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Dental Information Guide - Effective from 1 June 2015
Contents
Code and item guide
Incomplete metal dentures
Incomplete acrylic dentures
Item 1 - General examination time-bars Information notes relating to Item 1
Item 1 - Orthodontic examination time-bars Information notes relating to Item 1
Item 10 - Periodontal treatment time-bars Information notes relating to Item 10
Combination codes - General
Combination codes - Orthodontic
Free repair and replacement
Miscellaneous information Maximum patient charge Prior approval limit Payment dates Further help
3 - 9
10
11
12
13
14
15
16
17
18
Important note You should not regard the dental information guide as a substitute for the statement of dental remuneration (SDR). Please consult the current SDR for
and provisos to items of treatment.
Images © Crown Copyright 2009
Code and item guide Dental Information Guide - Effective from 1 October 2016
3
CODE FEE PATIENT CHARGE
TOOTH SPECIFIC
EXAMINATION 1A 1B 1C 1D
0101 0111 0121 0131
£8.70 £13.00 £27.15 £4.25
£0.00 £0.00 £0.00 £3.40
X-RAYS - Registered/Occasional
2A[1] / 49 Small 2A[2] / 49 Medium 2A[3] / 49 Large
Panoral* Ceph [ORTHO]
0201 / 49010202 / 4911 0203 / 49210204 / 4931
0205
£4.25 £5.65 £8.95 £13.25 £19.55
£3.40 £4.52 £7.16
£10.60 £15.64
STUDY MODELS
2B Upper + Lower Duplicate set Single
0211 0212 0213
£19.15 £12.05 £9.45
£15.32 £9.64 £7.56
PHOTOGRAPHS 3 0301 £4.25 £3.40 SCALING - X-rays to be available for 10C 10A 10B 10B Incomplete [1st Visit] 10C 1 - 4 teeth
5 - 9 teeth 10 - 16 teeth 17 or more teeth
Additional fee for each sextant of mouth treated under 10c
1001 1011
1000 01 1021 1021 1021 1021 1022
£13.60 £33.00 £16.50 £42.10 £51.40 £60.80 £68.05 £8.55
£10.88 £26.40 £13.20 £33.68 £41.12 £48.64 £54.44 £6.84
TS TS TS TS
FILLINGS 14A[1] Single surface 14A[2] Two surfaces 14A[3] MO or DO 14A[4] MOD 14B Tunnel Restoration Mo or Do
Maximum per tooth 14C[1] Resin
Acid etch One angle
Incisal edge Two angles
14C[2] Glass ionomer
14D Pin
1401 1402 1403 1404 1411 1412 1421 1420 1422 1423 1424 1425 1426 1427 1431
£9.25 £13.60 £18.00 £23.75 £18.00 £23.75 £17.45 £27.15 £5.65 £1.10 £9.25
£13.25 £15.85 £21.65 £7.25
£7.40 £10.88 £14.40 £19.00 £14.40 £19.00 £13.96 £21.72 £4.52 £0.88 £7.40 £10.60 £12.68 £17.32 £5.80
TS TS TS TS TS TS TS TS TS TS TS TS TS TS TS
Code and item guide Dental Information Guide - Effective from 1 October 2016
4
CODE FEE PATIENT
CHARGE TOOTH
SPECIFIC
SEALANT RESTORATIONS
14H 14I 14J
1481 1482 1483
£8.55 £12.05 £18.00
£6.84 £9.64
£14.40
TS TS TS
MAXIMUM FILLING FEES
Combinations of materials WITHOUT pins/acid etch/cusp tip Combinations of materials WITH pins/acid etch or cusp tip
1470
1471
£33.00
£36.80
£26.40
£29.44
TS
TS
ROOT TREATMENTS - X-rays to be available
15A Incisor or canine Upper premolar Lower premolar Molar
15B Vital pulpotomy
1501 1502 1503 1504 1511
£50.00 £68.10 £59.00
£104.65 £19.80
£40.00 £54.48 £47.20 £83.72 £15.84
TS TS TS TS TS
APICECTOMY - X-rays to be available 15C Incisor or canine
Premolar Upper molar
1521 1522 1523 1541
£44.20 £60.80 £71.60 £9.45
