Acts and Regulations
84-115 - General
Schedule
Disposition versions
10Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a pharmacy shall be that set out in section 16 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11 which may be collected from the person.
12Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a dispensing physician shall be that set out in section 22 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11, which may be collected from the person.
1 | DIAGNOSTIC SERVICES | Fee on or after May 1, 1989 |
01200 | Oral examination | $13.00 |
01200 | Recall oral examination | $13.00 |
A fee for an oral examination will be paid once within a period of twelve consecutive months. A fee for a recall oral examination may be paid once within a period of six consecutive months for children in the care of the Minister of Social Development under the Family Services Act and social assistance dependent children who have not reached their fourteenth birthday. | ||
01300 | Emergency examination | $13.00 |
02111 | First film | $10.20 |
02112 | Each additional film (regardless of type) | $ 3.80 |
Radiographs are required for all services listed in Article 5.02 or when requested by the Dental Advisory Committee. | ||
Only radiographs of proper angulation and exposure will be covered under the Agreement. | ||
Diagnostic films for a beneficiary are limited to four unless additional films are requested by the Dental Advisory Committee. | ||
02600 | Panorex | $28.50 |
The above rate of payment for Panorex shall be paid when the x-rays are | ||
(a) | ||
(b) | ||
(c) | ||
Where a Panorex x-ray is submitted in cases other than those enumerated above, the rate of payment on or after May 1, 1989 is $17.70. | ||
Panorex x-rays are not accepted for evaluation of restorative work. | ||
85-61; 86-77; 87-138; 88-219; 89-182; 2016, c.37, s.84; 2019, c.2, s.68 | ||
2 | SURGICAL SERVICES | Fee on or after May 1, 1989 |
Removal of erupted teeth - uncomplicated | ||
71101 | Single tooth - initial extraction (bone contouring or treatment of post-surgical complications included) | $ 25.10 |
71111 | Each additional tooth - same quadrant | $ 12.00 |
72100 | Impactions - I.C. Maximum | $113.30 |
72210 | Impactions - I.C. Maximum | $113.30 |
72220 | Impactions - I.C. Maximum | $118.40 |
72230 | Impactions - I.C. Maximum | $118.40 |
The maximum fee on or after May 1, 1989 for full mouth surgical removal of teeth (twenty-two or more teeth) including alveoloplasty in any one case shall not exceed $186.00. Prior approval by the Dental Advisory Committee is required for | ||
(a) | ||
(b) | ||
73133 | Excision of torus palatinus | $164.00 |
73134 | Excision of torus mandibularis (unilateral) | $ 90.00 |
73135 | Excision of torus mandibularis (bilateral) | $145.00 |
Fees for excisions under 73133, 73134 and 73135 shall be paid only if | ||
(a) | ||
(b) | ||
79306 | Closure of oro-antral fistula (oral surgeon only) - I.C. | |
The fees on or after May 1, 1989 shall be a minimum of $66.00 and a maximum of $112.00. | ||
79600 | Post surgical treatment - I.C. Maximum | $103.00 |
Approval of the fee by the Dental Advisory Committee is required for post surgical treatment. Payment shall be made only when this treatment is done by other than the treating dentist. | ||
79999 | Emergency treatment of accidental trauma to the mouth for persons under eighteen years of age. The request for payment shall be accompanied by an explanation of the circumstances of the accident and a description of the details of treatment. | I.C. |
85-61; 86-77; 87-138; 88-219; 89-182; 94-152; 2000, c.26, s.152; 2008, c.6, s.25 | ||
3 | RESTORATIVE SERVICES | Fee on or after May 1, 1989 |
Amalgam Restorations | ||
(a) | ||
21101 | Amalgam, one surface | $23.50 |
21102 | Amalgam, two surfaces | $31.50 |
21103 | Amalgam, three surfaces or more | $39.50 |
(b) | ||
21211 | Amalgam, one surface | $24.00 |
21212 | Amalgam, two surfaces | $39.50 |
21213 | Amalgam, three surfaces or more | $47.50 |
(c) | ||
21221 | Amalgam, one surface | $32.50 |
21222 | Amalgam, two surfaces | $45.50 |
21223 | Amalgam, three surfaces or more | $56.50 |
(d) | ||
21301 | Retentive pin, additional, one pin - per restoration | $ 8.80 |
21302 | Retentive pin, additional, two pins - per restoration | $19.00 |
(e) | ||
23101 | Class I and V | $30.50 |
23102 | Class III | $30.50 |
23103 | Class IV | $51.00 |
The maximum per tooth allowance for composite restoration on or after May 1, 1989 will ordinarily be $51.40 except in the case of two Class III restorations where the maximum per tooth allowance on or after May 1, 1989 will be $55.80. | ||
(f) | ||
23111 | Class I and V | $41.00 |
23112 | Class III | $50.00 |
23113 | Class IV | $79.80 |
23114 | Double Class IV | $93.30 |
The maximum per tooth allowance on or after May 1, 1989 for two Class III acid etched restorations is $84.50. | ||
Acid etch on deciduous teeth is not an entitled service. | ||
Acid etch Class V is an entitled service on permanent anteriors and buccal surfaces of maxillary bicuspids only. | ||
The maximum per tooth allowance on or after May 1, 1989 for more than one Class IV restoration is $93.30. This fee includes retentive pins if applicable. | ||
Acid etch Class I is an entitled service on anterior permanent teeth only. | ||
If a restoration is redone by the same dentist within a period of six months, the second restoration is not an entitled service. | ||
Restoration on tooth number 51, 52, 61, 62, 71, 72, 81 or 82 is not an entitled service. | ||
(g) | ||
Prior approval from the Dental Advisory Committee is required in all cases. | ||
22220 | Preformed stainless steel - Primary posterior tooth - per tooth | $68.00 |
Payment for preformed stainless steel primary posterior tooth number 54, 64, 74 or 84 is available only for children who are under nine years of age. | ||
22310 | Preformed stainless steel - Permanent anterior tooth | I.C. |
22320 | Preformed stainless steel - Permanent posterior tooth | $68.00 |
22410 | Prefabricated restoration on primary cuspid anterior tooth number 53, 63, 73, or 83 | $68.00 |
22510 | Acrylic or plastic transitional, direct (prefabricated) | I.C. |
Fees for filling include any necessary pulp protection. | ||
When at the same sitting, in order to conserve tooth structure, two separate restorations are performed on the same tooth involving a common surface, the fee will be assessed as one restoration. | ||
The dental practitioner must include the proper procedure code, international tooth code and the names of the surfaces restored in order to obtain payment for a restoration. | ||
85-61; 86-77; 87-138; 88-219; 89-182 | ||
4 | PREVENTIVE SERVICES | Fee on or after May 1, 1989 |
Dental prophylaxis | ||
11100 | Primary dentition | $18.20 |
11200 | Mixed dentition | $22.00 |
11300 | Permanent dentition | $35.00 |
Dental prophylaxis is available once within a period of six consecutive months for children who are under fourteen years of age. Children who are fourteen years of age and over and under eighteen years of age are entitled to one prophylaxis within a period of twelve consecutive months. Dental prophylaxis will be considered for persons eighteen years of age and over only in cases where minor scaling is necessary in order to fabricate a partial denture. | ||
Fluoride treatment | ||
12400 | Fluoride topical application | $11.30 |
Topical application of fluoride gel or liquid subsequent to prophylaxis is available once within a period of six consecutive months for children who are under fourteen years of age. Children who are fourteen years of age and over and under eighteen years of age are entitled to one topical application within a period of twelve consecutive months. | ||
85-61; 86-77; 87-138; 88-219; 89-182 | ||
5 | PROSTHETIC SERVICES | Gross fee on or after May 1, 1989 | 75% |
Prior approval by the Dental Advisory Committee is required for complete or partial dentures. | |||
Complete dentures | |||
51100 | Complete maxillary denture | $268.80 + Lab | $201.60 + Lab |
51110 | Complete mandibular denture | $268.80 + Lab | $201.60 + Lab |
These services include breakdown of T factor applicable, impressions, registrations, selection of shade and mold, try-in, insertion and adjustments. | |||
Removable partial dentures | |||
52120 | Maxillary, acrylic base - no clasps | $109.60 + Lab | $82.20 + Lab |
52121 | Mandibular, acrylic base - no clasps | $109.60 + Lab | $82.20 + Lab |
52220 | Maxillary, acrylic base - with wrought clasps | $159.70 + Lab | $119.80 + Lab |
52221 | Mandibular, acrylic base - with wrought clasps | $159.70 + Lab | $119.80 + Lab |
