Dental Information Guide 2013

With new guide to tooth specific information

Fees effective from 1 November 2013

CONTENTS Comments & Feedback To help us improve our services, we would appreciate your comments or suggestions about this publication.

Code/Item guide

3/4

Please send your comments to:

Discretionary fee list

5/6

Incomplete metal dentures

7

Incomplete acrylic dentures

8

Item 1 General examination time-bars Information notes relating to Item 1

9

Item 1 Orthodontic examination time-bars Information notes relating to Item 1

10

Item 10 Periodontal treatment time-bars Information notes relating to Item 10

11

Combination codes - General

12

Combination codes - Orthodontic

13

Changes to free repair and replacement

14

Miscellaneous information

14

Customer Services Practitioner Services Dental & Ophthalmic Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB Telephone the Helpdesk on: 0131 275 6300 [email protected]

NOVEMBER 2013 CODE/ITEM GUIDE MAXIMUM PATIENT CHARGE - £384

CODE

FEE

EXAMINATION 1A 0101 £8.30 1B 0111 £12.45 1C 0121 £25.95 1D 0131 £4.10 X-RAYS - Registered/Occasional 2A[1] / 49 Small 0201 / 4901 £4.10 2A[2] / 49 Medium 0202 / 4911 £5.40 2A[3] / 49 Large 0203 / 4921 £8.55 Panoral 0204 / 4931 £12.70 Ceph [ORTHO] 0205 £18.75 STUDY MODELS 2B Upper + Lower 0211 £18.35 Duplicate set 0212 £11.50 Single 0213 £9.05 PHOTOGRAPHS 3 0301 £4.10 SCALING X-rays to be available for 10C 10A 1001 £13.05 10B 1011 £31.60 10B Incomplete [1st Visit] 1000 01 £15.80 10C 1 - 4 teeth 1021 £40.30 5 - 9 teeth 1021 £49.20 10 - 16 teeth 1021 £58.15 17 or more teeth 1021 £65.15 Additional fee for sextants 1022 £8.15 FILLINGS 14A[1] Single surface 1401 £8.85 14A[2] Two surfaces 1402 £13.05 14A[3] MO or DO 1403 £17.20 14A[4] MOD 1404 £22.75 14B Tunnel Single filling 1411 £17.20 Double filling 1412 £22.75 14C[1] Resin Single filling 1421 £16.70 Double filling 1420 £25.95 Acid etch One angle 1422 £5.40 Incisal edge 1423 £1.10 Two angles 1424 £8.85 Cusp tip 1425 £12.70 14C[2] Glass ionomer Single filling 1426 £15.15 Double filling 1427 £20.70 Pin 14D 1431 £6.95 SEALANT RESTORATIONS 14H Sealant only 1481 £8.15 14I Resin 1482 £11.50 14J Resin + ionomer 1483 £17.20 14G Single filling 1461 £15.15 Double filling 1462 £22.55 MAXIMUM FILLING FEES Combinations of materials WITHOUT pins / acid etch / cusp tip 1470 £31.60 Combinations of materials WITH pins / acid etch or cusp tip 1471 £35.20 ROOT TREATMENTS X-rays to be available 15A Incisor 1501 £47.85 Upper premolar 1502 £65.20 Lower premolar 1503 £56.50 Molar 1504 £100.15 15B Vital pulpotomy 1511 £19.00

PATIENT CHARGE £0.00 £0.00 £0.00 £3.28 £3.28 £4.32 £6.84 £10.16 £15.00 £14.68 £9.20 £7.24 £3.28 £10.44 £25.28 £12.64 £32.24 £39.36 £46.52 £52.12 £6.52 £7.08 £10.44 £13.76 £18.20 £13.76 £18.20 £13.36 £20.76 £4.32 £0.88 £7.08 £10.16 £12.12 £16.56 £5.56 £6.52 £9.20 £13.76 £12.12 £18.04

£25.28 £28.16 £38.28 £52.16 £45.20 £81.12 £15.20

Remember to enter code for 1st crown [1700] or veneer [1600] Do not use occasional codes [items 47-60] for referral or partner/associates patients

