| Dental Item | Dental Service | Standard Fees |
| Diagnostic | ||
| 011 | Oral Exam – Comprehensive | 70 |
| 012 | Oral Exam – Periodic | 55 |
| 013 | Oral Exam – Limited | 50 |
| 014 | Consultation | 60 |
| 022 | X-Ray – Per Film | 45 |
| 037 | X-Ray – Panoramic (OPG) | 90 |
| 071 | Diagnostic Model – Per Model | 60 |
| 072 | Photographic Records – Intraoral | 40 |
| Preventive | ||
| 111 | Plaque/Stain Removal | 70 |
| 114 | Calculus Removal | 120 |
| 118 | Bleaching, External – Per Tooth | 40.60 |
| 121 | Topical Remineralising | 35 |
| 141 | Oral Hygiene Instruction | 40 |
| 151 | Provision of Mouthguard | 250 |
| 161 | Fissure Sealing – Per Tooth | 70 |
| Periodontics | ||
| 222 | Root Planing & Curettage – Per Tooth | 30 |
| Oral Surgery | ||
| 311 | Removal of a Tooth or Part(s) Thereof | 200 |
| 322 | Surgical Removal of Tooth or Tooth Fragment Not Requiring Bone Removal or Tooth Division | 350 |
| 323 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal | 375 |
| 324 | Surgical Removal of Tooth or Tooth Fragment Requiring Bone Removal and Tooth Division | 600 |
Endodontics |
||
| 411 | Direct Pulp Capping | 50 |
| 415 | Chemo-Mechanical Preparation – 1 Canal | 200 |
| 416 | Chemo-Mechanical Preparation – Additional Canal | 150 |
| 417 | Pulp Obturation – One Canal | 250 |
| 418 | Pulp Obturation – Each Additional Canal | 150 |
| 419 | Extirpation Pulp/Debridement of Root Canal(s) | 190 |
| 455 | Additional Visit Irrigate/Ressing Root Canal System – Per Tooth | 120 |
| 415,417 | Front Tooth Root Canal (1 Canal) (Excluding X-Rays) | 450 |
| 415,416,417, 418 |
Premolar Root Canal (2 Canals) (Excluding X-Rays) | 750 |
| 415,416,416, 417,418,418 |
Molar Root Canal (3 Canals)(Excluding x-rays, filling, crown & any other dental item you may require) | 1050 |
| Restorations | ||
| 511 | Metallic – 1 Surface | 160 |
| 512 | Metallic – 2 Surfaces | 180 |
| 513 | Metallic – 3 Surfaces | 200 |
| 514 | Metallic – 4 Surfaces | 220 |
| 515 | Metallic – 5 Surfaces | 240 |
| 521 | White Filling – 1 Surface – Front Tooth | 170 |
| 522 | White Filling – 2 Surfaces – Front Tooth | 190 |
| 523 | White Filling – 3 Surfaces – Front Tooth | 210 |
| 524 | White Filling – 4 Surfaces – Front Tooth | 240 |
| 525 | White Filling – 5 Surfaces – Front Tooth | 270 |
| 531 | White Filling – 1 Surface – Back Tooth | 180 |
| 532 | White Filling – 2 Surfaces – Back Tooth | 200 |
| 533 | White Filling – 3 Surfaces – Back Tooth | 220 |
| 534 | White Filling – 4 Surfaces – Back Tooth | 240 |
| 535 | White Filling – 5 Surfaces – Back Tooth | 270 |
| 575 | Pin Retention – Per Pin | 30 |
| 577 | Cusp Capping – Per Cusp | 30 |
| 578 | Restoration Incisal Corner – Per Corner | 30 |
| 526 | Composite Veneer – Direct – Per Tooth | 350 |
| 556 | Porcelain Veneer – Indirect – Per Tooth | 1200 |
| Crowns & Bridges (Lab Fees Included) | ||
| 615 | Full Crown – Veneered – Indirect | 1400 |
| 618 | Full Crown – Metallic – Indirect | 1200 |
| 627 | Preliminary Restoration for Crown – Direct | 300 |
| 643 | Bridge Pontic – Indirect – Per Pontic | 1100 |
| 651 | Re-cementing Crown or Veneer | 190 |
| Prosthodontics | ||
| 711 | Upper Denture (Full Denture) | 1200 |
| 721 | Partial (Acrylic, Flexible, Metal) – Starts from | 700 |
| 719 | Upper & Lower Denture | 2400 |
| 733 | Tooth/Teeth (Partial Denture) | 40 |
| 741 | Adjustment of a Denture | 50 |
| 743 | Relining – Complete Denture – Processed | 300 |
| 763 | Repair Base – Complete Denture | 190 |
| 768 | Partial Denture – Extracted Tooth Replacement – Per Tooth | 200 |
| 776 | Impression for Denture Repair | 65 |
| General | ||
| 911 | Palliative Care | 190 |
| 926 | Individually Made Tray – Medicament(s) | 150 |
| 965 | Occlusal Splint | 600 |
* Bulk Billing for Medicare Patient (Referral)