These services include breakdown of T factors applicable, diagnostic models, analysis and design, tooth preparation and master impression, bite registration, mold, selection and shade, try-in, insertion and adjustments. | |||
For children who are in the care of the Minister of Social Development under the Family Services Act and social assistance dependent children payment will be made at the gross amount. | |||
For adult beneficiaries and adult dependents payment will be made at 75%. Payment of the balance is to be negotiated between the patient and the dental practitioner. The payment of the balance by the patient is not to include any laboratory fees. The participation fee applies only to the dentist fee. | |||
The total laboratory fee for upper and lower vitallium partial dentures is payable if prior approval is obtained from the Dental Advisory Committee. | |||
Fees for dentures or partial dentures are not ordinarily payable more frequently than once in five years unless prior approval is obtained from the Dental Advisory Committee. | |||
For partial dentures the dental practitioner must state what teeth are missing as partial dentures will be approved only if | |||
(a) | |||
(b) | |||
85-61; 86-77; 87-138; 88-219; 89-182; 2016, c.37, s.84; 2019, c.2, s.68 | |||
6 | DENTURE REPAIRS | Gross Fee on or after May 1, 1989 | 75% |
Repair of Complete Dentures | |||
55101 | Maxillary, no impression required | $23.60 + Lab | $17.70 + Lab |
55201 | Maxillary, impression required | $34.90 + Lab | $26.20 + Lab |
55102 | Mandibular, no impression required | $23.60 + Lab | $17.70 + Lab |
55202 | Mandibular, impression required | $34.90 + Lab | $26.20 + Lab |
Repair of partial dentures (acrylic or vitallium only) | |||
55103 | Maxillary, no impression required | $26.30 + Lab | $19.70 + Lab |
55203 | Maxillary, impression required | $36.30 + Lab | $27.20 + Lab |
55104 | Mandibular, no impression required | $26.30 + Lab | $19.70 + Lab |
55204 | Mandibular, impression required | $36.30 + Lab | $ 27.20 + Lab |
55535 | Addition or replacement of a clasp with a new clasp | $32.00 + Lab | $24.00 + Lab |
55539 | Each additional clasp | $30.70 + Lab | $23.00 + Lab |
Denture (complete or partial) relining or rebasing | |||
56200 | Relining maxillary, complete denture - no lab required | $44.70 | $33.50 |
56201 | Relining mandibular, complete denture - no lab required | $44.70 | $33.50 |
56220 | Maxillary, complete - processed | $82.90 + Lab | $62.20 + Lab |
56221 | Mandibular, complete - processed | $82.90 + Lab | $62.20 + Lab |
56270 | Maxillary, soft tissue conditioning | $44.70 | $33.50 |
56271 | Mandibular, soft tissue conditioning | $44.70 | $33.50 |
Fees for complete or partial relining or rebasing or for tissue conditioning are not payable more frequently than once in each year. | |||
No prior approval of the Dental Advisory Committee is required for entitled denture repairs. | |||
For children in the care of the Minister of Social Development under the Family Services Act and social assistance dependent children payment will be made at the gross amount for denture repairs including any laboratory fee. | |||
For adult beneficiaries and adult dependents payment will be made at 75% for denture repairs. Payment of the balance is to be negotiated between the patient and the dental practitioner. The payment of the balance by the patient is not to include any laboratory fees. | |||
84-235; 85-61; 86-77; 87-138; 88-219; 89-182; 2016, c.37, s.84; 2019, c.2, s.68 | |||
7 | ADDITIONAL SERVICES | Fee on or after May 1, 1989 |
92310 | Conscious sedation (paedodontist only), per unit Fees for conscious sedation are not payable more often than eight units per patient per year and require referral by another dentist. | $ 30.00 |
94100 | Professional visit (at institution other than a hospital facility) A fee for a professional visit will be paid up to four times per patient per treatment plan. | $ 22.00 |
94200 | Hospital call | $ 24.00 |
94400 | Special office visit after normal hours | $ 32.00 |
86-77; 87-138; 88-219; 89-182; 93-26 | ||
8(1) | ENDODONTIC SERVICES | |
31100 | Pulp capping - traumatic exposure | $ 11.80 |
32200 | Vital pulpotomy - permanent tooth | $ 40.00 |
32210 | Vital pulpotomy - Primary posterior tooth - per tooth Payment for vital pulpotomy on primary tooth number 54, 64, 74 or 84 is available only for children who are under nine years of age. Root canal therapy | $ 27.00 |
33100 | One canal, fully developed root (on anterior teeth only) | $196.00 |
Prior approval by the Dental Advisory Committee is required. | ||
The fee for a root canal includes all x-rays and closing the access canal. | ||
Emergency procedures | ||
39902 | Emergency pulpectomy (trephination through crown included - primary and permanent tooth) | $ 28.50 |
39910 | Trephination through crown into root canal without pulpectomy | $ 17.50 |
39930 | Sedative (palliative) dressing (temporary filling only) | $ 22.00 |
8(2) | PERIODONTAL SERVICE | |
41200 | Emergency service - acute necrotizing ulcerative gingivitis (per unit of time) (A fee for emergency service will be paid for up to two units per service date.) | $ 21.00 |
8(3) | ORTHODONTIC SERVICES | |
01900 | Exam by orthodontist | $ 28.30 |
02600 | Panorex X-ray | $ 28.50 |
04530 | Model | $ 34.50 |
80000 | Treatment by orthodontist | I.C. |
The orthodontist will submit to the Dental Advisory Committee a proposed treatment plan, including an estimate of the cost of treatment, models and a panorex x-ray, if desired. The plan will be reviewed by the Dental Advisory Committee. The orthodontist will be notified of the committee’s decision and will receive payment for the entitled services rendered in preparing the plan, regardless of the decision made. | ||
86-77; 87-138; 88-219; 89-182 | ||
10Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a pharmacy shall be that set out in section 16 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11 which may be collected from the person.
12Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a dispensing physician shall be that set out in section 22 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11, which may be collected from the person.
For a major examination supplied to beneficiaries who are nineteen years of age or older and who are children in the care of the Minister of Social Development under the Family Services Act, payment will be made at the gross amount and for other beneficiaries and dependents payment will be made at the gross amount less the applicable participation fee which the optometrist may collect from the patient. No participation fee is required for minor examinations, tonometry, biomicroscopy or visual fields.
Notwithstanding section 5 of Schedule I, where, on and after September 1, 1986, a person referred to in paragraph 5(b) of that Schedule has a second major examination by another optometrist within the twenty-four month period referred to in that paragraph without receiving the approval of the Director, the second major examination is an entitled service and shall be paid for at the rate prescribed in this Schedule for a minor examination.
(b) (select, measure, order, receive, verify, fit) | Gross fee on or after October 13, 1990 | |
(i) | ||
00081 | Lenses pair, single vision | $18.30 |
00082 | Lenses pair, bifocal | $23.20 |
00090 | Frame (new) | $19.50 |
00091 | Frame (old) | $ 8.40 |
(ii) | ||
00101 | One lens, single vision | $ 8.40 |
00102 | One lens, bifocal | $10.50 |
00103 | Frame, complete | $12.70 |
00104 | Frame, front | $ 5.30 |
00105 | Frame, temple | $ 5.30 |
(iii) | ||
00106 | Miscellaneous repairs, alignment or adjustment (when not included in above fees) | $ 4.20 |
Dispensing fees for new frames are not available unless the optometrist has displayed and made available at all times, under the same conditions of convenience as apply to other frames, a supply of frames that have a wholesale cost per frame not greater than the maximum allowance for a complete frame specified in paragraph 15(a).
Fitting Fees (select, measure, order, receive, verify, fit - initial, replacement or repair) | Gross Fee | |
00010 | lens and frame, single vision | $18.00 |
00011 | lens and frame, bifocal | $20.00 |
00012 | lens only, single vision (each lens) | $ 4.00 |
00013 | lens only, bifocal (each lens) | $ 6.00 |
00014 | frame, complete | $ 4.25 |
00015 | frame, temple only | $ 1.25 |
00016 | frame, front only | $ 3.25 |
00017 | miscellaneous repairs, alignment or adjustment | $ 1.10 |
Dispensing fees for new frames are not available unless the optician has displayed and made available at all times, under the same conditions of convenience as apply to other frames, a supply of frames that have a wholesale cost per frame not greater than the maximum frame allowance specified in paragraph 15(b).