CODE

FEE

APICECTOMY X-rays to be available 15C Incisor 1521 £42.30 Premolar 1522 £58.15 Upper molar 1523 £68.55 Additional fee for retrograde 1541 £9.05 VENEERS 1601 £105.60 16 321/123 1600 £8.15 Additional fee for 1st veneer INLAYS 1701 £68.55 17A[1] Single surface 1702 £96.75 2 surfaces 2 surfaces involving £87.95 1703 the incisal £128.45 1704 3 surfaces CROWNS 1711 £114.40 17B[1] Precious metal 1712 £87.95 17B[2] NON precious metal 1716 £86.15 17C Porcelain jacket crown 1721 £131.10 17D[1] Bonded precious 1722 £117.75 17D[2] Bonded non-precious 1726 £70.30 17E Acrylic 1700 £8.15 Additional fee for 1st crown or inlay POSTS 1732 £36.45 17F[2] Metal alloy post 1733 £19.00 17F[3] Prefabricated post 1734 £9.05 17F[4] Pin / screw TEMPORARY CROWN 1742 £15.15 17G WITHOUT post 1743 £21.40 WITH post RE-CEMENT - Registered / Occasional 1781 5111 £10.90 17K / 51C Inlay 1782 5112 £10.90 Crown BRIDGES X-rays and/or study models to be available 18A[4] 1807 £138.75 Retainer Bonded precious 1808 £126.50 Bonded non-precious 18C[4] 1825 £78.85 Pontic Bonded precious 1826 £68.55 Bonded non-precious 1831 £40.30 18D Maryland retainer 1832 £77.05 Pontic TEMPORARY BRIDGE 1851 £17.95 18F[1] Lab produced 1852 £6.65 18F[2] Other RE-CEMENT BRIDGE 1861 £29.90 18G[1] Maryland 1862 £15.85 18G[2] Any other bridge EXTRACTIONS - Registered / Occasional - Updated 2101 5201 £8.15 21[1] / 52[1] 1 tooth 2101 5201 £14.75 Permanent 2 teeth 2101 5201 £22.75 or retained 3 or 4 teeth 2101 5201 £29.90 deciduous 5 - 9 teeth 2101 5201 £40.30 10 - 16 teeth 2101 5201 £49.20 17 or more teeth 2121 / 5206 £6.65 Additional fee for visits 21[2] / 52[2] 1 tooth Deciduous 2 teeth teeth 3 or 4 teeth 5 - 9 teeth 10 - 16 teeth 17 or more teeth Additional fee for visits

2102 5202 2102 5202 2102 5202 2102 5202 2102 5202 2102 5202 2121 / 5206

£8.15 £14.75 £22.75 £29.90 £40.30 £49.20 £6.65

PATIENT CHARGE £33.84 £46.52 £54.84 £7.24 £84.48 £6.52 £54.84 £77.40 £70.36 £102.76 £91.52 £70.36 £68.92 £104.88 £94.20 £56.24 £6.52 £29.16 £15.20 £7.24 £12.12 £17.12 £8.72 £8.72

£111.00 £101.20 £63.08 £54.84 £32.24 £61.64 £14.36 £5.32 £0.00 £0.00 £6.52 £11.80 £18.20 £23.92 £32.24 £39.36 £5.32 £0.00 £0.00 £0.00 £0.00 £0.00 £0.00 £0.00

3

NOVEMBER 2013 CODE/ITEM GUIDE PATIENT CHARGE SURGICAL EXTRACTIONS - VISIT fee not applicable / X-rays to be available £18.20 22A Soft tissue only £22.75 2201 £25.28 Bone removal on 1, 2 or 3s £31.60 2202 £31.04 4, 5, 6, 7 or 8s £38.80 2203 Impacted wisdom teeth £32.24 Upper NO DIVISION £40.30 2204 £38.04 Lower NO DIVISION £47.55 2206 £40.76 Upper WITH DIVISION £50.95 2205 £45.12 Lower WITH DIVISION £56.40 2207 POST OPERATIVE TREATMENT £0.00 23A[1] Arrest of haemorrhage £25.95 2301 £0.00 23A[2] Remove sutures £8.15 2302 £6.52 23B Septic socket £8.15 2311 GENERAL ANAESTHETIC - Deleted 01/04/2001 SEDATION 25A[1] WITH ITEM 21 £20.76 1 - 4 teeth £25.95 2551 £23.92 5 - 9 teeth £29.90 2552 £28.16 10 - 16 teeth £35.20 2553 £35.04 17 or more teeth £43.80 2554 £70.16 Maximum £87.70 2560 25A[2] WITH OTHER ITEMS [adults only] £20.76 < £10 £25.95 2555 £38.04 £10.01 - £25 £47.55 2556 £54.84 £25.01 - £50 £68.55 2557 £70.16 >£50 £87.70 2558 £9.96 25C[2] Inhalation £18.35 2573 Fee paid for 2573 is calculated as Inhalation @ £12.45 plus Supplement @ £5.90. The patient will only pay 80% of Inhalation CODE