£35.36 £48.64 £57.28 £7.56
TS TS TS TS
PORCELAIN VENEERS 16[A] 321 / 123 1601
1600 £110.40
£8.55 £88.32£6.84
TS
Remember to enter code for 1st veneer [1600]
INLAYS 17A[1] Single surface
2 surfaces 2 surfaces involving incisal angle 3 or more surfaces
1701 1702 1703
1704
£71.60 £101.15 £91.95
£134.25
£57.28 £80.92 £73.56
£107.40
TS TS TS
TS
CROWNS 17B[1] Precious metal 17B[2] NON precious metal 17C Porcelain jacket crown 17D[1] Bonded precious 17D[2] Bonded non-precious 17E Acrylic
ch
1711 1712 1716 1721 1722 1726 1700
£119.55 £91.95 £90.00
£137.05 £123.10 £73.45
£8.55
£95.64 £73.56 £72.00 £109.64 £98.48 £58.76
£6.84
TS TS TS TS TS TS
Remember to enter code for 1st crown or inlay on an arch [1700]
Code and item guide Dental Information Guide - Effective from 1 October 2016
5
CODE FEE PATIENT
CHARGE TOOTH
SPECIFIC POSTS 17F[2] Cast metal alloy post 17F[3] Prefabricated post 17F[4] Pin / screw
1732 1733 1734
£38.10 £19.80 £9.45
£30.48 £15.84 £7.56
TS TS TS
TEMPORARY CROWN
17G WITHOUT post WITH post
1742 1743
£15.85 £22.35
£12.68 £17.88
TS TS
RE-CEMENT - Registered / Occasional
17K / 51C Inlay Crown
1781 / 5111 1782 / 5112
£11.45 £11.45
£9.16 £9.16
TS TS
Do not use occasional codes (items 47-60) for referral or partner/associate patients
BRIDGES - X-rays and study models to be available
18A[4] Retainer Bonded precious
Bonded non-precious 18C[4] Pontic Bonded precious
Bonded non-precious 18D[1] Acid etch retained 18D[2] Pontic
1807 1808
1825 1826 1831 1832
£144.95 £132.20
£82.40 £71.60 £42.10 £80.50
£115.96 £105.76
£65.92 £57.28 £33.68 £64.40
TS TS
TS TS TS TS
TEMPORARY BRIDGE 18F[1] Lab produced 18F[2] Other
1851 1852
£18.75 £6.95
£15.00 £5.56
TS TS
RE-CEMENT BRIDGE 18G[1] Acid etch retained 18G[2] Any other bridge
1861 1862
£31.25 £16.55
£0.00 £0.00
EXTRACTIONS - Registered / Occasional 21[1] / 52[1] 1 tooth Permanent or 2 teeth retained deciduous 3 or 4 teeth
5 - 9 teeth 10 - 16 teeth 17 or more teeth
Additional fee for visits 21[2] / 52[2] 1 tooth Deciduous teeth 2 teeth
3 or 4 teeth 5 - 9 teeth 10 - 16 teeth 17 or more teeth
Additional fee for visits
2101 / 5201 2101 / 5201 2101 / 5201 2101 / 5201 2101 / 5201 2101 / 5201 2121 / 5206
2102 / 5202 2102 / 5202 2102 / 5202 2102 / 5202 2102 / 5202 2102 / 5202 2121 / 5206
£8.55 £15.40 £23.75 £31.25 £42.10 £51.40 £6.95
£8.55 £15.40 £23.75 £31.25 £42.10 £51.40 £6.95
£6.84 £12.32 £19.00 £25.00 £33.68 £41.12 £5.56
£0.00 £0.00 £0.00 £0.00 £0.00 £0.00 £0.00
TS TS TS TS TS TS
TS TS TS TS TS TS
Do not use occasional codes (items 47-60) for referral or partner/associate patients
Code and item guide Dental Information Guide - Effective from 1 October 2016
6
CODE FEE PATIENT
CHARGE TOOTH
SPECIFIC EXTRACTIONS OF SPECIAL DIFFICULTY - Visit fee not applicable / X-rays to be available
22A[1] Soft tissue only 22A[2][i] Bone removal on 1,2 or 3s 22A[2][ii] 4,5,6,7 or 8s Impacted wisdom teeth 22A[2][iii] Upper NO DIVISION
Lower NO DIVISION 22A[2][iv] Upper WITH DIVISION
Lower WITH DIVISION
2201 2202 2203
2204 2206 2205 2207
£23.75 £33.00 £40.55
£42.10 £49.70 £53.25 £58.90
£19.00 £26.40 £32.44