(a) | Maximum Allowance on and after October 13, 1990 | ||
00041 | frame - complete: | ||
(i) | $34.00 | ||
(ii) | $17.00 | ||
00042 | case | $ 1.05 | |
00043 | frame - front only | ||
(i) | $18.60 | ||
(ii) | $ 9.30 | ||
00044 | frame - both temples | ||
(i) | $12.40 | ||
(ii) | $ 6.20 | ||
00045 | frame - one temple | ||
(i) | $ 6.20 | ||
(ii) | $ 3.10 | ||
00047 | replacement frame | $15.80 | |
(b) Opticians | |||
00020 | lenses | Wholesale Price | |
00021 | frame - complete | ||
(i) | $20.00 | ||
(ii) | $17.00 | ||
00022 | frame - front only | ||
(i) | $ 5.50 | ||
(ii) | $ 1.50 | ||
00023 | frame - both temples | ||
(i) | $ 3.00 | ||
(ii) | $ 1.50 | ||
00024 | frame- one temple | ||
(i) | $ 2.00 | ||
(ii) | $ 1.00 | ||
00025 | case | $ 1.00 | |
00027 | Replacement frame, on and after July 29, 1991 | $15.80 | |
84-235; 85-61; 87-27; 89-138; 92-41; 92-42; 2016, c.37, s.84; 2019, c.2, s.68 | |||
Gross Fee on or after January 1, 1989 | 75% | |
Complete maxillary or mandibular, denture - reline | $66.00 | $49.50 |
Complete maxillary or mandibular, denture - rebase | $76.00 | $57.00 |
Complete maxillary or mandibular tissue conditioning | $20.00 | $15.00 |
Complete maxillary or mandibular, denture - repairs (no impression required) | $19.65 | $14.75 |
Complete maxillary or mandibular, denture - repairs (impression required) | $38.00 | $28.50 |
Replacement of lost or fractured tooth | $18.90 | $14.20 |
Minor adjustments - after three months | $ 9.50 | $ 7.10 |
House, nursing home or hospital call - (maximum of four per case per year) | $12.00 | $12.00 |
1 | DIAGNOSTIC SERVICES | Fee on or after May 1, 1989 |
01200 | Oral examination | $13.00 |
01200 | Recall oral examination | $13.00 |
A fee for an oral examination will be paid once within a period of twelve consecutive months. A fee for a recall oral examination may be paid once within a period of six consecutive months for children in the care of the Minister of Families and Children under the Family Services Act and social assistance dependent children who have not reached their fourteenth birthday. | ||
01300 | Emergency examination | $13.00 |
02111 | First film | $10.20 |
02112 | Each additional film (regardless of type) | $ 3.80 |
Radiographs are required for all services listed in Article 5.02 or when requested by the Dental Advisory Committee. | ||
Only radiographs of proper angulation and exposure will be covered under the Agreement. | ||
Diagnostic films for a beneficiary are limited to four unless additional films are requested by the Dental Advisory Committee. | ||
02600 | Panorex | $28.50 |
The above rate of payment for Panorex shall be paid when the x-rays are | ||
(a) | ||
(b) | ||
(c) | ||
Where a Panorex x-ray is submitted in cases other than those enumerated above, the rate of payment on or after May 1, 1989 is $17.70. | ||
Panorex x-rays are not accepted for evaluation of restorative work. | ||
85-61; 86-77; 87-138; 88-219; 89-182; 2016, c.37, s.84 | ||
2 | SURGICAL SERVICES | Fee on or after May 1, 1989 |
Removal of erupted teeth - uncomplicated | ||
71101 | Single tooth - initial extraction (bone contouring or treatment of post-surgical complications included) | $ 25.10 |
71111 | Each additional tooth - same quadrant | $ 12.00 |
72100 | Impactions - I.C. Maximum | $113.30 |
72210 | Impactions - I.C. Maximum | $113.30 |
72220 | Impactions - I.C. Maximum | $118.40 |
72230 | Impactions - I.C. Maximum | $118.40 |
The maximum fee on or after May 1, 1989 for full mouth surgical removal of teeth (twenty-two or more teeth) including alveoloplasty in any one case shall not exceed $186.00. Prior approval by the Dental Advisory Committee is required for | ||
(a) | ||
(b) | ||
73133 | Excision of torus palatinus | $164.00 |
73134 | Excision of torus mandibularis (unilateral) | $ 90.00 |
73135 | Excision of torus mandibularis (bilateral) | $145.00 |
Fees for excisions under 73133, 73134 and 73135 shall be paid only if | ||
(a) | ||
(b) | ||
79306 | Closure of oro-antral fistula (oral surgeon only) - I.C. | |
The fees on or after May 1, 1989 shall be a minimum of $66.00 and a maximum of $112.00. | ||
79600 | Post surgical treatment - I.C. Maximum | $103.00 |
Approval of the fee by the Dental Advisory Committee is required for post surgical treatment. Payment shall be made only when this treatment is done by other than the treating dentist. | ||
79999 | Emergency treatment of accidental trauma to the mouth for persons under eighteen years of age. The request for payment shall be accompanied by an explanation of the circumstances of the accident and a description of the details of treatment. | I.C. |
85-61; 86-77; 87-138; 88-219; 89-182; 94-152; 2000, c.26, s.152; 2008, c.6, s.25 | ||
3 | RESTORATIVE SERVICES | Fee on or after May 1, 1989 |
Amalgam Restorations | ||
(a) | ||
21101 | Amalgam, one surface | $23.50 |
21102 | Amalgam, two surfaces | $31.50 |
21103 | Amalgam, three surfaces or more | $39.50 |
(b) | ||
21211 | Amalgam, one surface | $24.00 |
21212 | Amalgam, two surfaces | $39.50 |
21213 | Amalgam, three surfaces or more | $47.50 |
(c) | ||
21221 | Amalgam, one surface | $32.50 |
21222 | Amalgam, two surfaces | $45.50 |
21223 | Amalgam, three surfaces or more | $56.50 |
(d) | ||
21301 | Retentive pin, additional, one pin - per restoration | $ 8.80 |
21302 | Retentive pin, additional, two pins - per restoration | $19.00 |
(e) | ||
23101 | Class I and V | $30.50 |
23102 | Class III | $30.50 |
23103 | Class IV | $51.00 |
The maximum per tooth allowance for composite restoration on or after May 1, 1989 will ordinarily be $51.40 except in the case of two Class III restorations where the maximum per tooth allowance on or after May 1, 1989 will be $55.80. | ||
(f) | ||
23111 | Class I and V | $41.00 |
23112 | Class III | $50.00 |
23113 | Class IV | $79.80 |
23114 | Double Class IV | $93.30 |
The maximum per tooth allowance on or after May 1, 1989 for two Class III acid etched restorations is $84.50. | ||
Acid etch on deciduous teeth is not an entitled service. | ||
Acid etch Class V is an entitled service on permanent anteriors and buccal surfaces of maxillary bicuspids only. | ||
The maximum per tooth allowance on or after May 1, 1989 for more than one Class IV restoration is $93.30. This fee includes retentive pins if applicable. | ||
Acid etch Class I is an entitled service on anterior permanent teeth only. | ||
If a restoration is redone by the same dentist within a period of six months, the second restoration is not an entitled service. | ||
Restoration on tooth number 51, 52, 61, 62, 71, 72, 81 or 82 is not an entitled service. | ||
(g) | ||
Prior approval from the Dental Advisory Committee is required in all cases. | ||
22220 | Preformed stainless steel - Primary posterior tooth - per tooth | $68.00 |
Payment for preformed stainless steel primary posterior tooth number 54, 64, 74 or 84 is available only for children who are under nine years of age. | ||
22310 | Preformed stainless steel - Permanent anterior tooth | I.C. |
22320 | Preformed stainless steel - Permanent posterior tooth | $68.00 |
22410 | Prefabricated restoration on primary cuspid anterior tooth number 53, 63, 73, or 83 | $68.00 |
22510 | Acrylic or plastic transitional, direct (prefabricated) | I.C. |
Fees for filling include any necessary pulp protection. | ||
When at the same sitting, in order to conserve tooth structure, two separate restorations are performed on the same tooth involving a common surface, the fee will be assessed as one restoration. | ||
The dental practitioner must include the proper procedure code, international tooth code and the names of the surfaces restored in order to obtain payment for a restoration. | ||
85-61; 86-77; 87-138; 88-219; 89-182 | ||
4 | PREVENTIVE SERVICES | Fee on or after May 1, 1989 |
Dental prophylaxis | ||
11100 | Primary dentition | $18.20 |
11200 | Mixed dentition | $22.00 |
11300 | Permanent dentition | $35.00 |
Dental prophylaxis is available once within a period of six consecutive months for children who are under fourteen years of age. Children who are fourteen years of age and over and under eighteen years of age are entitled to one prophylaxis within a period of twelve consecutive months. Dental prophylaxis will be considered for persons eighteen years of age and over only in cases where minor scaling is necessary in order to fabricate a partial denture. | ||
Fluoride treatment | ||
12400 | Fluoride topical application | $11.30 |
Topical application of fluoride gel or liquid subsequent to prophylaxis is available once within a period of six consecutive months for children who are under fourteen years of age. Children who are fourteen years of age and over and under eighteen years of age are entitled to one topical application within a period of twelve consecutive months. | ||
85-61; 86-77; 87-138; 88-219; 89-182 | ||
5 | PROSTHETIC SERVICES | Gross fee on or after May 1, 1989 | 75% |
Prior approval by the Dental Advisory Committee is required for complete or partial dentures. | |||
Complete dentures | |||
51100 | Complete maxillary denture | $268.80 + Lab | $201.60 + Lab |
51110 | Complete mandibular denture | $268.80 + Lab | $201.60 + Lab |
