupplyofservicesofthatkind;or

(c)inthecaseofservicescoveredbyitem3inthetabletheserviceissuppliedbyanaccreditedserviceproviderwithin themeaningof section4of theHearing Services Administration Act 1977.

39. InallStatesandTerritories,dentistsarerequiredtoberegisteredpursuanttotherelevantStateorTerritoryAct.Accordingly,apersonwhoisregisteredpursuanttotheStateorTerritoryActwillbeconsideredtobearecognisedprofessionalindentalservicespursuanttoparagraph195-1(a).

Paragraph 38-10(1)(c)

40. To satisfy this requirement, the servicemust generally be accepted in theprofession associatedwithsupplyingservicesofthatkind(inthiscase,thedentalprofession)asbeingnecessaryfortheappropriatetreatmentoftherecipientofthesupply.

What is appropriate treatment?

41. Adentistwillprovideappropriatetreatmenttothepatientifthedentistassessesthepatientsstateofhealthanddeterminesaprocessforpreserving,restoringorimprovingthephysicalorpsychologicalwellbeingofthatpatient.Appropriatetreatmentincludesanysubsequentservicesprovidedtothepatientaspartofthatprocess.

42. Appropriate treatment also includesmedical treatment of a preventative nature, for example, aperiodicoralexaminationwherethereisnoevidenceofanailmentpriortoattendance.However,thisdoesnotextendtothesupplyofservicesandgoodsinrelationtocustomisedmouthguards.Whilstacustomisedmouthguardisadevicethatmaypreventorreducedamagesustainedtothemouthandteethintheeventofaninjury,itisnotconsideredtobetreatmentthatisperformedonapatient.

43. TobeGST-free, thedentalprofessionmustaccept that theservice isnecessaryandacceptabletreatment,takingintoaccountthepatientsindividualcircumstances.

xxiiiThe Australian Schedule of Dental Services and Glossary


44. Servicesprovidedinassessingapatientfor insuranceor litigationpurposes,that is,medico-legalservices,arenotnecessaryfortheappropriatetreatmentofthepatientandarenotGST-free.

45. Serviceswhicharepredominantlyfortheimprovementoftheappearanceofthepatientarealsonotnecessaryfortheappropriatetreatmentofthepatientandtherefore,arenotGST-free.

46. Servicesthatareintendedtoimprovethehealthofthepatientbutwhichalsocompriseacosmeticcomponent,forexample,reconstructionofabadlydamagedtooth,arenecessaryfortheappropriatetreatmentofthepatientandaretherefore,GST-free.

47. Amodificationtoadentureorotherapplianceundertakenforthechangingconditionofthepatientisappropriate treatmentof thatpatientand isGST-free if suppliedbyadentist toapatient.Thechangingconditionofthepatientwillincludesituationssuchas:

anadditiontothedenturewherethepatienthashadatoothextracted;or

amodificationoradjustmenttoadentureduetoachangeintheshapeorstructureofapatientsmouth,palate,gumsorjaw.

48. ServicesfordeterminingthatamodificationisrequiredandanysubsequentservicestoensurethatthedenturefitscorrectlyarealsoGST-freeiftheelementsofsection38-10aresatisfied.

Who is the recipient of the supply?

49. Paragraph 38-10(1)(c) requires that the supply must be generally accepted in the professionassociatedwithsupplyingservicesofthatkindasbeingnecessaryfortheappropriatetreatmentoftherecipientofthesupply.

50. Asonlyan individualcan receive treatmentasapatient, the recipientof thesupplymustbeanindividualforthesupplytobeGST-freeundersection38-10.

Supply of dental services under arrangements with third parties

51. In some cases, dentists will have agreements with third parties under which there is a bindingobligationonthedentisttoprovidesomethingtothepatientforwhichthethirdpartyisliabletopay.Inthesecases,thethirdpartyistherecipientofthesupply.Dependingontheparticularagreement,thedentistmaybemakingsuppliestothepatientaswellasthethirdparty3.

52. Intheabsenceofabindingobligation,theremaystillbeasupplybythedentisttothethirdpartywherethefollowingfactors4arepresent:

(a)thereisapre-existingframeworkoragreementbetweenthethirdpartyandthedentistwhichcontemplatesthatthepartiesactinaparticularmannerinrespectofsuppliesbythedentisttoparticularpatientsoraclassofpatients;

(b)thepre-existingframeworkoragreement:

(i) identifiesamechanismbywhichtheparticularpatientsor theclassofpatientsare tobeidentifiedsuchthatthesuppliesmadetothemcomewithinthescopeoftheframeworkoragreement;and

(ii) specifiesthatthethirdpartyisunderanobligationtopaythedentistifthereisarelevantsupplybythedentisttoapatientandalsosetsoutamechanismbywhichsuchpaymentisauthorised;

3 Seeforexample,thecaseofFederal Commissioner of Taxation v Secretary to the Department of Transport (Vic) [2010] FCAFC84;2102ATC20-196.

4 Seeparagraph221BofGSTR2006/9butnotethedifferenceinterminology.Here,thirdpartyisusedinsteadofpayer,dentistisusedinsteadofsupplierandpatientisusedinsteadofthirdparty.


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(c)theframeworkoragreementandthemechanismforauthorisingthepaymentareinexistencebeforethesupplybythedentisttothepatient(thatis,thedentistknowsinadvancethatthethirdpartyisobligedtopaysomeoralloftheconsiderationintheeventofthesupplytothepatient);

(d)thedentistmakesthesupply to thepatient inconformitywith thepre-existing frameworkoragreementbetweentheparties;and

(e)the obligationof the thirdparty tomakepayment pursuant to thepre-existing frameworkoragreementisnotanadministrativearrangementtopayonbehalfofthepatientforaliabilityowedbythepatienttothedentist.Rather,oncethesupplybecomesasupplytowhichtheframeworkoragreementapplies,theframeworkoragreementestablishesaliabilityowedbythethirdparty(notthepatient)tothedentistintheeventthatthereisasupplybythedentisttothepatient.