FEE

25C[2] Injection £29.95 2574 Fee paid for 2574 is calculated as Injection @ £22.25 plus Supplement @ £7.70. The patient will only pay 80% of Injection ACRYLIC DENTURES 27B[1] Full Upper + Lower £179.75 2730 27B[2] Full Upper Lower 2731 £112.15 2732 27B[3] Partial 1 - 3 teeth 2733 £70.30 2735 4 - 8 teeth 2733 £93.20 2735 9 or more 2733 £110.85 2735

£17.80

£143.80 £89.72 £56.24 £74.56 £88.68

Note 2738 maximum denture code no longer applies: Use Upper/Lower codes. 2741

2742

£158.45

£126.76

27C[2]

Part plate design 1 - 3 teeth 2743 4 - 8 teeth 2743 9 or more 2743

2747 2747 2747

£161.90 £177.60 £184.65

£129.52 £142.08 £147.72

27C[3]

Single bar 1 - 3 teeth 4 or more

2744 2744

2748 2748

£170.70 £186.35

£136.56 £149.08

2745 2745

2749 2749

£177.60 £198.85

£142.08 £159.08

2801 2803 2821

2802 2804 2822

£16.95 £24.60 £7.85

£0.00 £0.00 £0.00

£38.80 £38.80

£0.00 £0.00



27C[1]

Full



27C[4] Multi bar 1 - 3 teeth 4 or more REPAIRS 28A[1] 28A[2] 28A[4] Impression MAXIMUM REPAIR Upper Lower

2810 01 2810 01 2820 01 2820 01

CODE Upper

EASING 2831 28B RELINES 2851 28C[1] 2853 28C[2] 2855 28C[3] ADDITIONS 2861 28D[1] Clasp 2863 28D[2] Tooth 2865 28D[3] Gum Maximum addition fee - per denture

CODE Lower

FEE

PATIENT CHARGE

2832

£11.90

£9.52

2852 2854 2856

£40.30 £45.75 £61.70

£32.24 £36.60 £49.36

2862 2864 2866

£33.35 £28.10 £28.10

£26.68 £22.48 £22.48

Combinations of 2 or more additions with or without repairs £38.04 2880 19 £47.55 Maximum fee applies per denture ORTHODONTIC APPLIANCE £99.84 3201 3202 £124.80 32A[1] £95.76 3203 3204 £119.70 32A[2] 3205 3206 £349.95 £279.96 32A[3] 3207 £214.60 £171.68 32A[4] £73.28 3211 3212 £91.60 32A[5] £40.76 3221 3223 £50.95 Extra-oral traction £40.76 3222 3224 £50.95 Anchorage RETENTION £25.28 3231 £31.60 32B[1] First period £12.68 3232 £15.85 Additional period RETENTION APPLIANCES £49.36 3234 £61.70 32B[2] Removable 3233 £56.24 3235 3236 £70.30 Fixed £40.00 3237 3238 £50.00 Pressure REPAIRS - Updated £0.00 3241 3247 £25.95 32C[1] £0.00 3242 3428 £31.60 32C[2] One repair £0.00 3242 3428 £8.15 Each additional £0.00 £40.30 3230 32C[3] (upper + lower) £0.00 3245 3246 £7.85 IMPRESSION REPLACEMENT APPLIANCES - REG 9 charge is decided by the Health Board £39.36 3281 £49.20 32E[1] Space maintainer £53.48 3282 £66.85 32E[2] Removable £54.84 3283 £68.55 32E[3] Simple fixed 3284 £128.45 £102.76 32E[4] Multiband £63.36 3285 £79.20 32E[5] Functional DOMICILIARY VISITS - Registered/Occasional - supporting observations should be given £0.00 3501 / 5701 £37.00 35 / 57A < 10 miles £0.00 3502 / 5702 £50.95 10 - 40 miles £0.00 3503 / 5703 £66.85 over 40 miles RE-OPEN SURGERY - Registered/Occasional £0.00 3511 / 5711 £43.80 35 / 57B < 1 mile £0.00 3512 / 5712 £72.15 over 1 mile ITEM 36 - MISCELLANEOUS TREATMENTS £9.96 3601 £12.45 36A Pathological exam £2.32 3611 £2.90 36B Grinding £4.32 3631 £5.40 36D Sensitive cement PRESCRIPTION - Registered/Occasional - cannot claim with treatment items £3.60 3641 / 4801 £4.50 36E / 48 ACUTE INFECTION - Registered/Occasional £6.28 3701 / 5601 £7.85 37 / 56 DRESSINGS - Occasional - Updated 50A[1] Permanent 1 tooth £4.96 5001 £6.20 or retained 2 teeth £7.08 5001 £8.85 deciduous Each additional £1.84 5001 £2.30 Maximum £14.72 5001 £18.40 50A[2] Deciduous 1 tooth £0.00 5002 £6.20 2 teeth £0.00 5002 £8.85 Each additional £0.00 5002 £2.30 Maximum £0.00 5002 £18.40