These services include breakdown of T factor applicable, impressions, registrations, selection of shade and mold, try-in, insertion and adjustments. | |||
Removable partial dentures | |||
52120 | Maxillary, acrylic base - no clasps | $109.60 + Lab | $82.20 + Lab |
52121 | Mandibular, acrylic base - no clasps | $109.60 + Lab | $82.20 + Lab |
52220 | Maxillary, acrylic base - with wrought clasps | $159.70 + Lab | $119.80 + Lab |
52221 | Mandibular, acrylic base - with wrought clasps | $159.70 + Lab | $119.80 + Lab |
These services include breakdown of T factors applicable, diagnostic models, analysis and design, tooth preparation and master impression, bite registration, mold, selection and shade, try-in, insertion and adjustments. | |||
For children who are in the care of the Minister of Families and Children under the Family Services Act and social assistance dependent children payment will be made at the gross amount. | |||
For adult beneficiaries and adult dependents payment will be made at 75%. Payment of the balance is to be negotiated between the patient and the dental practitioner. The payment of the balance by the patient is not to include any laboratory fees. The participation fee applies only to the dentist fee. | |||
The total laboratory fee for upper and lower vitallium partial dentures is payable if prior approval is obtained from the Dental Advisory Committee. | |||
Fees for dentures or partial dentures are not ordinarily payable more frequently than once in five years unless prior approval is obtained from the Dental Advisory Committee. | |||
For partial dentures the dental practitioner must state what teeth are missing as partial dentures will be approved only if | |||
(a) | |||
(b) | |||
85-61; 86-77; 87-138; 88-219; 89-182; 2016, c.37, s.84 | |||
6 | DENTURE REPAIRS | Gross Fee on or after May 1, 1989 | 75% |
Repair of Complete Dentures | |||
55101 | Maxillary, no impression required | $23.60 + Lab | $17.70 + Lab |
55201 | Maxillary, impression required | $34.90 + Lab | $26.20 + Lab |
55102 | Mandibular, no impression required | $23.60 + Lab | $17.70 + Lab |
55202 | Mandibular, impression required | $34.90 + Lab | $26.20 + Lab |
Repair of partial dentures (acrylic or vitallium only) | |||
55103 | Maxillary, no impression required | $26.30 + Lab | $19.70 + Lab |
55203 | Maxillary, impression required | $36.30 + Lab | $27.20 + Lab |
55104 | Mandibular, no impression required | $26.30 + Lab | $19.70 + Lab |
55204 | Mandibular, impression required | $36.30 + Lab | $ 27.20 + Lab |
55535 | Addition or replacement of a clasp with a new clasp | $32.00 + Lab | $24.00 + Lab |
55539 | Each additional clasp | $30.70 + Lab | $23.00 + Lab |
Denture (complete or partial) relining or rebasing | |||
56200 | Relining maxillary, complete denture - no lab required | $44.70 | $33.50 |
56201 | Relining mandibular, complete denture - no lab required | $44.70 | $33.50 |
56220 | Maxillary, complete - processed | $82.90 + Lab | $62.20 + Lab |
56221 | Mandibular, complete - processed | $82.90 + Lab | $62.20 + Lab |
56270 | Maxillary, soft tissue conditioning | $44.70 | $33.50 |
56271 | Mandibular, soft tissue conditioning | $44.70 | $33.50 |
Fees for complete or partial relining or rebasing or for tissue conditioning are not payable more frequently than once in each year. | |||
No prior approval of the Dental Advisory Committee is required for entitled denture repairs. | |||
For children in the care of the Minister of Families and Children under the Family Services Act and social assistance dependent children payment will be made at the gross amount for denture repairs including any laboratory fee. | |||
For adult beneficiaries and adult dependents payment will be made at 75% for denture repairs. Payment of the balance is to be negotiated between the patient and the dental practitioner. The payment of the balance by the patient is not to include any laboratory fees. | |||
84-235; 85-61; 86-77; 87-138; 88-219; 89-182; 2016, c.37, s.84 | |||
7 | ADDITIONAL SERVICES | Fee on or after May 1, 1989 |
92310 | Conscious sedation (paedodontist only), per unit Fees for conscious sedation are not payable more often than eight units per patient per year and require referral by another dentist. | $ 30.00 |
94100 | Professional visit (at institution other than a hospital facility) A fee for a professional visit will be paid up to four times per patient per treatment plan. | $ 22.00 |
94200 | Hospital call | $ 24.00 |
94400 | Special office visit after normal hours | $ 32.00 |
86-77; 87-138; 88-219; 89-182; 93-26 | ||
8(1) | ENDODONTIC SERVICES | |
31100 | Pulp capping - traumatic exposure | $ 11.80 |
32200 | Vital pulpotomy - permanent tooth | $ 40.00 |
32210 | Vital pulpotomy - Primary posterior tooth - per tooth Payment for vital pulpotomy on primary tooth number 54, 64, 74 or 84 is available only for children who are under nine years of age. Root canal therapy | $ 27.00 |
33100 | One canal, fully developed root (on anterior teeth only) | $196.00 |
Prior approval by the Dental Advisory Committee is required. | ||
The fee for a root canal includes all x-rays and closing the access canal. | ||
Emergency procedures | ||
39902 | Emergency pulpectomy (trephination through crown included - primary and permanent tooth) | $ 28.50 |
39910 | Trephination through crown into root canal without pulpectomy | $ 17.50 |
39930 | Sedative (palliative) dressing (temporary filling only) | $ 22.00 |
8(2) | PERIODONTAL SERVICE | |
41200 | Emergency service - acute necrotizing ulcerative gingivitis (per unit of time) (A fee for emergency service will be paid for up to two units per service date.) | $ 21.00 |
8(3) | ORTHODONTIC SERVICES | |
01900 | Exam by orthodontist | $ 28.30 |
02600 | Panorex X-ray | $ 28.50 |
04530 | Model | $ 34.50 |
80000 | Treatment by orthodontist | I.C. |
The orthodontist will submit to the Dental Advisory Committee a proposed treatment plan, including an estimate of the cost of treatment, models and a panorex x-ray, if desired. The plan will be reviewed by the Dental Advisory Committee. The orthodontist will be notified of the committee’s decision and will receive payment for the entitled services rendered in preparing the plan, regardless of the decision made. | ||
86-77; 87-138; 88-219; 89-182 | ||
10Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a pharmacy shall be that set out in section 16 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11 which may be collected from the person.
12Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a dispensing physician shall be that set out in section 22 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11, which may be collected from the person.
For a major examination supplied to beneficiaries who are nineteen years of age or older and who are children in the care of the Minister of Families and Children under the Family Services Act, payment will be made at the gross amount and for other beneficiaries and dependents payment will be made at the gross amount less the applicable participation fee which the optometrist may collect from the patient. No participation fee is required for minor examinations, tonometry, biomicroscopy or visual fields.
Notwithstanding section 5 of Schedule I, where, on and after September 1, 1986, a person referred to in paragraph 5(b) of that Schedule has a second major examination by another optometrist within the twenty-four month period referred to in that paragraph without receiving the approval of the Director, the second major examination is an entitled service and shall be paid for at the rate prescribed in this Schedule for a minor examination.
(b) (select, measure, order, receive, verify, fit) | Gross fee on or after October 13, 1990 | |
(i) | ||
00081 | Lenses pair, single vision | $18.30 |
00082 | Lenses pair, bifocal | $23.20 |
00090 | Frame (new) | $19.50 |
00091 | Frame (old) | $ 8.40 |
(ii) | ||
00101 | One lens, single vision | $ 8.40 |
00102 | One lens, bifocal | $10.50 |
00103 | Frame, complete | $12.70 |
00104 | Frame, front | $ 5.30 |
00105 | Frame, temple | $ 5.30 |
(iii) | ||
00106 | Miscellaneous repairs, alignment or adjustment (when not included in above fees) | $ 4.20 |
Dispensing fees for new frames are not available unless the optometrist has displayed and made available at all times, under the same conditions of convenience as apply to other frames, a supply of frames that have a wholesale cost per frame not greater than the maximum allowance for a complete frame specified in paragraph 15(a).
Fitting Fees (select, measure, order, receive, verify, fit - initial, replacement or repair) | Gross Fee | |
00010 | lens and frame, single vision | $18.00 |
00011 | lens and frame, bifocal | $20.00 |
00012 | lens only, single vision (each lens) | $ 4.00 |
00013 | lens only, bifocal (each lens) | $ 6.00 |
00014 | frame, complete | $ 4.25 |
00015 | frame, temple only | $ 1.25 |
00016 | frame, front only | $ 3.25 |
00017 | miscellaneous repairs, alignment or adjustment | $ 1.10 |
Dispensing fees for new frames are not available unless the optician has displayed and made available at all times, under the same conditions of convenience as apply to other frames, a supply of frames that have a wholesale cost per frame not greater than the maximum frame allowance specified in paragraph 15(b).