53. Undersection38-60,wherethethirdparty isan insurer,anoperatorofastatutorycompensationschemeorcompulsorythirdpartyscheme(schemeoperator),oranAustraliangovernmentagency,thesupplytothethirdpartybythedentistisGST-freetotheextentthattheunderlyingsupplyofthedentalservicetothepatientisaGST-freesupplyundersection38-10or38-7.

54. Undersubsection38-60(4),thedentistandthethirdpartycanagreethatthesupplynotbetreatedasGST-free.ThedentistandthirdpartymaychoosetonottreatsuppliesasGST-freewhere,forexample,thereisacombinationofGST-freeandtaxablesuppliesanddeterminingtheamountsforeachsupplymaybecomplex.TheoptionofnottreatinganyofthesuppliesasGST-freemaybeadministrativelyeasierfortheparties.

55. Whereathirdpartyisnotaninsurer,aschemeoperatororanAustraliangovernmentagency,thesupplytothethirdpartyisnotaGST-freesupplyundersection38-60.

Example 1 Supply of health services by a dentist to an insurer

56. ABC Health Fund has a pre-existing agreement with a dentist for the supply of goods and services to settle claims made under their insurance policies.

57. The agreement outlines what both parties need to do when the dentist treats an ABC Health Fund member. Under the agreement, the payment to the dentist from ABC Health Fund is for the supply made by the dentist to ABC Health Fund for supplying dental treatment to the ABC Health Fund member.

58. As the supply of the dental treatment to the ABC Health Fund member is a GST-free supply under section 38-10, the supply by the dentist to ABC Health Fund is GST-free under section 38-60.

Example 2 Supply of health services by a dentist to a third party not being an insurer, a scheme operator or an Australian government agency

59. XYZ Company contracts with a dentist to provide dental treatment to its employees. XYZ Company is not an insurer, a scheme operator or an Australian government agency.

60. XYZ Company is the recipient of the supply of professional services from the dentist. If the dentist is registered for GST, the supply of the services is a taxable supply.

61. Section 38-60 does not apply in this scenario to make the supply to the third party GST-free because XYZ Company is not an insurer, a scheme operator or an Australian government agency.

Supplies paid for by someone other than the patient

62. Underothertypesofarrangements,athirdpartymeetsthepatients liabilitytothedentistwithoutasupplybeingmadetothethirdpartybythedentist.Afeatureofthesearrangementsisthattheagreementforthesupplyofgoodsorservicesisbetweenthedentistandthepatientandtheobligationtopayforthatsupplyremainswiththepatient.Thethirdpartymerelypaysforthesupplyonbehalfofthepatient.

xxvThe Australian Schedule of Dental Services and Glossary


63. Whopays for a supplyof services is not relevantwhenworkingout if the supply isGST-free. Iftherecipientofthesupplyisthepatient,itdoesnotmatterthatthesupplyisbeingpaidforonthepatientsbehalfbyathirdparty5.

Example 3 The third party merely pays for the supply of dental treatment on a patients behalf

64. Jenny is a dentist who is a recognised professional for GST purposes. Adam makes an appointment to see Jenny. At the initial consultation, Adam tells Jenny that he sustained damage to his tooth whilst at work and that she can bill his employer for the costs. Jenny confirms with Adams employer that she can send the bill to them.

65. Jenny does not have a pre-existing agreement or a binding obligation with Adams employer to provide the treatment to Adam.

66. Jenny is making a GST-free supply to Adam which is paid for by Adams employer. Jenny is not making any supply to Adams employer they are merely paying the bill on Adams behalf. The fact that another entity pays for the service does not alter its GST-free status.

67. GoodsandServicesTaxRulingGSTR2006/9(Supplies),atparagraphs114-246,providesdetailedguidanceinanalysingthirdpartyarrangementsfordeterminingwhotherecipientofasupplyis.

Dental goods subsections 38-7(3) and 38-10(3)

68. If a dentist supplies goods as part of aGST-free service, those goods are alsoGST-free undersubsection38-7(3)or38-10(3)iftheyaresuppliedtothepatientinthecourseofsupplyingadentalserviceandthesupplyismadeatthepremisesatwhichtheserviceissupplied.

69. Thephraseinthecourseofsupplyingmeansthatthegoodsaresuppliedatthesametimeasthedentalserviceandtheyare:

individuallycustomisedormanipulatedforthetreatmentoftheillnessordisabilityofthatparticularpatient;or

essentialfortreatingthatpatientduringthatparticularconsultation.

Supplies of medical aids and appliances under section 38-45

Medical aids and appliances subsection 38-45(1)


AsupplyisGST-free if:

(a)itiscoveredbySchedule3(medicalaidsandappliances),orspecifiedintheregulations;and

(b)thethingsuppliedisspecificallydesignedforpeoplewithanillnessordisability,andisnotwidelyusedbypeoplewithoutanillnessordisability.

71. Asupplythatsatisfiesalltherequirementsinsubsection38-45(1)isGST-free.ThesupplyisGST-freenomatterwhomakesthesupplyorwhothesupplyismadeto.

72. Indeterminingwhetheramedicalaidorapplianceisspecificallydesignedforpeoplewithanillnessordisability,referenceshouldbemadetoitsfeaturesandthedesignersormanufacturersintentionofhowthegoodistobeused.Indicatorsofthedesignersormanufacturersintentionofhowthegoodistobeusedincludehowthegoodismarketedandthetypeofretailoutletsatwhichthegoodscanbepurchased.

5 Subsection9-15(2).


xxvi


73. Indeterminingwhether amedical aidor appliance iswidely usedbypeoplewithout an illnessordisability, reference shouldbemade to how thewider community uses thesegoods. That is, thecommon purpose for which the goods are purchased. Subsection 38-45(1) does not require themedicalaidorappliancetobeusedinaparticularwaybutratherfocusesonthepurposeforwhichthewidercommunitypurchasestheseproducts.IrregularoruncommonuseofamedicalaidorapplianceinawaycontrarytoitsmanufacturedpurposedoesnotpreventthegoodfrombeingGST-free.