4

NOVEMBER 2013 DISCRETIONARY FEE LIST These are the more commonly used discretionary fee items. Some items are often claimed in a course of treatment with discretionary items, and also shown here. The code + fee should be entered onto the GP17. All other discretionary fees must be obtained by contacting Practitioner Services on 0131 275 6300. Enter on the GP17 as previously described. ANAESTHETICS - For treatment other than item 21 use codes as detailed below GENERAL ANAESTHETIC Deleted from the statement of dental remuneration

CODE NO 24A3 [CHILD]

24A2 [ADULT]

25A3 [CHILD]

25A2 [ADULT] [non-discretionary] 2555 01 2556 01 2557 01 2558 01

SEDATION TREATMENT VALUE

UP TO £10.01 £25.01 OVER

2561 01 2561 02 2561 03 2561 04

£10.00 - £25.00 - £50.00 £50.00

FEE £25.95 £47.55 £68.55 £87.70

PATIENT CHARGE [ADULT only] £20.76 £38.04 £54.84 £70.16

TREATMENT DESCRIPTION

CODE NO

FEE

PATIENT CHARGE

RE-CEMENT VENEER

4003 03

£15.00

£12.00

SCALING - Incomplete 10B [1st Visit only]

1000 01

£15.80

£12.64

OPERCULECTOMY

2221 39

£22.25

£17.80

1771 24

£64.70

£51.76

1771 24

£64.70

£51.76

This group has both discretionary and non-discretionary elements RE-CEMENTING A CROWN + PROVIDING A NEW POST 1. Cast metal alloy core + post

[F2]

2. Radix Anchor or Kurer Crown Saver 3. Prefabricated post

[F3]

1771 23

£47.20

£37.76

4. Pinned core

[F4]

1771 21

£31.85

£25.48

Removal of Crown prior to repair

1771 11

£16.35

£13.08

Removal of Post prior to repair [this item is non-discretionary]

1744 01

£16.60

£13.28

1 unit

1771 14

£25.95

£20.76

2 units

1771 15

£39.05

£31.24

1771 16

£52.00

£41.60

1871 11

£62.80

£0.00

1871 12

£51.40

£0.00

1871 12

£51.40

£0.00

REPAIR OF A PORCELAIN USING A SPECIAL PORCELAIN REPAIR KIT

3 units

Maximum

RE-CEMENTING A BRIDGE + PROVIDING A NEW POST 1. Cast precious metal core + post

[B1]

2. Cast non-precious metal alloy core + post

[B2]

3. Radix Anchor or Kurer Crown Saver 4. Prefabricated post

[B3]

1871 13

£44.35

£0.00

5. Pinned core

[B4]

1871 10

£34.35

£0.00

1. Cast precious metal core + post

[B1]

1871 26

£100.30

£0.00

2. Cast non-precious metal alloy core + post

[B2]

1871 27

£77.35

£0.00

1871 27

£77.35

£0.00

1871 28

£63.35

£0.00

1871 25

£43.40

£0.00

RE-CEMENTING A BRIDGE + PROVIDING 2 NEW POSTS

3. Radix Anchor or Kurer Crown Saver 4. Prefabricated post

[B3]

5. Pinned core

[B4]

5

NOVEMBER 2013 DISCRETIONARY FEE LIST DESCRIPTION REPAIR TO PORCELAIN BY RE-BONDING PORCELAIN IN A LAB

CODE NO

FEE

PATIENT CHARGE

1 unit

1871 07

£39.00

£0.00

2 units

1871 08

£58.50

£0.00

1871 09

£77.85

£0.00

1 unit

1871 14

£ 25.95

£0.00

2 units

1871 15

£39.00

£0.00

1871 16

£51.90

£0.00

1871 01 1871 23

£23.80 £113.70

£0.00 £0.00

2801 01

£16.95

£0.00

2821 01

£7.85

£0.00

2811 07

£23.10

£0.00

3 units



Maximum

REPAIR TO PORCELAIN USING A SPECIAL PORCELAIN REPAIR KIT

3 units

Maximum

Sectioning / Removal of Bridge Repair of Bridge using a Porcelain Veneer REPAIRS INVOLVING METALWORK [SOLDERING/WELDING] Repair fee [Fracture/Re-fix tooth]

[this item is non-discretionary]

Impression fee

[this item is non-discretionary]

Metalwork fee Total Repair fee [Clasp]

[this item is non-discretionary]

Impression fee

[this item is non-discretionary]