(a) | Maximum Allowance on and after October 13, 1990 | ||
00041 | frame - complete: | ||
(i) | $34.00 | ||
(ii) | $17.00 | ||
00042 | case | $ 1.05 | |
00043 | frame - front only | ||
(i) | $18.60 | ||
(ii) | $ 9.30 | ||
00044 | frame - both temples | ||
(i) | $12.40 | ||
(ii) | $ 6.20 | ||
00045 | frame - one temple | ||
(i) | $ 6.20 | ||
(ii) | $ 3.10 | ||
00047 | replacement frame | $15.80 | |
(b) Opticians | |||
00020 | lenses | Wholesale Price | |
00021 | frame - complete | ||
(i) | $20.00 | ||
(ii) | $17.00 | ||
00022 | frame - front only | ||
(i) | $ 5.50 | ||
(ii) | $ 1.50 | ||
00023 | frame - both temples | ||
(i) | $ 3.00 | ||
(ii) | $ 1.50 | ||
00024 | frame- one temple | ||
(i) | $ 2.00 | ||
(ii) | $ 1.00 | ||
00025 | case | $ 1.00 | |
00027 | Replacement frame, on and after July 29, 1991 | $15.80 | |
84-235; 85-61; 87-27; 89-138; 92-41; 92-42; 2016, c.37, s.84 | |||
Gross Fee on or after January 1, 1989 | 75% | |
Complete maxillary or mandibular, denture - reline | $66.00 | $49.50 |
Complete maxillary or mandibular, denture - rebase | $76.00 | $57.00 |
Complete maxillary or mandibular tissue conditioning | $20.00 | $15.00 |
Complete maxillary or mandibular, denture - repairs (no impression required) | $19.65 | $14.75 |
Complete maxillary or mandibular, denture - repairs (impression required) | $38.00 | $28.50 |
Replacement of lost or fractured tooth | $18.90 | $14.20 |
Minor adjustments - after three months | $ 9.50 | $ 7.10 |
House, nursing home or hospital call - (maximum of four per case per year) | $12.00 | $12.00 |
1 | DIAGNOSTIC SERVICES | Fee on or after May 1, 1989 |
01200 | Oral examination | $13.00 |
01200 | Recall oral examination | $13.00 |
A fee for an oral examination will be paid once within a period of twelve consecutive months. A fee for a recall oral examination may be paid once within a period of six consecutive months for children in the care of the Minister under the Family Services Act and social assistance dependent children who have not reached their fourteenth birthday. | ||
01300 | Emergency examination | $13.00 |
02111 | First film | $10.20 |
02112 | Each additional film (regardless of type) | $ 3.80 |
Radiographs are required for all services listed in Article 5.02 or when requested by the Dental Advisory Committee. | ||
Only radiographs of proper angulation and exposure will be covered under the Agreement. | ||
Diagnostic films for a beneficiary are limited to four unless additional films are requested by the Dental Advisory Committee. | ||
02600 | Panorex | $28.50 |
The above rate of payment for Panorex shall be paid when the x-rays are | ||
(a) | ||
(b) | ||
(c) | ||
Where a Panorex x-ray is submitted in cases other than those enumerated above, the rate of payment on or after May 1, 1989 is $17.70. | ||
Panorex x-rays are not accepted for evaluation of restorative work. | ||
85-61; 86-77; 87-138; 88-219; 89-182 | ||
2 | SURGICAL SERVICES | Fee on or after May 1, 1989 |
Removal of erupted teeth - uncomplicated | ||
71101 | Single tooth - initial extraction (bone contouring or treatment of post-surgical complications included) | $ 25.10 |
71111 | Each additional tooth - same quadrant | $ 12.00 |
72100 | Impactions - I.C. Maximum | $113.30 |
72210 | Impactions - I.C. Maximum | $113.30 |
72220 | Impactions - I.C. Maximum | $118.40 |
72230 | Impactions - I.C. Maximum | $118.40 |
The maximum fee on or after May 1, 1989 for full mouth surgical removal of teeth (twenty-two or more teeth) including alveoloplasty in any one case shall not exceed $186.00. Prior approval by the Dental Advisory Committee is required for | ||
(a) | ||
(b) | ||
73133 | Excision of torus palatinus | $164.00 |
73134 | Excision of torus mandibularis (unilateral) | $ 90.00 |
73135 | Excision of torus mandibularis (bilateral) | $145.00 |
Fees for excisions under 73133, 73134 and 73135 shall be paid only if | ||
(a) | ||
(b) | ||
79306 | Closure of oro-antral fistula (oral surgeon only) - I.C. | |
The fees on or after May 1, 1989 shall be a minimum of $66.00 and a maximum of $112.00. | ||
79600 | Post surgical treatment - I.C. Maximum | $103.00 |
Approval of the fee by the Dental Advisory Committee is required for post surgical treatment. Payment shall be made only when this treatment is done by other than the treating dentist. | ||
79999 | Emergency treatment of accidental trauma to the mouth for persons under eighteen years of age. The request for payment shall be accompanied by an explanation of the circumstances of the accident and a description of the details of treatment. | I.C. |
85-61; 86-77; 87-138; 88-219; 89-182; 94-152; 2000, c.26, s.152; 2008, c.6, s.25 | ||
3 | RESTORATIVE SERVICES | Fee on or after May 1, 1989 |
Amalgam Restorations | ||
(a) | ||
21101 | Amalgam, one surface | $23.50 |
21102 | Amalgam, two surfaces | $31.50 |
21103 | Amalgam, three surfaces or more | $39.50 |
(b) | ||
21211 | Amalgam, one surface | $24.00 |
21212 | Amalgam, two surfaces | $39.50 |
21213 | Amalgam, three surfaces or more | $47.50 |
(c) | ||
21221 | Amalgam, one surface | $32.50 |
21222 | Amalgam, two surfaces | $45.50 |
21223 | Amalgam, three surfaces or more | $56.50 |
(d) | ||
21301 | Retentive pin, additional, one pin - per restoration | $ 8.80 |
21302 | Retentive pin, additional, two pins - per restoration | $19.00 |
(e) | ||
23101 | Class I and V | $30.50 |
23102 | Class III | $30.50 |
23103 | Class IV | $51.00 |
The maximum per tooth allowance for composite restoration on or after May 1, 1989 will ordinarily be $51.40 except in the case of two Class III restorations where the maximum per tooth allowance on or after May 1, 1989 will be $55.80. | ||
(f) | ||
23111 | Class I and V | $41.00 |
23112 | Class III | $50.00 |
23113 | Class IV | $79.80 |
23114 | Double Class IV | $93.30 |
The maximum per tooth allowance on or after May 1, 1989 for two Class III acid etched restorations is $84.50. | ||
Acid etch on deciduous teeth is not an entitled service. | ||
Acid etch Class V is an entitled service on permanent anteriors and buccal surfaces of maxillary bicuspids only. | ||
The maximum per tooth allowance on or after May 1, 1989 for more than one Class IV restoration is $93.30. This fee includes retentive pins if applicable. | ||
Acid etch Class I is an entitled service on anterior permanent teeth only. | ||
If a restoration is redone by the same dentist within a period of six months, the second restoration is not an entitled service. | ||
Restoration on tooth number 51, 52, 61, 62, 71, 72, 81 or 82 is not an entitled service. | ||
(g) | ||
Prior approval from the Dental Advisory Committee is required in all cases. | ||
22220 | Preformed stainless steel - Primary posterior tooth - per tooth | $68.00 |
Payment for preformed stainless steel primary posterior tooth number 54, 64, 74 or 84 is available only for children who are under nine years of age. | ||
22310 | Preformed stainless steel - Permanent anterior tooth | I.C. |
22320 | Preformed stainless steel - Permanent posterior tooth | $68.00 |
22410 | Prefabricated restoration on primary cuspid anterior tooth number 53, 63, 73, or 83 | $68.00 |
22510 | Acrylic or plastic transitional, direct (prefabricated) | I.C. |
Fees for filling include any necessary pulp protection. | ||
When at the same sitting, in order to conserve tooth structure, two separate restorations are performed on the same tooth involving a common surface, the fee will be assessed as one restoration. | ||
The dental practitioner must include the proper procedure code, international tooth code and the names of the surfaces restored in order to obtain payment for a restoration. | ||
85-61; 86-77; 87-138; 88-219; 89-182 | ||
4 | PREVENTIVE SERVICES | Fee on or after May 1, 1989 |
Dental prophylaxis | ||
11100 | Primary dentition | $18.20 |
11200 | Mixed dentition | $22.00 |
11300 | Permanent dentition | $35.00 |
Dental prophylaxis is available once within a period of six consecutive months for children who are under fourteen years of age. Children who are fourteen years of age and over and under eighteen years of age are entitled to one prophylaxis within a period of twelve consecutive months. Dental prophylaxis will be considered for persons eighteen years of age and over only in cases where minor scaling is necessary in order to fabricate a partial denture. | ||
Fluoride treatment | ||
12400 | Fluoride topical application | $11.30 |
Topical application of fluoride gel or liquid subsequent to prophylaxis is available once within a period of six consecutive months for children who are under fourteen years of age. Children who are fourteen years of age and over and under eighteen years of age are entitled to one topical application within a period of twelve consecutive months. | ||
85-61; 86-77; 87-138; 88-219; 89-182 | ||
5 | PROSTHETIC SERVICES | Gross fee on or after May 1, 1989 | 75% |
Prior approval by the Dental Advisory Committee is required for complete or partial dentures. | |||
Complete dentures | |||
51100 | Complete maxillary denture | $268.80 + Lab | $201.60 + Lab |
51110 | Complete mandibular denture | $268.80 + Lab | $201.60 + Lab |