£33.68 £39.76 £42.60 £47.12
TS TS TS
TS TS TS TS
POST OPERATIVE TREATMENT
2551 2552 2553 2554 2560
£27.15 £31.25 £36.80 £45.75 £91.65
£21.72 £25.00 £29.44 £36.60 £73.32
2555 2556 2557 2558
£27.15 £49.70 £71.60 £91.65
£21.72 £39.76 £57.28 £73.32
2573 £19.15 £10.40
2574 £31.30 £18.60
23A[1] Arrest of haemorrhage 23A[2] Remove sutures 23B Treatment of infected socket
2301 2302 2311
£27.15 £8.55 £8.55
£0.00 £0.00 £6.84
SEDATION 25A[1] WITH ITEM 21
1 - 4 teeth 5 - 9 teeth 10 - 16 teeth 17 or more teeth Maximum
25A[2] WITH OTHER ITEMS [adults only] ≤ £10 £10.01 - £25 £25.01 - £50 > £50
25C[2] Inhalation Fee paid for 2573 is calculated as Inhalation @ £13.00 plus Supplement @ £6.15. The patient will only pay 80% of Inhalation.
25C[2] Injection Fee paid for 2574 is calculated as Injection @ £23.25 plus Supplement @ £8.05. The patient will only pay 80% of Injection.
Code and item guide Dental Information Guide - Effective from 1 October 2016
7
CODE FEE PATIENT
CHARGE TOOTH
SPECIFIC ACRYLIC DENTURES
27B[1] Full Upper + Lower 27B[2] Full Upper
Full Lower 27B[3] Partial Upper 1 - 3 teeth
4 - 8 teeth 9 or more teeth
Partial Lower 1 - 3 teeth 4 - 8 teeth 9 or more teeth
2730 2731 2732 2733 2733 2733 2735 2735 2735
£187.85 £117.20 £117.20 £73.45 £97.45 £115.85 £73.45 £97.45 £115.85
£150.28 £93.76 £93.76 £58.76 £77.96 £92.68 £58.76 £77.96 £92.68
TS TS TS TS TS TS
2741 2742
£165.60 £165.60
£132.48 £132.48
27C[1] Full Upper Full Lower
27C[2] Part plate design
Note 2738 maximum denture code no longer applies: use Upper/Lower codes.
2743 2743 2743 2747 2747 2747
£169.20 £185.60 £192.95 £169.20 £185.60 £192.95
£135.36 £148.48 £154.36 £135.36 £148.48 £154.36
TS TS TS TS TS TS
Upper 1 - 3 teeth 4 - 8 teeth 9 or more teeth
Lower 1 - 3 teeth 4 - 8 teeth 9 or more teeth
27C[3] Single bar skeleton design 2744 2744 2748 2748
£178.40 £194.80 £178.40 £194.80
£142.72 £155.84 £142.72 £155.84
TS TS TS TS
Upper 1 - 3 teeth 4 or more teeth
Lower 1 - 3 teeth 4 or more teeth
27C[4] Multi bar skeleton design
Upper 1 - 3 teeth 4 or more teeth
Lower 1 - 3 teeth 4 or more teeth
2745 2745 2749 2749
£185.60 £207.80 £185.60 £207.80
£148.48 £166.24 £148.48 £166.24
TS TS TS TS
REPAIRS 28A[1] Crack/fracture Upper
Lower
Upper Lower 28A[4] Impression Upper
Lower
2801 2802 2803 2804 2821 2822
£17.75 £17.75 £25.70 £25.70 £8.25 £8.25
£0.00 £0.00 £0.00 £0.00 £0.00 £0.00
MAXIMUM COMBINATION OF REPAIRS Upper Lower
2810 01 2820 01
£40.55 £40.55
£0.00 £0.00
Code and item guide Dental Information Guide - Effective from 1 October 2016
8
CODE FEE PATIENT
CHARGE TOOTH
SPECIFIC ADJUSTMENT TO DENTURES
28B Upper Lower
2831 2832
£12.45 £12.45
£9.96 £9.96
RELINING/REBASING
28C[1] Upper Reline/rebase only
Lower 28C[2] Upper Reline/rebase and
addition of labial or Lower
28C[3] Upper Renewal of soft lining
2880 19 £49.70 £39.76
Lower
2851 2852 2853
2854
2855 2856
£42.10 £42.10 £47.85
£47.85
£64.45 £64.45
£33.68 £33.68 £38.28
£38.28
£51.56 £51.56
ADDITIONS
28D[1] Clasp Upper Lower
28D[2] Tooth Upper Lower
28D[3] Gum Upper Lower
2861 2862 2863 2864 2865 2866
£34.85 £34.85 £29.40 £29.40 £29.40 £29.40
