This page outlines the Schedule of fees for OHFFSS providers. Fees have been indexed in alignment with movement in the Department of Veteran's Affairs Fee Schedules of Dental Services. These fees will be effective as of 1 July 2024.
This information is to be read in conjunction with NSW Health policy directive Oral Health Fee For Service Scheme (PD2024_003), and The Australian Schedule of Dental Services and Glossary, 12th Ed. (Australian Dental Association).
The maximum amounts payable for authorised vouchers are:
Local health districts and specialty health networks may:
Actual limits are printed on each voucher.
022
Limit of 6 total 022 per day.
Limit of 4 per tooth undergoing endodontic treatment per voucher.
34.60
U, G
Panoramic radiograph -per exposure
037
Prior approval required
Radiograph must be taken on-premises at the provider's surgery.
107.05
G
Removal of calculus -first
appointment
Oral hygiene instruction
141
Where a full appointment of at least 15 minutes is used.Limit of one per 12 month period.
56.20
Fissure and/or tooth surface sealing
-per tooth
Treatment of acute periodontal
infection –per appointment
Clinical periodontal analysis and recording
221
Limit of one (1) per 12 month period.
Evidence of clinical periodontal analysis and recording must be submitted when claiming for 221.
60.15
Periodontal debridement –per tooth
222
Limit of 10 per day.Limit of 20 per 12 month period.Item 222 can only be claimed in conjunction with item 221. Item 221 can be claimed on the same voucher or claimed within the previous 12 months.
29.60
G
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The item number and its fee includes anaesthesia, the insertion of sutures, normal post-operative care, suture removal, and the treatment of alveolar osteitis should it arise. All surgical procedures should be supported by an appropriate radiographic image and clinical notes may be requested. Surgical extractions (item numbers 322 and 324) are only claimable where a mucoperiosteal flap has been raised.
For first tooth extracted per quadrant per day.
Permanent teeth only.
Complete chemo-mechanical
preparation of root canal –one canal
When placing separate restorations on the same or different surfaces of the same tooth at the same visit, the restorations should be itemised separately. For each tooth restored, the reimbursed fee will represent a fee equivalent to the maximum number of surfaces restored. For example, if two separate one-surface restorations are placed on two different surfaces on the same day, these should be itemised as separate restorations, and providers will be reimbursed for a two-surface restoration. If multiple restorations are placed on the same surface on the same day, that surface can only be counted once. When two materials are used in the same restoration, the predominant material type should be used for claiming the restoration.
Adhesive restoration –one surface –anterior tooth –direct
521
Limit of 1 restorative service (511-535) to be reimbursed per tooth per day (see above note).
Limit of 5 adhesive single surface restorations (521/531) per day
131.20
Adhesive restoration –one surface –posterior tooth –direct
531
140.15
572
Limit of 3 per three month period.
Not claimable with endodontic items except 419.
Not claimable with restorative item numbers (511-535) on same tooth on same day.
55.40
Limit of 6 per voucher.
The fee associated with item numbers for new complete or partial dentures includes any reasonable adjustments following provision of the denture. At least three or more denture adjustments must be provided, as necessary, following the issue of a denture.
This will only be paid with:
Limit of one per dental appliance repair/modification.
A kilometre allowance may be paid to, dentists and dental prosthetists, in addition to a fee for item 916 if you are required to travel from your normal place of business to visit an entitled person at home or in an institution. Prior approval is required to claim the allowance and the per kilometre fee is to be determined in negotiation with the Local Health District (LHD). The allowance will not be paid for the first 10 kilometres travelled. The allowance will be paid on the basis of the distance travelled, including between patients, not the number of entitled persons attended. To claim the allowance the number of kilometres must be identified on the OHFFSS voucher against each individual patient.
Palliative care
911
Limit of 2 per 6 month period.Not to be claimed with an extraction, endodontic or restorative treatment on same tooth.
77.75
Travel to provide services
916
Limit of 1 per patient per day. Limit of 1 per location per day.Not claimable by providers operating a mobile dental clinic.
75.90
Travel to provide services
68.25
D
Splinting and stabilization
-direct -per tooth