These services include breakdown of T factor applicable, impressions, registrations, selection of shade and mold, try-in, insertion and adjustments. | |||
Removable partial dentures | |||
52120 | Maxillary, acrylic base - no clasps | $109.60 + Lab | $82.20 + Lab |
52121 | Mandibular, acrylic base - no clasps | $109.60 + Lab | $82.20 + Lab |
52220 | Maxillary, acrylic base - with wrought clasps | $159.70 + Lab | $119.80 + Lab |
52221 | Mandibular, acrylic base - with wrought clasps | $159.70 + Lab | $119.80 + Lab |
These services include breakdown of T factors applicable, diagnostic models, analysis and design, tooth preparation and master impression, bite registration, mold, selection and shade, try-in, insertion and adjustments. | |||
For children who are in the care of the Minister under the Family Services Act and social assistance dependent children payment will be made at the gross amount. | |||
For adult beneficiaries and adult dependents payment will be made at 75%. Payment of the balance is to be negotiated between the patient and the dental practitioner. The payment of the balance by the patient is not to include any laboratory fees. The participation fee applies only to the dentist fee. | |||
The total laboratory fee for upper and lower vitallium partial dentures is payable if prior approval is obtained from the Dental Advisory Committee. | |||
Fees for dentures or partial dentures are not ordinarily payable more frequently than once in five years unless prior approval is obtained from the Dental Advisory Committee. | |||
For partial dentures the dental practitioner must state what teeth are missing as partial dentures will be approved only if | |||
(a) | |||
(b) | |||
85-61; 86-77; 87-138; 88-219; 89-182 | |||
6 | DENTURE REPAIRS | Gross Fee on or after May 1, 1989 | 75% |
Repair of Complete Dentures | |||
55101 | Maxillary, no impression required | $23.60 + Lab | $17.70 + Lab |
55201 | Maxillary, impression required | $34.90 + Lab | $26.20 + Lab |
55102 | Mandibular, no impression required | $23.60 + Lab | $17.70 + Lab |
55202 | Mandibular, impression required | $34.90 + Lab | $26.20 + Lab |
Repair of partial dentures (acrylic or vitallium only) | |||
55103 | Maxillary, no impression required | $26.30 + Lab | $19.70 + Lab |
55203 | Maxillary, impression required | $36.30 + Lab | $27.20 + Lab |
55104 | Mandibular, no impression required | $26.30 + Lab | $19.70 + Lab |
55204 | Mandibular, impression required | $36.30 + Lab | $ 27.20 + Lab |
55535 | Addition or replacement of a clasp with a new clasp | $32.00 + Lab | $24.00 + Lab |
55539 | Each additional clasp | $30.70 + Lab | $23.00 + Lab |
Denture (complete or partial) relining or rebasing | |||
56200 | Relining maxillary, complete denture - no lab required | $44.70 | $33.50 |
56201 | Relining mandibular, complete denture - no lab required | $44.70 | $33.50 |
56220 | Maxillary, complete - processed | $82.90 + Lab | $62.20 + Lab |
56221 | Mandibular, complete - processed | $82.90 + Lab | $62.20 + Lab |
56270 | Maxillary, soft tissue conditioning | $44.70 | $33.50 |
56271 | Mandibular, soft tissue conditioning | $44.70 | $33.50 |
Fees for complete or partial relining or rebasing or for tissue conditioning are not payable more frequently than once in each year. | |||
No prior approval of the Dental Advisory Committee is required for entitled denture repairs. | |||
For children in the care of the Minister under the Family Services Act and social assistance dependent children payment will be made at the gross amount for denture repairs including any laboratory fee. | |||
For adult beneficiaries and adult dependents payment will be made at 75% for denture repairs. Payment of the balance is to be negotiated between the patient and the dental practitioner. The payment of the balance by the patient is not to include any laboratory fees. | |||
84-235; 85-61; 86-77; 87-138; 88-219; 89-182 | |||
7 | ADDITIONAL SERVICES | Fee on or after May 1, 1989 |
92310 | Conscious sedation (paedodontist only), per unit Fees for conscious sedation are not payable more often than eight units per patient per year and require referral by another dentist. | $ 30.00 |
94100 | Professional visit (at institution other than a hospital facility) A fee for a professional visit will be paid up to four times per patient per treatment plan. | $ 22.00 |
94200 | Hospital call | $ 24.00 |
94400 | Special office visit after normal hours | $ 32.00 |
86-77; 87-138; 88-219; 89-182; 93-26 | ||
8(1) | ENDODONTIC SERVICES | |
31100 | Pulp capping - traumatic exposure | $ 11.80 |
32200 | Vital pulpotomy - permanent tooth | $ 40.00 |
32210 | Vital pulpotomy - Primary posterior tooth - per tooth Payment for vital pulpotomy on primary tooth number 54, 64, 74 or 84 is available only for children who are under nine years of age. Root canal therapy | $ 27.00 |
33100 | One canal, fully developed root (on anterior teeth only) | $196.00 |
Prior approval by the Dental Advisory Committee is required. | ||
The fee for a root canal includes all x-rays and closing the access canal. | ||
Emergency procedures | ||
39902 | Emergency pulpectomy (trephination through crown included - primary and permanent tooth) | $ 28.50 |
39910 | Trephination through crown into root canal without pulpectomy | $ 17.50 |
39930 | Sedative (palliative) dressing (temporary filling only) | $ 22.00 |
8(2) | PERIODONTAL SERVICE | |
41200 | Emergency service - acute necrotizing ulcerative gingivitis (per unit of time) (A fee for emergency service will be paid for up to two units per service date.) | $ 21.00 |
8(3) | ORTHODONTIC SERVICES | |
01900 | Exam by orthodontist | $ 28.30 |
02600 | Panorex X-ray | $ 28.50 |
04530 | Model | $ 34.50 |
80000 | Treatment by orthodontist | I.C. |
The orthodontist will submit to the Dental Advisory Committee a proposed treatment plan, including an estimate of the cost of treatment, models and a panorex x-ray, if desired. The plan will be reviewed by the Dental Advisory Committee. The orthodontist will be notified of the committee’s decision and will receive payment for the entitled services rendered in preparing the plan, regardless of the decision made. | ||
86-77; 87-138; 88-219; 89-182 | ||
10Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a pharmacy shall be that set out in section 16 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11 which may be collected from the person.
12Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a dispensing physician shall be that set out in section 22 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11, which may be collected from the person.
For a major examination supplied to beneficiaries who are nineteen years of age or older and who are children in the care of the Minister under the Family Services Act, payment will be made at the gross amount and for other beneficiaries and dependents payment will be made at the gross amount less the applicable participation fee which the optometrist may collect from the patient. No participation fee is required for minor examinations, tonometry, biomicroscopy or visual fields.
Notwithstanding section 5 of Schedule I, where, on and after September 1, 1986, a person referred to in paragraph 5(b) of that Schedule has a second major examination by another optometrist within the twenty-four month period referred to in that paragraph without receiving the approval of the Director, the second major examination is an entitled service and shall be paid for at the rate prescribed in this Schedule for a minor examination.
(b) (select, measure, order, receive, verify, fit) | Gross fee on or after October 13, 1990 | |
(i) | ||
00081 | Lenses pair, single vision | $18.30 |
00082 | Lenses pair, bifocal | $23.20 |
00090 | Frame (new) | $19.50 |
00091 | Frame (old) | $ 8.40 |
(ii) | ||
00101 | One lens, single vision | $ 8.40 |
00102 | One lens, bifocal | $10.50 |
00103 | Frame, complete | $12.70 |
00104 | Frame, front | $ 5.30 |
00105 | Frame, temple | $ 5.30 |
(iii) | ||
00106 | Miscellaneous repairs, alignment or adjustment (when not included in above fees) | $ 4.20 |
Dispensing fees for new frames are not available unless the optometrist has displayed and made available at all times, under the same conditions of convenience as apply to other frames, a supply of frames that have a wholesale cost per frame not greater than the maximum allowance for a complete frame specified in paragraph 15(a).
Fitting Fees (select, measure, order, receive, verify, fit - initial, replacement or repair) | Gross Fee | |
00010 | lens and frame, single vision | $18.00 |
00011 | lens and frame, bifocal | $20.00 |
00012 | lens only, single vision (each lens) | $ 4.00 |
00013 | lens only, bifocal (each lens) | $ 6.00 |
00014 | frame, complete | $ 4.25 |
00015 | frame, temple only | $ 1.25 |
00016 | frame, front only | $ 3.25 |
00017 | miscellaneous repairs, alignment or adjustment | $ 1.10 |
Dispensing fees for new frames are not available unless the optician has displayed and made available at all times, under the same conditions of convenience as apply to other frames, a supply of frames that have a wholesale cost per frame not greater than the maximum frame allowance specified in paragraph 15(b).