£27.88 £27.88 £23.52 £23.52 £23.52 £23.52
TS TS
Combinations of 2 or more additions with or without repairs Maximum fee applies per denture ORTHODONTIC APPLIANCE
32A[1] Removable spring/screw Upper Lower
Upper Lower
32A[3] Fixed multiband Upper Lower
32A[4] Functional 32A[5] Bite plane Upper
Lower Extra-oral traction Upper
Lower Anchorage Upper
Lower
3201 3202 3203 3204 3205 3206 3207 3211 3212 3221 3223 3222 3224
£130.45 £130.45 £125.10 £125.10 £365.80 £365.80 £224.25 £95.70 £95.70 £53.25 £53.25 £53.25 £53.25
£104.36 £104.36 £100.08 £100.08
£292.64 £292.64 £179.40 £76.56 £76.56 £42.60 £42.60 £42.60 £42.60
RETENTION
32B[1] First period Additional period
3231 3232
£33.00 £16.55
£26.40 £13.24
RETENTION APPLIANCES
32B[2] Removable Upper Lower
Fixed Upper Lower
Pressure Upper Lower
3233 3234 3235 3236 3237 3238
£64.45 £64.45 £73.45 £73.45 £52.25 £52.25
£51.56 £51.56 £58.76 £58.76 £41.80 £41.80
Code and item guide Dental Information Guide - Effective from 1 October 2016
9
CODE FEE PATIENT
CHARGE TOOTH
SPECIFIC REPAIRS
32C[1] Acrylic Upper Lower
32C[2] Metal One repair Upper Lower
Each additional 32C[3] (Upper + Lower) Removable Functional Appliance Impression Upper
Lower
3241 3247 3242 3248 3248 3230 3245 3246
£27.15 £27.15 £33.00 £33.00 £8.55
£42.10 £8.25 £8.25
£0.00 £0.00 £0.00 £0.00 £0.00 £0.00 £0.00 £0.00
REPLACEMENT APPLIANCES - Reg 9 charge is decided by the NHS Board
32E[1] Space maintainer 32E[2] Removable 32E[3] 32E[4] Multiband 32E[5] Functional
3281 3282 3283 3284 3285
£51.40 £69.90 £71.60
£134.25 £82.75
£41.12 £55.92 £57.28
£107.40 £66.20
DOMICILIARY VISITS - Registered / Occasional - supporting observations should be given
35A / 57A < 10 miles 10 - 40 miles over 40 miles
3501 / 57013502 / 57023503 / 5703
£38.70 £53.25 £69.90
£0.00 £0.00 £0.00
Do not use occasional codes [items 47 - 60] for referral or partner/associate patients
RE-OPEN SURGERY - Registered / Occasional
35B / 57B < 1 mile 1 mile or more
3511 / 57113512 / 5712
£45.75 £75.45
£0.00 £0.00
Do not use occasional codes [items 47 - 60] for referral or partner/associate patients
ITEM 36 - MISCELLANEOUS TREATMENTS
36A Pathological exam 36B Stoning and smoothing 36D Sensitive cementum / dentine
3601 3611 3631
£13.00 £3.05 £5.65
£10.40 £2.44 £4.52
TS
Do not use occasional codes [items 47 - 60] for referral or partner/associate patients
PRESCRIPTION - Registration / Occasional - cannot claim with treatment items
36E / 48 3641 / 4801 £4.70 £3.76 ACUTE INFECTION - Registration / Occasional
37 / 56 3701 / 5601 £8.25 £6.60 DRESSINGS - Occasional
50A[1] Permanent 1 tooth or retained 2 teeth deciduous Each additional
Maximum 50A[2] Deciduous 1 tooth
2 teeth Each additional Maximum
5001 5001 5001 5001 5002 5002 5002 5002
£6.45 £9.25 £2.45
£19.20 £6.45 £9.25 £2.45
£19.20
£5.16 £7.40 £1.96
£15.36 £0.00 £0.00 £0.00 £0.00
TS TS TS TS TS TS TS TS
Do not use occasional codes [items 47 - 60] for referral or partner/associate patients
Incomplete metal dentures Dental Information Guide - Ef
10
fective from 1 October 2016
FEE FEE TS62F - 50% 6250 01
FEE TSTS62E - 25%