74. TheitemsinthetableinSchedule3totheGSTActthatareofrelevancetothedentalindustryare:

item29customisedtoothbrushesforpeoplewithdisabilities

item30denturesandartificialteeth,and

item75mandibularadvancementsplints.

75. For GST purposes, customised toothbrushes for people with disabilities are considered to betoothbrushesthathavebeenadapted,forexample,contoured,tosuittheneedsofaclassofdisabledpersons.

76. Dentures forGSTpurposes,areconsideredtobeanartificial restorationofseveral teeth (partialdenture)oralloftheteethofeitherjaw(fulldenture).Artificialteethareconsideredtobethosewhicharefabricatedandreplacenaturalteethinformandfunction.Thephraseartificialteethincludesasingletoothaswellasmultipleteeth.Fullcrownsandbridgesareartificialteeth.

77. Amandibularadvancementsplintisasmalldevicemadeofplasticorsimilarmaterialthatisworninthemouthwhilstsleeping(similarinappearancetoamouthguard).Itisdesignedtohelpstopsometypesofsnoring.Thesplint isdesignedtopushthemandible(lower jaw)forwardhelpingtokeepthetongueclearofthepharynx(thebackofthethroat).Thesplintsarealsosometimesusedforthetreatmentoftemporomandibularjointdisorder(TMJ).

Consumables

78. Where,inthecourseofsupplyingoneoftheproductslistedatitem28,item30oritem75inthetableinSchedule3,adentistconsumesvariousthings,thereisonlyoneoverallsupplyofthelisteditem.ThingsmadeandconsumedintheprocessofconstructingandsupplyingalisteditemformpartoftheoneoverallGST-freesupplyofthatproduct,evenifthecomponentsareseparatelyitemisedinthebill.

79. ExamplesofthingsconsumedintheprocessofconstructingandsupplyingaGST-freemedicalaidorapplianceincludeoil,lubricant,glueandgenericpartslikescrewsandwires.Consumableitemsareacquiredwith the intention that theywillbedestroyed,consumedorexpended.Theydonotretaintheirindividualcharacterornaturewhenanewmedicalaidorapplianceissuppliedorwhenarepairedmedicalaidorapplianceisreturnedtoitsowner.

80. However,wherethesethingsaresuppliedseparatelytothemedicalaidorappliance,theyareonlyGST-freeiftheyarespecificallydesignedsparepartsofthatmedicalaidorappliance(seeparagraphs82to84ofthisClassRuling).

Example 4 Goods used or consumed in the process of constructing and supplying a GST-free medical aid or appliance

81. Steve (a dentist) contracts Mike (a dental technician) to make a crown for Steves patient. In order to make the crown, Mike must first create a plaster model. Mike itemises the crown and plaster model separately on his bill to Steve. The plaster model is integral to the manufacturing process and is not used for any other purpose. The plaster model forms part of the overall supply of the crown, all of which is GST-free. Goods made and consumed in the process of constructing and supplying a GST-free medical aid or appliance form part of the overall GST-free supply of that item.

xxviiThe Australian Schedule of Dental Services and Glossary


Spare parts for GST-free medical aids and appliances subsection 38-45(2)

82. Undersubsection38-45(2),asparepartforaGST-freemedicalaidorapplianceisalsoGST-freeifisspecificallydesignedasasparepartforthatGST-freemedicalaidorapplianceandissuppliedforthatpurpose.

83. ForGSTpurposes,asparepartisapartthatcanbeusedtoreplaceafaulty,wornorbrokenpartofanotherthing.Thepartneedonlybecapableofreplacingthefaulty,wornorbrokenpart.Itdoesnotactuallyhavetobeusedforthatpurpose.

84. Sparepartsthatarenotspecificallydesignedtoreplaceafaulty,wornorbrokenpartofaGST-freemedicalaidorappliancearenotGST-free.Thismeans that things likegenericscrewswhicharenot specifically designed for aGST-freemedical aid or appliance are notGST-free spare parts.However,asexplainedinparagraphs78to80ofthisClassRuling,thingsusedandorconsumedintheconstructionandoverallsupplyofaGST-freemedicalaidorappliancearepartofthatoverallGST-freesupply.Therefore,whilstagenericscrewwhensuppliedonitsownisnotaGST-freesparepartforadenturebecauseitisnotspecificallydesignedforthatpurpose,itwouldbeGST-freeifthatscrewformedpartofthesupplyofthedenture.

Example 5 A part that cannot be used as a spare part for a GST-free medical aid or appliance

85. A chrome/cobalt casting frame is the internal framework for a denture. Dentures are covered by item 30 in the table in Schedule 3 and are GST-free. Whilst the framework is a component for a denture, it is not a spare part for a denture. This is because if the framework is broken, it is either repaired or a completely new denture is supplied. A new framework is never actually supplied to replace a faulty, worn or broken framework of the denture. Therefore, it is not a GST-free spare part.

Repair services

86. OtherthanrepairsofdentalgoodswhichmaybeGST-freeundersection38-7(seeparagraphs31to34above),thereisnospecificexemptionintheGSTActforthesupplyofrepairsofmedicalaidsorappliancesortheirspareparts.

Supply of spare parts with labour services

87. Where the specifically designed spare parts are supplied togetherwith a labour component (forexample,installationorfittingservice)thatisnotGST-free,theGSTtreatmentwilldependonhowthesupplyischaracterised.Thetablebelowprovidesasummaryofhowthesupplymaybecharacterised.

What is the character of the supply?

Type Dominant component

Integral, ancillary or incidental component

GST outcome

A Specificallydesignedspareparts

Labour AsinglecompositeGST-freesupplyofspecificallydesignedspareparts

B Labour(notGST-free)

Specificallydesignedspareparts

Asinglecompositetaxablesupplyoflabour

C Separatelyidentifiablesuppliesofsparepartsandlabour

Neitherisintegral,ancillaryorincidentaltotheother

ApartlytaxableandpartlyGST-freesupply(amixedsupply).ThetaxablecomponentisthelabourandtheGST-freecomponentisthespecificallydesignedsparepart.Areasonablebasismustbeusedforapportionment


xxviii


What does integral, ancillary or incidental mean?