Metalwork fee

£47.90 2803 01

£24.60

£0.00

2821 01

£7.85

£0.00

2811 07

£23.10

£0.00

£55.55

Total This group has both discretionary and non-discretionary elements ADDITIONS INVOLVING METALWORK [SOLDERING/WELDING] 2863 01

£28.10

£22.48

2871 15

£23.10

£18.48

£51.20

£40.96

2861 01

£33.35

£26.68

2871 15

£23.10

£18.48

£56.45

£45.16

2871 14

£23.80

£19.04

1-3 teeth

2733 01-03

£70.30

£56.24

4-8 teeth

2733 04-08

£93.20

£74.56

9+ teeth

2733 09-15

£110.85

£88.68

[this item is non-discretionary] Lower

2735 01-03

£70.30

£56.24

2735 04-08

£93.20

£74.56

2735 09-15

£110.85

£88.68

Addition [Tooth]

[this item is non-discretionary]

Metalwork fee Total Addition [Clasp]

[this item is non-discretionary]

Metalwork fee Total Note -

Do not claim an impression fee as this is already included in the Addition fee

Stripping Fee Reconstruction of a metal denture

[this item is non-discretionary] Upper

1 -3 teeth

Note 4-8 teeth When reconstructing a metal denture involving stripping, claim the stripping fee 2871 14 and add the fee for the 9+ teeth denture corresponding to the number of teeth involved. Example To reconstruct a partial upper denture involving 5 teeth: Add 2871 14 to 2733 05: £23.80 + £93.20 = £117.00

6

NOVEMBER 2013 INCOMPLETE METAL DENTURES CODES AND FEES

62E - 25%

62F - 50%

6240 01

F/F

£44.95 6250 01 F / F £89.90

6241 01 6242 01 - 03 6242 04 - 08 6242 09 or more

F / - P / - P / - P / -

£28.05 6251 01 F / - £56.10 £17.55 6252 01 - 03 P / - £35.15 £23.30 6252 04 - 08 P / - £46.60 £27.70 6252 09 or more P / - £55.45

