Dentistry

Benefits / Dentistry

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    Basic and emergency dentistry

    Covered at any dentist on the Dental Network
    dentistry Basic dentistry such as fillings, extractions, infection control, cleaning and polishing of teeth


    Specialised dentistry such as bridges, crowns, surgical extractions, implants, root canals, gold fillings, dentures and braces are not covered

    Provided in accordance with the Dental Network protocols and approved Health4Me dentistry list

    A 3 month waiting period applies

    You may visit any dentist on the Dental Network. You have benefits for basic dentistry, such as fillings, extractions, infection control and cleaning and polishing of teeth.

    The dentist will send the account to us for payment. Specialised dentistry, such as bridges, crowns, surgical extractions, implants, root canals, gold fillings, dentures and braces, is not covered.

    If a specific dental procedure is not covered, the dentist will let you know and you will need to pay for it from your own pocket.

    Examinations

    Tariff code Description Tooth number required
    8101
    Consultation (oral examination) - Maximum one per member per year
    N
    8104
    Consultation (specific problem) - Designated service provider: Unlimited but managed (Momentum dental protocols)
    N

    Diagnostic codes

    Tariff code Description Tooth number required
    8109
    Infection control (gloves/masks) - Maximum two per service date
    N
    8110
    Sterilised instrumentation - Maximum one per service date
    N
    8145
    Local anaesthetic - Maximum one per service date
    N
    8107 & 8112
    Intra oral radiographs/bite wings - Designated service provider: Maximum four per member per year, combined limit per year
    N

    Preventive

    Tariff code Description Tooth number required
    8163
    Fissure sealant - Maximum two per child per year - Patients younger than 12
    Y
    8155
    Polishing only - Maximum one per member per year
    N
    8159
    Scaling and polishing - Maximum one per member per year
    N
    8161
    Topical fluoride - Maximum one per child per year - Patients younger than 12
    N
    8935
    Septic socket treatment
    Y

    Extractions

    Tariff code Description Tooth number required
    8201
    Single extraction (1st extraction in quadrant)
    Y
    8202
    Extraction (additional tooth in the same quadrant)
    Y
    8935
    Septic socket treatment after extraction (if necessary)
    Y

    Restorations

    – Maximum of four allowed (authorisation required for additional four)

    – Any additional restorations without an authorisation will be rejected

    Tariff code Description Tooth number required
    8341 & 8367
    One surface amalgam restoration - Posterior teeth only (14-18, 24-28, 34-38, 44-48)
    Y
    8342 & 8368
    Two surface amalgam restorations - Posterior teeth only (14-18, 24-28, 34-38, 44-48)
    Y
    8343 & 8369
    Three surface amalgam restorations - Posterior teeth only (14-18, 24-28, 34-38, 44-48)
    Y
    8344 & 8370
    Four surface amalgam restorations - Posterior teeth only (14-18, 24-28, 34-38, 44-48)
    Y
    8351
    One surface resin restoration - Anterior teeth only (11-13, 21-23, 31-33, 41-43)
    Y
    8352
    Two surface resin restorations - Anterior teeth only (11-13, 21-23, 31-33, 41-43)
    Y
    8353
    Three surface resin restorations - Anterior teeth only (11-13, 21-23, 31-33, 41-43)
    Y
    8354
    Four surface resin restorations - Anterior teeth only (11-13, 21-23, 31-33, 41-43)
    Y

    Emergency

    Tariff code Description Tooth number required
    8131
    Dental pain treatment (emergency) - Unlimited procedure - Only with diagnostic codes on the same service date for the same tooth number
    Y
    8132
    Emergency root canal treatment (not covered on primary teeth) - Only the initial emergency root canal treatment is covered (subsequent root canal treatment is not covered)
    Y
    8307
    Pulp amputation (pulpotomy) - Only on primary teeth (51-55, 61-65, 71-75, 81-85) - Maximum of two per child without pre-authorisation and two with pre-authorisation (combined four per child per year)
    Y
    Please note that this benefit is only available on the Health4Me Silver and Health4Me Gold options. To download a copy of the Dentistry benefit information click on the download button below.

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