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May 30, 2023
Dentistry
Benefits / Dentistry
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.