6243 01 6244 01 - 03 6244 04 - 08 6244 09 or more

-/F -/P -/P -/P

£28.05 £17.55 £23.30 £27.70

62G - 70% Horseshoe / Plate

6253 6254 6254 6254

62H - 85% Horseshoe / Plate

01 01 - 03 04 - 08 09 or more

-/F -/P -/P -/P

£56.10 £35.15 £46.60 £55.45

62i - 95% Horseshoe / Plate



6261 01 6263 01 - 03 6263 04 - 08 6263 09 or more

F / - P / - P / - P / -

£110.90 £113.35 £124.30 £129.25

6271 01 6273 01 - 03 6273 04 - 08 6273 09 or more

F / - P / - P / - P / -

£134.70 £137.60 £150.95 £156.95

6281 01 6283 01 - 03 6283 04 - 08 6283 09 or more

F / - P / - P / - P / -

£150.55 £153.80 £168.70 £175.40

6262 01 6266 01 - 03 6266 04 - 08 6266 09 or more

- / F - / P - / P - / P

£110.90 £113.35 £124.30 £129.25

6272 01 6276 01 - 03 6276 04 - 08 6276 09 or more

-/F - / P - / P -/P

£134.70 £137.60 £150.95 £156.95

6282 01 6286 01 - 03 6286 04 - 08 6286 09 or more

-/F -/P - / P - / P

£150.55 £153.80 £168.70 £175.40

Skeleton - Single Connecting Bars

Skeleton - Single Connecting Bars

Skeleton - Single Connecting Bars

6264 01 - 03 6264 04 or more

P / - P / -

£119.50 £130.45

6274 01 - 03 6274 04 or more

P / - P / -

£145.10 £158.40

6284 01 - 03 6284 04 or more

P / - P / -

£162.15 £177.05

6267 01 - 03 6267 04 or more

-/P -/P

£119.50 £130.45

6277 01 - 03 6277 04 or more

-/P -/P

£145.10 £158.40

6287 01 - 03 6287 04 or more

-/P -/P

£162.15 £177.05

Skeleton - Multiple Connecting Bars

Skeleton - Multiple Connecting Bars

Skeleton - Multiple Connecting Bars

6265 01 - 03 6265 04 or more

P / - P / -

£124.30 £139.20

6275 01 - 03 6275 04 or more

P / - P / -

£150.95 £169.00

6285 01 - 03 6285 04 or more

P / - P / -

£168.70 £188.90

6268 01 - 03 6268 04 or more

-/P -/P

£124.30 £139.20

6278 01 - 03 6278 04 or more

-/P - / P

£150.95 £169.00

6288 01 - 03 6288 04 or more

-/P -/P

£168.70 £188.90

7

NOVEMBER 2013 INCOMPLETE ACRYLIC DENTURES CODES AND FEES

62A - 25%

62B - 50%

6200 01

F/F

£44.95

6210 01

F/F

£89.90

6201 01 6202 01 - 03 6202 04 - 08 6202 09 or more

F / - P / - P / - P / -

£28.05 £17.55 £23.30 £27.70



6211 01 6212 01 - 03 6212 04 - 08 6212 09 or more

F / - P / - P / - P / -

£56.10 £35.15 £46.60 £55.45

6203 01

-/F

£28.05



6213 01

-/F

£56.10

6204 01 - 03 6204 04 - 08 6204 09 or more

-/P -/P -/P

£17.55 £23.30 £27.70



6214 01 - 03 6214 04 - 08 6214 09 or more

-/P -/P -/P

£35.15 £46.60 £55.45



62C - 66 2/3 % 62D - 95% 6220 01

F/F

£119.85

6230 01

F/F

£170.75

6221 01

F / -

£74.75

6231 01

F / -

£106.55

6222 01 - 03 6222 04 - 08 6222 09 or more

P / - P / - P / -

£46.85 £62.15 £73.90

6232 01 - 03 6232 04 - 08 6232 09 or more

P / - P / - P / -

£66.80 £88.55 £105.30

6223 01

-/F

£74.75

6233 01

-/F

£106.55

6224 01 - 03 6224 04 - 08 6224 09 or more

-/P -/P -/P

£46.85 £62.15 £73.90

6234 01 - 03 6234 04 - 08 6234 09 or more

-/P -/P -/P

£66.80 £88.55 £105.30

Please note:

From 01/12/98 the maximum denture code/fee no longer applies - use upper and lower codes.



When a patient returns to have a denture fitted, 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.

8



In the last 5 complete calendar months In the last 23 complete calendar months

In the last 5 complete calendar months In the last 23 complete calendar months

1 2 3 4 5 6 7 8 9 10 11



In the last 23 complete calendar months In the last 23 complete calendar months (see note 8)

In the last 5 complete calendar months

Item 1c

No time-bar

No time-bar

No time-bar

Item 1a Trauma

9

Time-bar checks are carried out against a history for the same dentist. The same dentist is defined as the original dentist, a partner/principal/associate, or another dentist with whom the original dentist has a financial arrangement. The examination time-bar is calculated based on the acceptance date of the claims. The time-bars do not apply if the examination is a result of trauma. The trauma box must be ticked and observations given. To calculate complete calendar months, for example 5 calendar months, add 6 months, the time bar will expire on the first day of the sixth month. For example:Claim on 18/03/2002, the next claim is possible on or after 01/09/2002. If a patient returns after their registration has lapsed, the 23 month time-bar for Item 1(b) or 1(c) examinations still applies. The Item 1(c) time-bar does not apply when the total fee for treatment claimed exceeds £600.00 Item 1(a) is most likely to be claimed for a regular patient, when the dentist is familiar with the patient’s oral health. Item 1(b) is most likely to be claimed for a patient who is new to the practice. Charting of the patient’s periodontal status must be reported in the patient record. Item 1(c) may be claimed in connection with Item 10(c); Item 18; when treatment is of special complexity involving Items 16, 17; in dentate cases involving  Item 27(b) and 27(c), and when the total fee for treatment claimed exceeds £600.00. 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.

INFORMATION NOTES

No time-bar

Item 1b

Item 1a

Item 1c No time-bar

Item 1a Item 1b

If you have You cannot claim an carried out an

HISTORICAL CLAIM AND TIME-BAR PERIOD

EXAMPLE If you wish to claim an item 1(a) exam, and you previously claimed an item 1(c) you would need to wait 5 complete calendar months.

USING THE TABLE Identify the exam being claimed in left-hand side of the table and cross-reference along the table to ensure a previously claimed exam has not been paid within the stated time period.

ITEM 1 - GENERAL EXAMINATION TIME-BARS

Item 1c Orthodontic

1 2 3 4 5



In the last 5 complete calendar months

In the last 5 complete calendar months

In the last 23 complete calendar months

Orthodontic examination fees can only be paid for a patient who has an established or developing malocclusion. An Item 1(c) examination is only payable when study casts and radiographs (if appropriate) are available, and are recorded as available on the claim; the referring dentist or hospital may provide models or radiographs for the orthodontist. An item 1(a) and an item 1(c) are not payable where there are no permanent teeth present. An Item 1(c) claim on a GP17(0) does not bar simultaneous claims for Items 1(a) or 1(b) on GP17 forms when the dentist is also responsible for thepatient’s general care. Orthodontic examinations must be made using GP17(0) forms, with the appropriate information detailed.