62G - 70% 6240 01 F / F £46.95 F / F £93.95
6251 01 6252 01-03 6252 04-08 6252 09 or more
F / -P / -P / -P / -
£58.60£36.75£48.75£57.95
TS TS TS
6253 01 6254 01-03 6254 04-08 6254 09 or more
- / F £58.60 - / P
Horseshoe / Plate
- / P- / P
£36.75£48.75£57.95
TS TS TS
FEE TS62I - 95% Horseshoe / Plate 6281 01 6283 01-03 6283 04-08 6283 09 or more
F / - £157.30 P / -P / -P / -
£160.75£176.30£183.30
TS TS TS
6282 01 6286 01-03 6286 04-08 6286 09 or more
- / F- / P- / P- / P
£157.30£160.75£176.30£183.30
TS TS TS
FEE TS62H - 85% Horseshoe / Plate 6271 01 6273 01-03 6273 04-08 6273 09 or more
F / - £140.75 P / -P / -P / -
£143.80£157.75£164.00
TS TS TS
6272 01 6276 01-03 6276 04-08 6276 09 or more
- / F- / P- / P- / P
£140.75£143.80£157.75£164.00
TS TS TS
FEE TSSkeleton - Single Connecting Bars
6274 01-03 6274 04 or more
P / - P / -
£151.65£165.60
TS TS
6277 01-03 6277 04 or more
- / P- / P
£151.65£165.60
TS TS
FEE TSSkeleton - Single Connecting Bars 6284 01-03 6284 04 or more
P / - P / -
£169.50£185.05
TS TS
6287 01-03 6287 04 or more
- / P- / P
£169.50£185.05
TS TS
FEE TSSkeleton - Multiple Connecting Bars6275 01-03 6275 04 or more
P / - P / -
£157.75£176.65
TS TS
6278 01-03 6278 04 or more
- / P- / P
£157.75£176.65
TS TS
FEE TSSkeleton - Multiple Connecting Bars6285 01-03 6285 04 or more
P / - P / -
£176.30£197.40
TS TS
6288 01-03 6288 04 or more
- / P- / P
£176.30£197.40
TS TS
6261 01 6263 01-03 6263 04-08 6263 09 or more
F / - £115.90 P / -P / -P / -
£118.45£129.90£135.05
TS TS TS
6262 01 6266 01-03 6266 04-08 6266 09 or more
- / F- / P- / P- / P
£115.90£118.45£129.90£135.05
TS TS TS
FEE TSSkeleton - Single Connecting Bars 6264 01-03 6264 04 or more
P / - P / -
£124.90 £136.35
TS TS
6267 01-03 6267 04 or more
- / P - / P
£124.90 £136.35
TS TS
6241 01 6242 01-03 6242 04-08 6242 09 or more
F / - P / - P / - P / -
£29.30 £18.35 £24.35 £28.95
TS TS TS
6243 01 6244 01-03 6244 04-08 6244 09 or more
- / F £29.30 - / P - / P - / P
£18.35 £24.35 £28.95
TS TS TS
FEE TSSkeleton - Multiple Connecting Bars6265 01-03 6265 04 or more
P / - P / -
£129.90 £145.45
TS TS
6268 01-03 6268 04 or more
- / P - / P
£129.90 £145.45
TS TS
Incomplete acrylic dentures Dental Information Guide - Ef
11
fective from 1 October 2016
FEE TS62B - 50% 6210 01
FEE TS 62A - 25%
F / F £93.95
6211 01 6212 01-03 6212 04-08 6212 09 or more
F / - P / - P / - P / -
£58.60£36.75£48.75£57.95
TS TS TS
6213 01 6214 01-03 6214 04-08 6214 09 or more
- / F £58.60 - / P
6200 01 F / F £46.95
- / P - / P
£36.75£48.75£57.95
TS TS TS
FEE TS62D - 95% 6230 01 F / F £178.45
6231 01 6232 01-03 6232 04-08 6232 09 or more
F / - P / - P / - P / -
£111.35£69.80£92.60
£110.05
TS TS TS
6233 01 6234 01-03 6234 04-08 6234 09 or more
- / F - / P - / P - / P
£111.35£69.80£92.60
£110.05
TS TS TS
FEE TS 62C - 66 2/3% 6220 01 F / F £125.25
6221 01 6222 01-03 6222 04-08 6222 09 or more
F / - P / - P / - P / -
£78.15£48.95£64.95£77.25
TS TS TS
6223 01 6224 01-03 6224 04-08 6224 09 or more
- / F - / P - / P - / P
£78.15£48.95£64.95£77.25
TS TS TS
Please note:
• submit a GP17 to us requesting a balance fee to be paid.