(a) | Maximum Allowance on and after October 13, 1990 | ||
00041 | frame - complete: | ||
(i) | $34.00 | ||
(ii) | $17.00 | ||
00042 | case | $ 1.05 | |
00043 | frame - front only | ||
(i) | $18.60 | ||
(ii) | $ 9.30 | ||
00044 | frame - both temples | ||
(i) | $12.40 | ||
(ii) | $ 6.20 | ||
00045 | frame - one temple | ||
(i) | $ 6.20 | ||
(ii) | $ 3.10 | ||
00047 | replacement frame | $15.80 | |
(b) Opticians | |||
00020 | lenses | Wholesale Price | |
00021 | frame - complete | ||
(i) | $20.00 | ||
(ii) | $17.00 | ||
00022 | frame - front only | ||
(i) | $ 5.50 | ||
(ii) | $ 1.50 | ||
00023 | frame - both temples | ||
(i) | $ 3.00 | ||
(ii) | $ 1.50 | ||
00024 | frame- one temple | ||
(i) | $ 2.00 | ||
(ii) | $ 1.00 | ||
00025 | case | $ 1.00 | |
00027 | Replacement frame, on and after July 29, 1991 | $15.80 | |
84-235; 85-61; 87-27; 89-138; 92-41; 92-42 | |||
Gross Fee on or after January 1, 1989 | 75% | |
Complete maxillary or mandibular, denture - reline | $66.00 | $49.50 |
Complete maxillary or mandibular, denture - rebase | $76.00 | $57.00 |
Complete maxillary or mandibular tissue conditioning | $20.00 | $15.00 |
Complete maxillary or mandibular, denture - repairs (no impression required) | $19.65 | $14.75 |
Complete maxillary or mandibular, denture - repairs (impression required) | $38.00 | $28.50 |
Replacement of lost or fractured tooth | $18.90 | $14.20 |
Minor adjustments - after three months | $ 9.50 | $ 7.10 |
House, nursing home or hospital call - (maximum of four per case per year) | $12.00 | $12.00 |
1 | DIAGNOSTIC SERVICES | Fee on or after May 1, 1989 |
01200 | Oral examination | $13.00 |
01200 | Recall oral examination | $13.00 |
A fee for an oral examination will be paid once within a period of twelve consecutive months. A fee for a recall oral examination may be paid once within a period of six consecutive months for children in the care of the Minister under the Family Services Act and social assistance dependent children who have not reached their fourteenth birthday. | ||
01300 | Emergency examination | $13.00 |
02111 | First film | $10.20 |
02112 | Each additional film (regardless of type) | $ 3.80 |
Radiographs are required for all services listed in Article 5.02 or when requested by the Dental Advisory Committee. | ||
Only radiographs of proper angulation and exposure will be covered under the Agreement. | ||
Diagnostic films for a beneficiary are limited to four unless additional films are requested by the Dental Advisory Committee. | ||
02600 | Panorex | $28.50 |
The above rate of payment for Panorex shall be paid when the x-rays are | ||
(a) | ||
(b) | ||
(c) | ||
Where a Panorex x-ray is submitted in cases other than those enumerated above, the rate of payment on or after May 1, 1989 is $17.70. | ||
Panorex x-rays are not accepted for evaluation of restorative work. | ||
85-61; 86-77; 87-138; 88-219; 89-182 | ||
2 | SURGICAL SERVICES | Fee on or after May 1, 1989 |
Removal of erupted teeth - uncomplicated | ||
71101 | Single tooth - initial extraction (bone contouring or treatment of post-surgical complications included) | $ 25.10 |
71111 | Each additional tooth - same quadrant | $ 12.00 |
72100 | Impactions - I.C. Maximum | $113.30 |
72210 | Impactions - I.C. Maximum | $113.30 |
72220 | Impactions - I.C. Maximum | $118.40 |
72230 | Impactions - I.C. Maximum | $118.40 |
The maximum fee on or after May 1, 1989 for full mouth surgical removal of teeth (twenty-two or more teeth) including alveoloplasty in any one case shall not exceed $186.00. Prior approval by the Dental Advisory Committee is required for | ||
(a) | ||
(b) | ||
73133 | Excision of torus palatinus | $164.00 |
73134 | Excision of torus mandibularis (unilateral) | $ 90.00 |
73135 | Excision of torus mandibularis (bilateral) | $145.00 |
Fees for excisions under 73133, 73134 and 73135 shall be paid only if | ||
(a) | ||
(b) | ||
79306 | Closure of oro-antral fistula (oral surgeon only) - I.C. | |
The fees on or after May 1, 1989 shall be a minimum of $66.00 and a maximum of $112.00. | ||
79600 | Post surgical treatment - I.C. Maximum | $103.00 |
Approval of the fee by the Dental Advisory Committee is required for post surgical treatment. Payment shall be made only when this treatment is done by other than the treating dentist. | ||
79999 | Emergency treatment of accidental trauma to the mouth for persons under eighteen years of age. The request for payment shall be accompanied by an explanation of the circumstances of the accident and a description of the details of treatment. | I.C. |
85-61; 86-77; 87-138; 88-219; 89-182; 94-152; 2000, c.26, s.152; 2008, c.6, s.25 | ||
3 | RESTORATIVE SERVICES | Fee on or after May 1, 1989 |
Amalgam Restorations | ||
(a) | ||
21101 | Amalgam, one surface | $23.50 |
21102 | Amalgam, two surfaces | $31.50 |
21103 | Amalgam, three surfaces or more | $39.50 |
(b) | ||
21211 | Amalgam, one surface | $24.00 |
21212 | Amalgam, two surfaces | $39.50 |
21213 | Amalgam, three surfaces or more | $47.50 |
(c) | ||
21221 | Amalgam, one surface | $32.50 |
21222 | Amalgam, two surfaces | $45.50 |
21223 | Amalgam, three surfaces or more | $56.50 |
(d) | ||
21301 | Retentive pin, additional, one pin - per restoration | $ 8.80 |
21302 | Retentive pin, additional, two pins - per restoration | $19.00 |
(e) | ||
23101 | Class I and V | $30.50 |
23102 | Class III | $30.50 |
23103 | Class IV | $51.00 |
The maximum per tooth allowance for composite restoration on or after May 1, 1989 will ordinarily be $51.40 except in the case of two Class III restorations where the maximum per tooth allowance on or after May 1, 1989 will be $55.80. | ||
(f) | ||
23111 | Class I and V | $41.00 |
23112 | Class III | $50.00 |
23113 | Class IV | $79.80 |
23114 | Double Class IV | $93.30 |
The maximum per tooth allowance on or after May 1, 1989 for two Class III acid etched restorations is $84.50. | ||
Acid etch on deciduous teeth is not an entitled service. | ||
Acid etch Class V is an entitled service on permanent anteriors and buccal surfaces of maxillary bicuspids only. | ||
The maximum per tooth allowance on or after May 1, 1989 for more than one Class IV restoration is $93.30. This fee includes retentive pins if applicable. | ||
Acid etch Class I is an entitled service on anterior permanent teeth only. | ||
If a restoration is redone by the same dentist within a period of six months, the second restoration is not an entitled service. | ||
Restoration on tooth number 51, 52, 61, 62, 71, 72, 81 or 82 is not an entitled service. | ||
(g) | ||
Prior approval from the Dental Advisory Committee is required in all cases. | ||
22220 | Preformed stainless steel - Primary posterior tooth - per tooth | $68.00 |
Payment for preformed stainless steel primary posterior tooth number 54, 64, 74 or 84 is available only for children who are under nine years of age. | ||
22310 | Preformed stainless steel - Permanent anterior tooth | I.C. |
22320 | Preformed stainless steel - Permanent posterior tooth | $68.00 |
22410 | Prefabricated restoration on primary cuspid anterior tooth number 53, 63, 73, or 83 | $68.00 |
22510 | Acrylic or plastic transitional, direct (prefabricated) | I.C. |
Fees for filling include any necessary pulp protection. | ||
When at the same sitting, in order to conserve tooth structure, two separate restorations are performed on the same tooth involving a common surface, the fee will be assessed as one restoration. | ||
The dental practitioner must include the proper procedure code, international tooth code and the names of the surfaces restored in order to obtain payment for a restoration. | ||
85-61; 86-77; 87-138; 88-219; 89-182 | ||
4 | PREVENTIVE SERVICES | Fee on or after May 1, 1989 |
Dental prophylaxis | ||
11100 | Primary dentition | $18.20 |
11200 | Mixed dentition | $22.00 |
11300 | Permanent dentition | $35.00 |
Dental prophylaxis is available once within a period of six consecutive months for children who are under fourteen years of age. Children who are fourteen years of age and over and under eighteen years of age are entitled to one prophylaxis within a period of twelve consecutive months. Dental prophylaxis will be considered for persons eighteen years of age and over only in cases where minor scaling is necessary in order to fabricate a partial denture. | ||
Fluoride treatment | ||
12400 | Fluoride topical application | $11.30 |
Topical application of fluoride gel or liquid subsequent to prophylaxis is available once within a period of six consecutive months for children who are under fourteen years of age. Children who are fourteen years of age and over and under eighteen years of age are entitled to one topical application within a period of twelve consecutive months. | ||
85-61; 86-77; 87-138; 88-219; 89-182 | ||
5 | PROSTHETIC SERVICES | Gross fee on or after May 1, 1989 | 75% |
Prior approval by the Dental Advisory Committee is required for complete or partial dentures. | |||
Complete dentures | |||
51100 | Complete maxillary denture | $268.80 + Lab | $201.60 + Lab |
51110 | Complete mandibular denture | $268.80 + Lab | $201.60 + Lab |
These services include breakdown of T factor applicable, impressions, registrations, selection of shade and mold, try-in, insertion and adjustments. | |||
Removable partial dentures | |||
52120 | Maxillary, acrylic base - no clasps | $109.60 + Lab | $82.20 + Lab |
52121 | Mandibular, acrylic base - no clasps | $109.60 + Lab | $82.20 + Lab |