88. Indicators6thatapartofasupplyisintegral,ancillaryorincidentaltothedominantpartofthesupplyincludethefollowing:

itrepresentsamarginalproportionofthetotalvalueofthepackagecomparedtothedominantpart

itisnecessaryorcontributestothesupplyasawholebutcannotbeidentifiedasthedominantpartofthesupply

itcontributestotheproperperformanceofthecontracttosupplythedominantpart,and

asupplierwouldreasonablyconcludethatitdoesnotconstituteforcustomersanaiminitselfbutisameansofbetterenjoyingthedominantthingsupplied.

Example 6 GST-free supply of spare parts to which labour is integral, ancillary or incidental

89. A tooth is fitted to a denture to replace a broken or missing tooth under a supply and fit contract. The supply of the tooth itself is GST-free under section 38-7 or section 38-10. The fitting of the tooth is merely integral, ancillary or incidental to the supply of the tooth. The fitting of the tooth and the supply of the tooth is a single composite GST-free supply of an artificial tooth. SeeTypeAinthetableinparagraph87ofthisClassRuling.

Example 7 Taxable supply of labour to which the spare parts are integral, ancillary or incidental

90. A denture is in poor condition and is sent to be restored which involves a significant amount of labour. The restoration service is not GST-free under section 38-7 as no medicare benefit is payable for the service. As part of that restoration, a clasp is replaced. Of itself, the clasp is a GST-free spare part for a denture under subsection 38-45(2). However, in this case, the supply of the clasp is integral, ancillary or incidental to the supply of the restoration service which is not GST-free. The supply of the clasp merely contributes to the proper performance of the contract to restore the denture, takes up a marginal proportion of the total value of the service package, and the customer does not seek the supply of the clasp as an aim in itself, but merely as part of the supply of the restoration service. The supply of the restoration service and the spare part is a single composite taxable supply. SeeTypeBinthetableinparagraph87ofthisClassRuling.

Example 8 Partly taxable and partly GST-free supply of spare parts and labour as neither component is integral, ancillary or incidental to each other

91. A tooth is added to a denture to replace a broken or missing tooth under a supply and fit contract. At the same time, a small crack which is discovered in the denture base is repaired. This repair service is not GST-free under section 38-7 as no medicare benefit is payable for the service. An extra charge is made for the repair of the crack. Neither the repair of the crack nor the fitted tooth is integral, incidental or ancillary to each other. The fitted tooth part of the supply is GST-free under section 38-10 and the repair part is taxable. The supply is partly taxable and partly GST-free. SeeTypeCinthetableinparagraph87ofthisClassRuling.

Apportionment

A supply that is partly taxable and partly GST-free

92. WhereadentistmakesasupplywhichispartlytaxableandpartlyGST-free(amixedsupply),thedentistwillneedtoapportiontheconsiderationchargedforthesupplybetweentheGST-freeandtaxablepartspursuanttosection9-80.

6 SeeGoodsandServicesTaxRulingGSTR2001/8forfurtherguidanceindeterminingwhetherapartofasupplyisintegral,ancillaryorincidentaltothedominantpartofthesupply.

xxixThe Australian Schedule of Dental Services and Glossary


93. Areasonablebasisforapportionmentmustbeusedandeachcasemustbedeterminedonitsownfacts.Recordsmustbekeptthatexplainthemethodofapportionmentused.GoodsandServicesTaxRulingGSTR2001/8givesfurtherguidanceonmixedsuppliesandapportionment.

94. As ameans ofminimising compliance costs, part of a supplymay be treated as being integral,ancillaryorincidentaltotheotherpartiftheconsiderationthatwouldbeapportionedtoit(ifitwerepartofamixedsupply)doesnotexceedthe lesser of:

$3.00;or

20%oftheconsiderationofthetotalsupply.

95. Thisapproachmaybeadoptedtotreatasupplyasacompositesupply(thatis,eitherwhollyGST-freeortaxable),althoughitmightotherwisebeconsideredasamixedsupply.However,iftheconsiderationforapartexceedsthelesserof$3.00or20%oftheconsiderationforthetotalsupply,itdoesnotnecessarilymeanthatthepartisnotintegral,ancillaryorincidental.

Charging GST on a GST-free medical aid or appliance or a specifically designed spare part

96. Insomecircumstances,itmaybedifficulttodeterminethosesuppliesthatareGST-freeandthosethataretaxable.

97. Subsection38-45(3)allowsasupplierand recipient toagreenot to treatsupplies,oraparticularsupply, asGST-free. For example, if a supply of amedical aid or appliance ismade to anotherbusiness,bothbusinessescanagreetotreatthesupplyastaxable.


xxx

Schedule of Dental Services and Glossary

Diagnostic Services

Examinations

Onlyoneoftheitemnumbers011-017maybeusedatonevisit.

011 Comprehensive oral examination

012 Periodic oral examination

013 Oral examination limited

014 Consultation

015 Consultation extended (30 minutes or more)

016 Consultation by referral

017 Consultation by referral extended (30 minutes or more)

018 Written report (not elsewhere included)

019 Letter of referral

011 Comprehensive oral examination #

Evaluation of all teeth, their supporting tissues and the oral tissues in order to record theconditionofthesestructures.Thisevaluationincludesrecordinganappropriatemedicalhistoryandanyotherrelevantinformation.

012 Periodic oral examination

Anevaluationperformedonapatientofrecordtodetermineanychangesinthepatientsdentalandmedicalhealthstatussinceapreviouscomprehensiveorperiodicexamination.

013 Oral examination limited

Alimitedoralproblem-focussedevaluationcarriedoutimmediatelypriortorequiredtreatment.This evaluation includes recording an appropriate medical history and any other relevantinformation.