INFORMATION NOTES



You cannot claim an Item 1a Item 1b Item 1c If you have Orthodontic Orthodontic Orthodontic carried out an In the last 5 complete In the last 5 complete In the last 5 complete Item 1a Orthodontic calendar months calendar months calendar months In the last 23 complete In the last 23 complete In the last 23 complete Item 1b Orthodontic calendar months calendar months calendar months

HISTORICAL CLAIM AND TIME-BAR PERIOD

EXAMPLE If you wish to claim an item 1(b) Orthodontic exam, and you previously claimed an item 1(c) you would need to wait 23 complete calendar months.

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USING THE TABLE Identify the exam being claimed in the left-hand side of the table and cross-reference along the table to ensure a previously claimed exam has not been paid within the stated time period.

ITEM 1 - ORTHODONTIC EXAMINATION TIME-BARS

1 2 3 4 5 6 7 8 9

11

Time-bar checks are carried out against a history for the same dentist. The same dentist is defined as the original dentist, a partner/principal/associate, or another dentist with whom the original dentist has a financial arrangement. The time-bars for item 10 are calculated based on the acceptance date of the historical claim to the completion date of the current claim. Only one item 10 is payable per course of treatment. Treatment under item 10 is inclusive of oral hygiene instruction, therefore a fee under item 6 cannot be claimed at the same time. Item 10(a) is only payable in conjunction with an item 1(a), (b) or c) exam or where an exam was claimed within the previous 11 complete calendar months. Item 10(b) is only payable in conjunction with an item 1(a), (b) or (c) exam or where an exam was claimed within the previous 11 complete calendar months. Item 10(c) is only payable in conjunction with an item 1(c) exam or where an item 1 (c) exam was claimed within the previous 23 complete calendar months. Item 10(c) - radiographs must be available and recorded as available on the claim.

INFORMATION NOTES

9 complete calendar months

9 complete calendar months

No time-bar

Item 10c



9 complete calendar months

9 complete calendar months

Item 10b



No time-bar

Item 10c

No time-bar

No time-bar No time-bar (normally 2 complete calendar months)



Item 10a



Item 10b

Item 10a

You cannot claim an carried out an

If you have

HISTORICAL CLAIM AND TIME-BAR PERIOD

USING THE TABLE Identify the exam being claimed in left-hand side of the table and cross-reference along the table to ensure a previously claimed exam has not been paid within the stated time period. EXAMPLE If you wish to claim an item 10(b), and you previously claimed an item 10(c) you would have to wait 9 complete calendar months.

ITEM 10 - PERIODONTAL TREATMENT TIME-BARS

NOVEMBER 2013 COMBINATION CODES - GENERAL* DESCRIPTION REGISTERED

OCCASIONAL

FEE

CHARGE

Re-fixing a clasp + 1 fracture

2805 01

5505 01

£30.55

£0.00

Re-fixing a clasp + 2 fractures

2805 02

5505 02

£36.45

£0.00

2805 03 - 05

5505 03 - 05

£38.80

£0.00

Re-fixing a clasp + 1 fracture

2806 01

5506 01

£30.50

£0.00

Re-fixing a clasp + 2 fractures

2806 02

5506 02

£36.40

£0.00

2806 03 - 05

5506 03 - 05

£38.80

£0.00

2810 01 2820 01

5507 01 5508 01

£38.80 £38.80

£0.00 £0.00

2880 01 2880 02

5560 01 5560 02

£33.35 £14.20

£26.68 £0.00

1 addition [tooth] with 1 repair [fracture]

2880 03 2880 04

5560 03 5560 04

£28.10 £16.95

£22.48 £0.00

1 addition [gum] with 1 repair [fracture]

2880 05 2880 06

5560 05 5560 06

£28.10 £16.95

£22.48 £0.00

COMBINATION OF REPAIRS UPPER

Re-fixing a clasp + 3 or more fractures

Maximum

LOWER

Re-fixing a clasp + 3 or more fractures

Maximum

MAXIMUM REPAIR FEE “PER DENTURE” U / - / L COMBINATIONS OF ADDITIONS + REPAIRS 1 addition [clasp] with 1 repair [fracture]

[balance fee**]

1 addition [clasp] with 2 or more repairs

[balance fee**]

2880 07 2880 08

5560 07 5560 08

£33.35 £14.20

£26.68 £0.00

1 addition [tooth] with 2 or more repairs

[balance fee**]

2880 09 2880 10

5560 09 5560 10

£28.10 £19.50

£22.48 £0.00

1 addition [gum] with 2 or more repairs

[balance fee**]