• Do not enter item 27 codes when claiming incomplete dentures.
• You must observe the requirements of narratives and provisos in the Statement of
Dental Remuneration for each item.
6201 01 6202 01-03 6202 04-08 6202 09 or more
F / - P / - P / - P / -
£29.30£18.35£24.35£28.95
TS TS TS
6203 01 6204 01-03 6204 04-08 6204 09 or more
- / F £29.30 - / P - / P - / P
£18.35£24.35£28.95
TS TS TS
Item 1 - General Examination Time-Bars Dental Information Guide - Effective from 1 October 2016
12
Historical Claim and Time-Bar Period Item 1a Item 1b Item 1c Item 1a Trauma Item 1a In the last 5 complete
calendar months In the last 5 complete calendar months
In the last 5 complete calendar months
No time-bar
Item 1b In the last 23 complete calendar months
In the last 23 complete calendar months
In the last 23 complete calendar months
No time-bar
Item 1c (1-3) In the last 5 compelete calendar months
In the last 23 complete calendar months
In the last 23 complete calendar months
No time-bar
Item 1c (4) For treatment over £600 No timebar
For treatment over £600 No timebar
In the last 23 complete calendar months (see note 7)
No time-bar
You cannot claim these items if you have claimed for the examinations in the months shown in the columns to the right.
Using the table Identify the exam being claimed in the left-hand side of the table and cross-reference along the table to make sure a previous examination fee has not been claimed within the stated time period.
Example If you wish to claim an item 1a exam, and you previously claimed an item 1c you would need to wait 5 complete calendar months.
Information notes: 1. Time-bar checks are carried out against a history for the same dentist. 2.
3. The examination time-bar is calculated based on the acceptance date of the claims. 4. The time-bars do not apply if the examination is a result of trauma. The trauma box must be ticked and observations given. 5.
For example: Claim on 18/03/2016, the next claim is possible on or after 01/09/2016. 6. In order for a 1b exam to be claimed, charting of the patient’s periodontal status must be recorded in the patient record. 7. Item 1c may be claimed in connection with:
• Item 10c; • Item 18 and when treatment is of special complexity, Items 16 and 17 and in
dentate cases Item 27b and 27c; and • When the total fee for treatment claimed exceeds £600.
Please note full charting of periodontal status must be recorded in the patient record.
8. One additional Item 1(a) may be claimed for patients who are pregnant or who have borne children in the past 12 complete calendar months. 9. Please make sure you check the current Statement of Dental Remuneration.
Item 1 - Orthodontic Examination Time-Bars Dental Information Guide - Effective from 1 October 2016
Historical Claim and Time-Bar Period Item 1a Orthodontic Item 1b Orthodontic Item 1c Orthodontic Item 1a Orthodontic In the last 5 complete
calendar months In the last 5 complete calendar months
You cannot claim these items if you have claimed for the examinations in the months shown in the columns to the right.
In the last 5 complete calendar months
Item 1b Orthodontic In the last 23 complete In the last 23 complete In the last 23 complete calendar months calendar months calendar months
Item 1c Orthodontic In the last 5 compelete In the last 5 complete In the last 23 complete calendar months calendar months calendar months
Using the table Identify the exam being claimed in the left-hand side of the table and cross-reference along the table to make sure a previously claimed exam has not been paid within the stated time period.