014 Consultation #

Aconsultationtoseekadviceordiscusstreatmentoptionsregardingaspecificdentalororalcondition.Thisconsultation includes recordinganappropriatemedicalhistoryandanyotherrelevantinformation.

015 Consultation extended (30 minutes or more) #

An extended consultation to seek advice or discuss treatment options regarding a specificdentalororalcomplaint.Thisconsultation includes recordinganappropriatemedicalhistoryandanyotherrelevantinformation.

016 Consultation by referral #

A consultation with a patient referred by a dental or medical practitioner for an opinionormanagement of a specific dental disorder. The consultationmay not necessarily bewitha specialist. The referringpractitioner shouldbeprovidedwitha report from theconsultant,includedwithintheitemnumber.

1The Australian Schedule of Dental Services and Glossary

Diagnostic Services

017 Consultation by referral extended (30 minutes or more) #

An extended consultation with a patient referred by a dental or medical practitioner for anopinionormanagementofaspecificdentaldisorder.Theconsultationmaynotnecessarilybewithaspecialist.Thereferringpractitionershouldbeprovidedwithareportfromtheconsultant,includedwithintheitemnumber.

018 Written report (not elsewhere included) T

Awrittenreportnotaddressedtoareferringpractitionerinvolvedinthepatientscare.

019 Letter of referral #

A letter from a dentist referring a patient to another practitioner and providing appropriateinformationtotheconsultant.

Radiological Examination and Interpretation

Radiographicitemisationalsoappliestodigitisedimagesperexposure.

022 Intraoral periapical or bitewing radiograph per exposure

025 Intraoral radiograph occlusal, maxillary, mandibular per exposure

031 Extraoral radiograph maxillary, mandibular per exposure

033 Lateral, antero-posterior, postero-anterior or submento-vertex radiograph of the skull per exposure

035 Radiograph of temporomandibular joint per exposure

036 Cephalometric radiograph lateral, antero-posterior, postero-anterior or submento-vertex per exposure

037 Panoramic radiograph per exposure

038 Hand-wrist radiograph for skeletal age assessment

039 Tomography of the skull or parts thereof

022 Intraoral periapical or bitewing radiograph per exposure #

Takingandinterpretingaradiographmadewiththefilminsidethemouth.

025 Intraoral radiograph occlusal, maxillary, mandibular per exposure #

Takingandinterpretinganocclusal,maxillaryormandibularintraoralradiograph.Thisradiographshowsamoreextensiveviewofteethandmaxillaryormandibularbone.

031 Extraoral radiograph maxillary, mandibular per exposure #

Takingandinterpretingaradiographoftheupperand/orlowerjawusingafilmplacedoutsidethemouth:forexample,obliquelateralradiograph.

033 Lateral, antero-posterior, postero-anterior or submento-vertex radiograph of the skull per exposure #

Takingandinterpretinganextraoralradiographoftheheadtakenfromtheside,thefront,thebackorthroughthevertexoftheskull.Nocephalostatisused.

035 Radiograph of temporomandibular joint per exposure #

Takingandinterpretingaradiographofthetemporomandibularjoint.

2 Australian DentalAssociation Incorporated

Diagnostic Services

036 Cephalometric radiograph lateral, antero-posterior, postero-anterior or submento-vertex per exposure #

Takingand interpretinga radiographof thehead taken from theside, the front, thebackorthroughthevertexoftheskull,forthepurposeofmeasurementandanalysis.Acephalostatisusedtostandardisetheconditionsofimaging.

037 Panoramic radiograph per exposure #

Takingandinterpretinganextraoralradiographpresentingapanoramicviewofpartorallofthemandibleand/ormaxillaand/oradjacentstructures.

038 Hand-wrist radiograph for skeletal age assessment #

Takingandinterpretingaradiographofthewristbones,usedtoassessthedegreeofskeletaldevelopmentandmaturity.

039 Tomography of the skull or parts thereof #

AradiographismadeofaregionusingtomographicX-rayequipmentthatmayproduceaseriesofdiagnosticimagesAcephalostatmaybeusedtostandardisetheconditionsofimaging.


Diagnostic Services

Other Diagnostic Services

041 Bacteriological examination

042 Culture examination and identification

043 Antibiotic sensitivity test

044 Collection of specimen for pathology examination

047 Saliva screening test

048 Bacteriological screening test

051 Biopsy of tissue

052 Histopathological examination of tissue

053 Cytological investigation

054 Mucosal screening

055 Blood sample

056 Haematological examination

061 Pulp testing per visit

071 Diagnostic model per model

072 Photographic records intraoral

073 Photographic records extraoral

074 Diagnostic wax-up

081 Cephalometric analysis excluding radiographs

082 Tooth-jaw size prediction analysis

083 Tomographic analysis

085 Electromyographic recording

086 Electromyographic analysis

041 Bacteriological examination

Anexaminationforbacteriaorothermicroorganismsinsamplesobtainedfromthepatient.

042 Culture examination and identification

Asample is takenfromoralmaterialand isculturedforexaminationand identificationof themicroorganismspresent.

043 Antibiotic sensitivity test

Alaboratoryprocedurewherealivecultureofasuspectedpathogenischallengedwithantibioticsamplestodeterminethesensitivityorresistanceofthemicroorganismstotheantibioticstested.

044 Collection of specimen for pathology examination

Thenon-surgicalcollectionandpreparation for transportofaspecimenforexaminationatapathologylaboratory.

047 Saliva screening test

Takingandtestingasalivasampletoassessitsphysiologicalproperties.


Diagnostic Services

048 Bacteriological screening test

Takingandtestingasampletoassessitsphysiologicalproperties.

051 Biopsy of tissue

Asurgicalproceduretoobtainasectionoftissueforpathologicalexamination.

052 Histopathological examination of tissue

Ahistopathologicalexaminationtodeterminethediseasestatusofasectionoftissue.

053 Cytological investigation

Amicroscopicexaminationofcellsobtained fromasmearor in situ stainingofasuspectedlesion todetermineanyaberrant characteristics thatmaysuggest the lesion ismalignantorrelatedtosomeothercondition.