2880 11 2880 12

5560 11 5560 12

£28.10 £19.50

£22.48 £0.00

1 addition [clasp] with re-fix clasp

[balance fee**]

2880 13 2880 14

5560 13 5560 14

£33.35 £14.20

£26.68 £0.00

1 addition [tooth] with re-fix clasp

[balance fee**]

2880 15 2880 16

5560 15 5560 16

£28.10 £19.50

£22.48 £0.00

1 addition [gum] with re-fix clasp

[balance fee**]

2880 17 2880 18

5560 17 5560 18

£28.10 £19.50

£22.48 £0.00

2880 19

5560 19

£47.55

£38.04

Any 2 additions with or without repairs - Maximum Fee

* Found in proviso for item 28/55 ** Maximum fee payable under item 28 and 55 is £47.55 Please note - no fee for impression can be paid with addition

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NOVEMBER 2013 COMBINATION CODES - ORTHODONTIC DESCRIPTION REGISTERED

FEE

CHARGE

32[C][2] + 1 repair under 32[C][1]

3252 01

£39.75

£0.00

32[C][2] + 2 or more repairs under 32[C][1]

3252 02

£47.90

£0.00

3252 03 - 05

£48.25

£0.00

32[C][2] + 1 repair under 32[C][1]

3253 01

£39.75

£0.00

32[C][2] + 2 or more repairs under 32[C][1]

3253 02

£47.90

£0.00

3253 03 - 05

£48.25

£0.00

OCCASIONAL

FEE

CHARGE

55[E][2] + 1 repair under 55[E][1]

5593 01

£39.75

£0.00

55[E][2] + 2 or more repairs under 55[E][1]

5593 02

£47.90

£0.00

5593 03 - 05

£48.25

£0.00

55[E][2] + 1 repair under 55[E][1]

5594 01

£39.75

£0.00

55[E][2] + 2 or more repairs under 55[E][1]

5594 02

£47.90

£0.00

5594 03 - 05

£48.25

£0.00

COMBINATION OF REPAIRS UPPER

32[C][2] + 3 or more repairs under 32[C][1]

Maximum

LOWER

32[C][2] + 3 or more repairs under 32[C][1]

Maximum

Please note - for item 32, the dentist must have fitted an appliance before any fee is payable. UPPER

55[E][2] + 3 or more repairs under 55[E][1]

Maximum

LOWER

55[E][2] + 3 or more repairs under 55[E][1]

Maximum

MAXIMUM REPAIR FEE PER APPLIANCE U/-

3250 01

5595 01

£48.25

£0.00

-/L

3251 01

5596 01

£48.25

£0.00

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CHANGES TO FREE REPAIR AND REPLACEMENT From 1 December 2012, a dentist cannot claim for repairing or replacing the following treatments when this happens within 11 complete calendar months of the original restoration by that dentist or another dentist acting on the dentist’s behalf: Permanent fillings: 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) Root fillings:

Items 15 (a) and (d)

Inlays and Crowns: Items 17 (a) - (k) Bridges:

Items 18 (a) - (h) Occasional treatment items 51 (d) and (e)

A dentist could still claim however where the repair or replacement is as a result of trauma external to the mouth, as defined in Section I of the Statement of Dental Remuneration, and observations are clearly given in the claim. No patient charge applies if: It is within 12 months of the original treatment, and is like-for-like, and is subject to the following exclusions: - If private treatment has been applied; - Is intended to be temporary; - Is at the insistence of the patient, but against the advice of the dentist; - Another dentist has carried out occasional (other than temporary) treatment within 12 months, and it doesn’t fall under the same dentist rule. - The dentist thinks restoring the tooth by repairing or replacing would not work, and that different treatment is needed; - It is due to trauma. Other conditions may apply, and we recommend you familiarise yourself with: NHS (General Dental Services)(Scotland) Regulations 2010 at : www.legislation.gov.uk/ssi/2010/208/contents/made?text=Dental%20Regulations

MISCELLANEOUS INFORMATION Maximum patient charge - £384 Prior approval limit - £350 Payments will arrive in your bank account on the twentieth of each month (or the Friday before, if the twentieth falls on a weekend).



Closing date for each schedule month (Example below is for June)

GP17 paper claims Electronic Data Interchange (EDI)

4.30pm on last working day of schedule (30 June in this example) Seventh day of the following month (7 July in this example)*

*Subject to change. Please check your broadcast messages.

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Helpdesk Tel

0131 275 6300

Mon-Thurs 8.45am - 4.45pm & Fri 8.45am - 4.15pm or email [email protected] When contacting Practitioner Services please quote your List Number. For Electronic Data Interchange (EDI) dentists, please quote your Location Number/Code.