Example If you wish to claim an item 1a exam, and you previously claimed an item 1c you would need to wait 5 calendar months.
Information notes: 1. Orthodontic examination fees can only be paid for a patient who has an established or developing malocclusion. 2. An Item 1c examination is only payable when:
• study casts and radiographs (if appropriate) are available; • any study casts and radiographs are recorded as available on the claim; and • the referring dentist or hospital may provide study models and radiographs for the orthodontist.
3. Orthodontic examinations are normally not payable where there are no permanent teeth present. 4. An Item 1c claim on a GP17(O) does not bar simultaneous claims for Items 1a or 1b on GP17 claims when the dentist is also responsible for the
patient’s general care. 5. Orthodontic examinations must be made using GP17(O) forms, with the appropriate information detailed. 6. Please make sure you check the current Statement of Dental Remuneration.
13
Item 10 - Periodontal Treatment Time-Bars Dental Information Guide - Effective from 1 October 2016
Historical Claim and Time-Bar Period Item 10a Item 10b Item 10c
You cannot claim these items if you have claimed for the examinations in the months shown in the columns to the right.
Item 10a No time-bar No time-bar Normally 2 complete calendar months
Item 10b No time-bar 9 complete calendar months 9 complete calendar months
Item 10c No time-bar 9 complete calendar months 9 complete calendar months
Using the table Identify the item being claimed in the left-hand side of the table and cross-reference along the table to make sure a previously claimed item has not been paid within the stated time period.
Example If you wish to claim an item 10b, and you previously claimed an item 10c you would need to wait 9 calendar months.
Information notes: 1. Time-bar checks are carried out against a history for the same dentist. 2.
arrangement. 3. The time-bars for Item 10 are calculated based on the history of the completion date to the claim acceptance date of the of the current claim. 4. Only one claim under Item 10a, b or c is payable per course of treatment. 5. Treatment under Item 10 is inclusive of oral hygiene instruction, therefore a fee under Item 6 cannot be claimed at the same time. 6. Item 10a is only payable in conjunction with:
• an Item 1a, b or c examination; or • an examination when claimed within the previous 11 complete calendar months.
7. Item 10b is only payable in conjunction with: • an Item 1a, b or c examination; or • an examination when claimed within the previous 11 complete calendar months.
8. Item 10c is only payable in conjunction with: • an Item 1c examination; or • an Item 1c examination when claimed within the previous 23 complete calendar months.
9. Item 10c: radiographs must be available and recorded as available on the claim. 10. Please make sure you check the current Statement of Dental Remuneration.
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Combination Codes - General* Dental Information Guide - Effective from 1 October 2016
15
REGISTERED OCCASIONAL FEE PATIENT
CHARGE COMBINATION OF REPAIRS UPPER
Maximum
2805 01 2805 02
2805 03 - 05
5505 01 5505 02
5505 03 - 05
£31.85 £38.00 £40.55
£0.00 £0.00 £0.00
LOWER
Maximum
2806 01 2806 02
2806 03 - 05
5506 01 5506 02
5506 03 - 05
£31.85 £38.00 £40.55
£0.00 £0.00 £0.00
MAXIMUM REPAIR FEE “PER DENTURE” U / - - / L
2810 01 2820 01
5507 01 5508 01
£40.55 £40.55
£0.00 £0.00
COMBINATIONS OF ADDITIONS + REPAIRS 1 addition [clasp] with 1 repair [fracture] [balance fee**]
2880 01 2880 02
5560 01 5560 02
£34.85 £14.85
£27.88 £0.00
1 addition [tooth] with 1 repair [fracture]
2880 03 2880 04
5560 03 5560 04
£29.40 £17.75
£23.52 £0.00
1 addition [gum] with 1 repair [fracture]
2880 05 2880 06
5560 05 5560 06
£29.40 £17.75
£23.52 £0.00
1 addition [clasp] with 2 or more repairs [balance fee**]
