i . iyou should not regard the dental information guide as a substitute for the statement of dental...

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I . I .

•

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


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]


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


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.


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


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


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


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


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


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


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


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



No time-bar

Item 1c (1-3) In the last 5 compelete 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



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


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.

14

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

16

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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http://www.legislation.gov.uk/ssi/2010/208/contents/made?text=Dental%20Regulations

Miscellaneous Information Dental Information Guide - Effective from 1 October 2016

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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.

mailto:[email protected]

mailto:[email protected]

i . iyou should not regard the dental information guide as a substitute for the statement of dental...

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