054 Mucosal screening

Anon-invasivetestforscreeningoforalmucosafororalcancerandorotherconditions.Mayinvolvestaining,specialisedlightorfluorescencetechniques.

055 Blood sample

Thecollectionofasuitablesampleofbloodforhaematologicalexamination.

056 Haematological examination

Theexaminationandreportingofthestatusofabloodsample.

061 Pulp testing per visit

Anon-invasivetestusedtodeterminetheclinicalstatusofthepulp.Itinvolvestheapplicationofexternalstimulationtothepulptodetermineitsresponse.Otherteetharegenerallytestedforcomparison.Thisprocedureshouldonlybeitemisedonceforeachvisitwhenpulptestingisperformed.

071 Diagnostic model per model #

Thepreparationofamodel,fromanimpression.Themodelisusedforexaminationandtreatmentplanningprocedures.Thisitemshouldnotbeusedtodescribeaworkingmodel.

072 Photographic records intraoral #

Photographsand/orprinteddigitisedimagesshowingstructuresinsidethemouthassociatedwithdentaldiagnosisorclinicalprocedure.Theseimagesshouldnotbeconfusedwithdigitisedradiographicimages.

073 Photographic records extraoral #

Photographsand/orprinteddigitisedimagesshowingthefaceoraregionoftheheadandneckoutsidethemouth,associatedwithdentaldiagnosisorclinicalprocedure.Theseimagesshouldnotbeconfusedwithdigitisedradiographicimages.

074 Diagnostic wax-up #

Thepreparationandwaxingupofdiagnosticmodelstofacilitatethedevelopmentofatreatmentplan.

081 Cephalometric analysis excluding radiographs #

Theanalysisofacephalometric radiograph (item036)bymeasurementofspecificbiologicallandmarksinordertodetermineandpredictpatternsofdevelopmentofthecranio-maxillofacialgrowthcomplex.Theprocedureisoftenemployedinorthodonticdiagnosis.


Diagnostic Services

082 Tooth-jaw size prediction analysis #

Theanalysisofrecords,includingradiographsandcasts,topredicttherelationshipbetweentheanticipatedsizeofthemandible,themaxillaandtheteeththeseboneshavetoaccommodate.

083 Tomographic analysis #

Theanalysisofatomograph(item039)bymeasurementofspecificbiologicallandmarks.Theprocedureisoftenemployedintreatmentplanningforimplantandothersurgicalprocedures.

085 Electromyographic recording #

Utilisationofelectronicapparatustodetectandrecordsensitivityoftheorofacialandassociatedmusculature.

086 Electromyographic analysis #

Theanalysisofelectromyographicrecordingsoftheorofacialandassociatedmusculature.


Preventive, Prophylactic and Bleaching Services


Dental Prophylaxis and Bleaching

111 Removal of plaque and/or stain

113 Recontouring and polishing of pre-existing restoration(s)

114 Removal of calculus first visit

115 Removal of calculus subsequent visit

116 Enamel micro-abrasion per tooth

117 Bleaching, internal per tooth

118 Bleaching, external per tooth

119 Bleaching, home application per arch

111 Removal of plaque and/or stain #

Removalofdentalplaqueand/orstainfromthesurfacesofall teeth.This itemis includedinproceduresdescribedbyitems114,115,281and282.

113 Recontouring and polishing of pre-existing restoration(s)

Thereshapingandpolishingofpre-existingrestorations.

114 Removal of calculus first visit

Removalofcalculusfromthesurfacesofteeth.

115 Removal of calculus subsequent visit

Thisitemdescribesproceduresinitem114when,becauseoftheextentordegreeofcalculus,anadditionalvisit(s)isrequiredtoremovedepositsfromtheteeth.

116 Enamel micro-abrasion per tooth

Thechemo-physicalremovalofdiscolouredand/orothersurfaceenameldefectsresultingfromdevelopmentaldefects,alteredmineralisationordecalcificationofthesuperficialenamellayer.

117 Bleaching, internal per tooth

Themodification of the colour of the discoloured crown of an endodontically treated toothusingchemicaland/orphysicalmethodsappliedinternally.Thisisaclinicalcourseoftreatmentcarriedoutexclusivelyinthesurgery.

118 Bleaching, external per tooth #

The modification of the colour of a tooth using chemical and/or physical methods appliedexternally.Thisisaclinicalcourseoftreatmentcarriedoutexclusivelyinthesurgery.

119 Bleaching, home application per arch #

Theprescribeduse,byapatientathome,ofacustom-madetrayfortheapplicationofbleachingmedicaments to the patients dentition. This procedure describes the complete course oftreatmentperarch.Forprovisionofthetrayandmedicaments,seeitems926and927.



Remineralisation Agents

121 Topical application of remineralisation and/or cariostatic agents, one treatment

122 Topical remineralisation and/or cariostatic agents, home application per arch

123 Concentrated remineralisation and/or cariostatic agents, application single tooth

121 Topical application of remineralisation and/or cariostatic agents, one treatment

Applicationofremineralisationand/orcariostaticagentstothesurfacesoftheteeth.Thismayincludeactivationoftheagent.Nottobeusedasanintrinsicpartoftherestoration.

122 Topical remineralisation and/or cariostatic agents, home application per arch

The prescribed use, by a patient at home, of a custom-made tray for the application ofremineralisationand/orcariostaticagentstothepatientsdentition.Thisproceduredescribesthecompletecourseoftreatmentperarch.Forprovisionofthetrayandmedicamentsorotherremineralisationagents,seeitems926and927.

123 Concentrated remineralisation and/or cariostatic agents, application single tooth

Aproceduretopromotecariesresistanceinaspecificsituation,involvingisolationandcontrolofthetargetareaandprolongedapplicationofaconcentratedfluorideorremineralisationand/or cariostatic agent. This includes necessary activation of the agent. Not to be used as anintrinsicpartoftherestoration.