2880 07 2880 08
5560 07 5560 08
£34.85 £14.85
£27.88 £0.00
1 addition [tooth] with 2 or more repairs [balance fee**]
2880 09 2880 10
5560 09 5560 10
£29.40 £20.40
£23.52 £0.00
1 addition [gum] with 2 or more repairs [balance fee**]
2880 11 2880 12
5560 11 5560 12
£29.40 £20.40
£23.24 £0.00
1 addition [clasp] with [balance fee**]
2880 13 2880 14
5560 13 5560 14
£34.85 £14.85
£27.88 £0.00
1 addition [tooth] with [balance fee**]
2880 15 2880 16
5560 15 5560 16
£29.40 £20.40
£23.52 £0.00
1 addition [gum] with [balance fee**]
2880 17 2880 18
5560 17 5560 18
£29.40 £20.40
£23.52 £0.00
Any 2 additions with or without repairs Maximum Fee 2880 19 5560 19
£49.70 £39.76
* Found in proviso for item 28/55 ** Maximum fee payable under items 28 and 55 is £49.70
Please note: No fee for impression can be paid with addition
Combination Codes - Orthodontic Dental Information Guide - Effective from 1 October 2016
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REGISTERED OCCASIONAL FEE PATIENT
CHARGE COMBINATION OF REPAIRS UPPER 32[C][2] + 1 repair under 32[C][1]
32[C][2] + 2 repairs under 32[C][1] 32[C][2] + 3 or more repairs under 32[C][1] Maximum
3252 01
3252 02
3252 03 - 05
£41.55
£50.10
£50.40
£0.00
£0.00
£0.00
LOWER 32[C][2] + 1 repair under 32[C][1]
32[C][2] + 2 repairs under 32[C][1] 32[C][2] + 3 or more repairs under 32[C][1] Maximum
3253 01
3253 02
3253 03 - 05
£41.55
£50.10
£50.40
£0.00
£0.00
£0.00
Practitioners providing occasional treatment, which involves repair to removable appliances, should include the following codes:
UPPER 55[E][2] + 1 repair under 55[E][1]
55[E][2] + 2 repairs under 55[E][1] 55[E][2] + 3 or more repairs under 55[E][1] Maximum
5593 01
5593 02
5593 03 - 05
£41.55
£50.10
£50.40
£0.00
£0.00
£0.00
LOWER 55[E][2] + 1 repair under 55[E][1]
55[E][2] + 2 repairs under 55[E][1] 55[E][2] + 3 or more repairs under 55[E][1] Maximum
5594 01
5594 02
5594 03 - 05
£41.55
£50.10
£50.40
£0.00
£0.00
£0.00
MAXIMUM REPAIR FEE PER FIXED APPLIANCE U / - - / L
3250 01 3251 01
5595 01 5596 01
£50.40 £50.40
£0.00 £0.00
Free Repair and Replacement Dental Information Guide - Effective from 1 October 2016
From 1 December 2012, the same dentist may no longer claim for repairing or replacing the following items of treatment within 11 complete calendar months of provision of the original restoration by that dentist unless the repair or replacement is necessitated by trauma:
Conservative treatment items 14(a) - (d) and (f) - (j). Conservative treatment, special to minors, items 44(a), (b) and (e). Occasional treatment items 58(b) - (f). Occasional treatment, special to minors, item 60(a).
Items 15(a) and (d).
Inlays and Crowns Items 17(a) - (k).
Bridges Items 18(a) - (h). Occasional treatment items 51(d) and (e).
* Please see definition of "trauma" at section 1 of the Statement of Dental Remuneration, and note that any claim must be supported by appropriate observations.
You can view the regulations on-line:
www.legislation.gov.uk/ssi/2010/208/contents/made?text=Dental%20Regulations
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Miscellaneous Information Dental Information Guide - Effective from 1 October 2016
18
Maximum patient charge £384
Prior approval limit £390
Payment dates Payments will arrive in your bank account on the twentieth of each month (or the Friday before, if the twentieth falls on a weekend).
Schedule month closing dates
Claim type Example for June GP17 paper claims Last working day of schedule (30 June in this example) Electronic Data Interchange (EDI) Seventh day of the following month (7 July in this example)*
*Subject to change. Please check your broadcast messages.
For further help contact our helpdesk
0131 275 6300
Mon-Thurs 8.30am - 4.30pm & Fri 8.30am - 4.00pm or email [email protected]
When contacting Practitioner Services please quote your List Number.