Other Preventive Services

131 Dietary advice

141 Oral hygiene instruction

151 Provision of a mouthguard indirect

153 Bi-maxillary mouthguard indirect

161 Fissure and/or tooth surface sealing per tooth

165 Desensitising procedure per visit

171 Odontoplasty per tooth

131 Dietary advice

Analysisofandadviceonapatientsdiettocorrectanydietaryimbalancesordeficiencieswhichmaycontributetodentaldisease.

141 Oral hygiene instruction

Instructionintechniquesfortheremovalofbacterialplaque.Adviceofappropriatetoothpasteandmedicamentsmaybeincluded.

151 Provision of a mouthguard indirect T

Constructionofamouthguard,usingamodel(s)prepared froman impression(s)of the teethtakenbyorunderthesupervisionoftheclinicianandsubsequentlyinserted.



153 Bi-maxillary mouthguard indirect T

Constructionofabi-maxillarymouthguardusingmodelspreparedfromimpressionsoftheteethtakenbyorunderthesupervisionoftheclinicianandsubsequentlyinserted.

161 Fissure and/or tooth surface sealing per tooth

Sealingofnon-cariouspits,fissures,smoothsurfacesorcracks ina toothwithanadhesivematerial.Anypreparationpriortoapplicationofthesealantisincludedinthisitemnumber.

165 Desensitising procedure per visit

Thisitemdescribesalldesensitisingundertakenatasinglevisitandmayincludeaproceduretodiminishorabolishthepainfulsensitivityanddiscomfortwhichcanoccurinexposeddentine.

171 Odontoplasty per tooth

Astand-aloneproceduretomodifythecontourofthecrownofatoothortheanatomyofthefissureofatooth.


Periodontics

Periodontics

Proceduresdescribedinthissectionincludeinsertionofsutures,normalpost-operativecareandsutureremoval.

213 Treatment of acute periodontal infection per visit

221 Clinical periodontal analysis and recording

222 Root planing and subgingival curettage per tooth

231 Gingivectomy per tooth or implant

232 Periodontal flap surgery per tooth or implant

235 Gingival graft per tooth or implant

236 Guided tissue regeneration per tooth or implant

237 Guided tissue regeneration membrane removal

238 Periodontal flap surgery for crown lengthening per tooth

241 Root resection per root

242 Osseous surgery per tooth or implant

243 Osseous graft per tooth or implant

244 Osseous graft block

245 Periodontal surgery involving one tooth or implant

281 Course of non-surgical periodontal treatment

282 Continuation of periodontal treatment or maintenance subsequent to item 281

213 Treatment of acute periodontal infection per visit

Thisitemdescribesthetreatmentofacuteperiodontalinfection(s).Itmayincludeestablishingdrainageandtheremovalofcalculusfromtheaffectedtooth(teeth).

221 Clinical periodontal analysis and recording

Thisisaspecialexaminationperformedaspartofthediagnosisandmanagementofperiodontaldisease.Theprocedureconsistsofassessingandrecordingapatientsperiodontalcondition.

222 Root planing and subgingival curettage per tooth

Theprocessofplaningtherootsurfacetoremoveroughorcontaminatedcementumordentineandmayincluderemovalofcalculus,curettingthesofttissuesoftheperiodontalpocketandremovinggranulationtissue.Wherecalculusremovalisundertakenforotherteethatthesamevisit that do not require root planing it is appropriate to itemise 114/115 for these teeth inconjunctionwithbutseparatefromtheteeththathaveundergonerootplaning.

231 Gingivectomy per tooth or implant

Thesurgicalremovalofthesofttissuewalloftheperiodontalpocketortheremovalofswollen,excessgingivaltissue,Theprocedureincludestheremovalofcalculusandrootplaningofthetoothorimplant.

232 Periodontal flap surgery per tooth or implant

Incisionandraisingofaflapofgingivaltissuetoenableremovalofinflammatoryorgranulationtissue.Theprocedureincludestheremovalofcalculusandrootplaningofthetoothorimplant.


Periodontics

235 Gingival graft per tooth or implant

Transferenceor transplantinggingivalorothersoft tissue fromadonorarea in thepatientsmouthtoanareaaroundatoothorimplanttoremedyagingivaldeficiency.

236 Guided tissue regeneration per tooth or implant

Asurgicaltechniqueinwhichamembraneisadaptedoverabonydefect,thetoothrootoranimplant.

237 Guided tissue regeneration membrane removal

Surgicalproceduretoremoveapreviouslypositionedmembrane.

238 Periodontal flap surgery for crown lengthening per tooth

Involvesaflapproceduretoestablishamoreapicalgingivalmarginforgreaterexposureoftoothstructure,includingreshapingofalveolarbonewhererequired.

241 Root resection per root

Removaloramputationofoneormorerootsofamulti-rootedtoothwithorwithoutaportionofthecrown.

242 Osseous surgery per tooth or implant

Reshapingandmodifyingdefectsanddeformitiesinthebonesupportingandsurroundingthetoothorimplant.Thisincludesproceduresdescribedinitem232.Theprocedureincludestheremovalofcalculusandrootplaningofthetoothorimplant.

243 Osseous graft per tooth or implant

Asurgicalprocedureinwhichparticulatebone,asyntheticsubstituteorothermatrix,isusedtoreplace,repairoraugmentalveolarbone.Itmaybeusedtorepairabonydefectaroundatoothordentalimplant.Thisisinadditiontoitemnumberssuchas232,245and684.

244 Osseous graft block

Asurgicalprocedureinwhichablockofboneisusedforaugmentationofabonyridge,securedbyscrewsorsimilardevices.

245 Periodontal surgery involving one tooth or an implant

Surgical intervention to aid the resolution of a localised periodontal inflammatory conditioninvolvingonetoothoranimplant.Theitemisalsousedtodescribepericision.

281 Course of non-surgical periodontal treatment

(SeeNotesforguidancepageix)

Analternativesystemofcodingencompassingallvisitssubsequent toperiodontaldiagnosisandtreatmentplanningforthenon-surgicalphaseofperiodontaltreatment.Thisitemincludesallformsofnon-surgicaltreatmentandprecludesreferencetootherperiodontaltechniquesorservices intheSchedule.Non-periodontal relatedproceduresshouldbeseparately itemised.Anassessmentandtreatmentformtobeusedwiththisitemmayberequestedinadvanceoftreatment.Seespecimenformonpage12.

282 Continuation of periodontal treatment or maintenance subsequent to item 281

Maintenance subsequent to item 281 for non-surgical periodontal treatment. Radiographs,periodontalchartingandotherdiagnosticprocedures,andnon-periodontalrelatedproceduresshouldbeseparatelyitemised.


Periodontics

Periodontal Treatment Form for use with Items 281 and 282

Patientsname:.............................................................................................................................................

Address:.......................................................................................................................................................

.......................................................................................................................................................................

Practitionersname:.....................................................................................................................................

Address:.......................................................................................................................................................

.......................................................................................................................................................................

Contributorsname:.....................................................................................................................................

Address:.......................................................................................................................................................

.......................................................................................................................................................................

Datetreatmentcommenced:.......................................................................................................................

Anticipateddurationofactivetreatment:.....................................................................................................

Estimatedcostoftreatment:........................................................................................................................

Signed:.........................................................................................................................................................(Secretary)

.........................................................................................................................................................(Date)

Thisformmaybephotocopiedwhererequired.


Periodontics

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Oral Surgery

Oral Surgery

Proceduresdescribedinthissectionincludeinsertionofsutures,normalpost-operativecareandsutureremoval.

SomeproceduresinthissectionmayattractaMedicarerebateforapproveddentalpractitioners.It isnotappropriatepracticetousebothADAandMedicareitemnumberstodescribethesameprocedure.

Onlyoneitemnumbershouldbeusedtodescribeeachoralsurgeryprocedureonthesamedaybythesameoperator.

Extractions

311 Removal of a tooth or part(s) thereof

314 Sectional removal of a tooth or part(s) thereof

311 Removal of a tooth or part(s) thereof

Aprocedureconsistingoftheremovalofatoothorpart(s)thereof.

314 Sectional removal of a tooth or part(s) thereof

Theremovalofatoothorpart(s)thereofinsections.Boneremovalmaybenecessary.

Surgical Extractions

322 Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division

323 Surgical removal of a tooth or tooth fragment requiring removal of bone

324 Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division

322 Surgical removal of a tooth or tooth fragment not requiring removal of bone or tooth division

Removalofatoothortoothfragmentwhereanincisionandtheraisingofamucoperiostealflapisrequired,butwhereremovalofboneorsectioningofthetoothisnotnecessarytoremovethetooth.

323 Surgical removal of a tooth or tooth fragment requiring removal of bone

Removalofatoothortoothfragmentwhereremovalofboneisrequiredafteranincisionandamucoperiostealflapraised.

324 Surgical removal of a tooth or tooth fragment requiring both removal of bone and tooth division

Removalofatoothortoothfragmentwherebothremovalofboneandsectioningofthetootharerequiredafteran incisionandamucoperiostealflapraised.Thetoothwillberemoved inportions.


Oral Surgery

Surgery for Prostheses

331 Alveolectomy per segment

332 Ostectomy per jaw

337 Reduction of fibrous tuberosity

338 Reduction of flabby ridge per segment

341 Removal of hyperplastic tissue

343 Repositioning of muscle attachment

344 Vestibuloplasty

345 Skin or mucosal graft

331 Alveolectomy per segment

Thesurgicalmodificationoftheshapeofasegmentofthealveolarbone.

332 Ostectomy per jaw

Thesurgicalmodificationofthebonyarchitectureofthemaxillaormandible.

337 Reduction of fibrous tuberosity

Asurgicalprocedure involving removaloffibrous tissue fromtheposteriormaxillaryalveolarridgeinordertomodifytheridgecontour.

338 Reduction of flabby ridge per segment

Asurgicalprocedureinvolvingremovalofunsupportedsofttissuefromasegmentorquadrantofthemaxillaryormandibularalveolarridge.

341 Removal of hyperplastic tissue

Thesurgicalremovalofanareaofhyperplastictissuefromthemaxillaryormandibularalveolarridgeoradjacentmucosa.

343 Repositioning of muscle attachment

Thesurgicalrepositioningofamuscleattachmenttoplaceitinamorefavourableposition.

344 Vestibuloplasty

Thesurgicaldeepeningofthebuccalorlabialvestibuleinthemucosa.

345 Skin or mucosal graft

Asurgicalprocedureinvolvingaskinormucosalgraft.


Oral Surgery

Treatment of Maxillofacial lnjuries

351 Repair of skin and subcutaneous tissue or mucous membrane

352 Fracture of maxilla or mandible not requiring splinting

353 Fracture of maxilla or mandible with wiring of teeth or intraoral fixation

354 Fracture of maxilla or mandible with external fixation

355 Fracture of zygoma

359 Fracture of the maxilla or mandible requiring open reduction

351 Repair of skin and subcutaneous tissue or mucous membrane

Thesurgicalcleaningandrepairofafacialskinwoundintheregionofthemouthorjaws,ortherepairoforalmucousmembrane,wherethewoundsinvolvethesubcutaneoustissues.

352 Fracture of maxilla or mandible not requiring splinting

Conservative treatment of a fracture of the maxilla or mandible where there is no markeddisplacementormobilityofthefragments.Nophysicalreductionorfixationisrequired.

353 Fracture of maxilla or mandible with wiring of teeth or intraoral fixation

Treatmentofafractureofthemaxillaormandiblewhereinterdentalwiringortheapplicationofadentalsplintisindicatedtoprovidereductionandfixationofthefragments.Whereasplintisrequireditshouldbeitemised.

354 Fracture of maxilla or mandible with external fixation

Treatmentofafractureofthemaxillaormandibleusingsetsofpinsinsertedthroughtheskinandintothemaxillaryormandibularbonetoreduceandfixthefracture.Thepinsarelockedintoafirmrelationshipusingclampsandasupportingapparatus.

355 Fracture of zygoma

Treatmentofafractureofthezygoma.

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