52220 | Maxillary, acrylic base - with wrought clasps | $159.70 + Lab | $119.80 + Lab |
52221 | Mandibular, acrylic base - with wrought clasps | $159.70 + Lab | $119.80 + Lab |
These services include breakdown of T factors applicable, diagnostic models, analysis and design, tooth preparation and master impression, bite registration, mold, selection and shade, try-in, insertion and adjustments. | |||
For children who are in the care of the Minister under the Family Services Act and social assistance dependent children payment will be made at the gross amount. | |||
For adult beneficiaries and adult dependents payment will be made at 75%. Payment of the balance is to be negotiated between the patient and the dental practitioner. The payment of the balance by the patient is not to include any laboratory fees. The participation fee applies only to the dentist fee. | |||
The total laboratory fee for upper and lower vitallium partial dentures is payable if prior approval is obtained from the Dental Advisory Committee. | |||
Fees for dentures or partial dentures are not ordinarily payable more frequently than once in five years unless prior approval is obtained from the Dental Advisory Committee. | |||
For partial dentures the dental practitioner must state what teeth are missing as partial dentures will be approved only if | |||
(a) | |||
(b) | |||
85-61; 86-77; 87-138; 88-219; 89-182 | |||
6 | DENTURE REPAIRS | Gross Fee on or after May 1, 1989 | 75% |
Repair of Complete Dentures | |||
55101 | Maxillary, no impression required | $23.60 + Lab | $17.70 + Lab |
55201 | Maxillary, impression required | $34.90 + Lab | $26.20 + Lab |
55102 | Mandibular, no impression required | $23.60 + Lab | $17.70 + Lab |
55202 | Mandibular, impression required | $34.90 + Lab | $26.20 + Lab |
Repair of partial dentures (acrylic or vitallium only) | |||
55103 | Maxillary, no impression required | $26.30 + Lab | $19.70 + Lab |
55203 | Maxillary, impression required | $36.30 + Lab | $27.20 + Lab |
55104 | Mandibular, no impression required | $26.30 + Lab | $19.70 + Lab |
55204 | Mandibular, impression required | $36.30 + Lab | $ 27.20 + Lab |
55535 | Addition or replacement of a clasp with a new clasp | $32.00 + Lab | $24.00 + Lab |
55539 | Each additional clasp | $30.70 + Lab | $23.00 + Lab |
Denture (complete or partial) relining or rebasing | |||
56200 | Relining maxillary, complete denture - no lab required | $44.70 | $33.50 |
56201 | Relining mandibular, complete denture - no lab required | $44.70 | $33.50 |
56220 | Maxillary, complete - processed | $82.90 + Lab | $62.20 + Lab |
56221 | Mandibular, complete - processed | $82.90 + Lab | $62.20 + Lab |
56270 | Maxillary, soft tissue conditioning | $44.70 | $33.50 |
56271 | Mandibular, soft tissue conditioning | $44.70 | $33.50 |
Fees for complete or partial relining or rebasing or for tissue conditioning are not payable more frequently than once in each year. | |||
No prior approval of the Dental Advisory Committee is required for entitled denture repairs. | |||
For children in the care of the Minister under the Family Services Act and social assistance dependent children payment will be made at the gross amount for denture repairs including any laboratory fee. | |||
For adult beneficiaries and adult dependents payment will be made at 75% for denture repairs. Payment of the balance is to be negotiated between the patient and the dental practitioner. The payment of the balance by the patient is not to include any laboratory fees. | |||
84-235; 85-61; 86-77; 87-138; 88-219; 89-182 | |||
7 | ADDITIONAL SERVICES | Fee on or after May 1, 1989 |
92310 | Conscious sedation (paedodontist only), per unit Fees for conscious sedation are not payable more often than eight units per patient per year and require referral by another dentist. | $ 30.00 |
94100 | Professional visit (at institution other than a hospital facility) A fee for a professional visit will be paid up to four times per patient per treatment plan. | $ 22.00 |
94200 | Hospital call | $ 24.00 |
94400 | Special office visit after normal hours | $ 32.00 |
86-77; 87-138; 88-219; 89-182; 93-26 | ||
8(1) | ENDODONTIC SERVICES | |
31100 | Pulp capping - traumatic exposure | $ 11.80 |
32200 | Vital pulpotomy - permanent tooth | $ 40.00 |
32210 | Vital pulpotomy - Primary posterior tooth - per tooth Payment for vital pulpotomy on primary tooth number 54, 64, 74 or 84 is available only for children who are under nine years of age. Root canal therapy | $ 27.00 |
33100 | One canal, fully developed root (on anterior teeth only) | $196.00 |
Prior approval by the Dental Advisory Committee is required. | ||
The fee for a root canal includes all x-rays and closing the access canal. | ||
Emergency procedures | ||
39902 | Emergency pulpectomy (trephination through crown included - primary and permanent tooth) | $ 28.50 |
39910 | Trephination through crown into root canal without pulpectomy | $ 17.50 |
39930 | Sedative (palliative) dressing (temporary filling only) | $ 22.00 |
8(2) | PERIODONTAL SERVICE | |
41200 | Emergency service - acute necrotizing ulcerative gingivitis (per unit of time) (A fee for emergency service will be paid for up to two units per service date.) | $ 21.00 |
8(3) | ORTHODONTIC SERVICES | |
01900 | Exam by orthodontist | $ 28.30 |
02600 | Panorex X-ray | $ 28.50 |
04530 | Model | $ 34.50 |
80000 | Treatment by orthodontist | I.C. |
The orthodontist will submit to the Dental Advisory Committee a proposed treatment plan, including an estimate of the cost of treatment, models and a panorex x-ray, if desired. The plan will be reviewed by the Dental Advisory Committee. The orthodontist will be notified of the committee’s decision and will receive payment for the entitled services rendered in preparing the plan, regardless of the decision made. | ||
86-77; 87-138; 88-219; 89-182 | ||
10Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a pharmacy shall be that set out in section 16 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11 which may be collected from the person.
12Except where otherwise provided in this Regulation, payment for an entitled service under section 9 when rendered by a dispensing physician shall be that set out in section 22 of New Brunswick Regulation 84-170 under the Prescription Drug Payment Act, less the applicable participation fee set out in section 11, which may be collected from the person.
For a major examination supplied to beneficiaries who are nineteen years of age or older and who are children in the care of the Minister under the Family Services Act, payment will be made at the gross amount and for other beneficiaries and dependents payment will be made at the gross amount less the applicable participation fee which the optometrist may collect from the patient. No participation fee is required for minor examinations, tonometry, biomicroscopy or visual fields.
Notwithstanding section 5 of Schedule I, where, on and after September 1, 1986, a person referred to in paragraph 5(b) of that Schedule has a second major examination by another optometrist within the twenty-four month period referred to in that paragraph without receiving the approval of the Director, the second major examination is an entitled service and shall be paid for at the rate prescribed in this Schedule for a minor examination.
(b) (select, measure, order, receive, verify, fit) | Gross fee on or after October 13, 1990 | |
(i) | ||
00081 | Lenses pair, single vision | $18.30 |
00082 | Lenses pair, bifocal | $23.20 |
00090 | Frame (new) | $19.50 |
00091 | Frame (old) | $ 8.40 |
(ii) | ||
00101 | One lens, single vision | $ 8.40 |
00102 | One lens, bifocal | $10.50 |
00103 | Frame, complete | $12.70 |
00104 | Frame, front | $ 5.30 |
00105 | Frame, temple | $ 5.30 |
(iii) | ||
00106 | Miscellaneous repairs, alignment or adjustment (when not included in above fees) | $ 4.20 |
Dispensing fees for new frames are not available unless the optometrist has displayed and made available at all times, under the same conditions of convenience as apply to other frames, a supply of frames that have a wholesale cost per frame not greater than the maximum allowance for a complete frame specified in paragraph 15(a).
Fitting Fees (select, measure, order, receive, verify, fit - initial, replacement or repair) | Gross Fee | |
00010 | lens and frame, single vision | $18.00 |
00011 | lens and frame, bifocal | $20.00 |
00012 | lens only, single vision (each lens) | $ 4.00 |
00013 | lens only, bifocal (each lens) | $ 6.00 |
00014 | frame, complete | $ 4.25 |
00015 | frame, temple only | $ 1.25 |
00016 | frame, front only | $ 3.25 |
00017 | miscellaneous repairs, alignment or adjustment | $ 1.10 |
Dispensing fees for new frames are not available unless the optician has displayed and made available at all times, under the same conditions of convenience as apply to other frames, a supply of frames that have a wholesale cost per frame not greater than the maximum frame allowance specified in paragraph 15(b).
(a) | Maximum Allowance on and after October 13, 1990 | ||
00041 | frame - complete: | ||
(i) | $34.00 | ||
(ii) | $17.00 | ||
00042 | case | $ 1.05 | |
00043 | frame - front only | ||
(i) | $18.60 | ||
(ii) | $ 9.30 | ||
00044 | frame - both temples | ||
(i) | $12.40 | ||
(ii) | $ 6.20 | ||
00045 | frame - one temple | ||
(i) | $ 6.20 | ||
(ii) | $ 3.10 | ||
00047 | replacement frame | $15.80 | |
(b) Opticians | |||
00020 | lenses | Wholesale Price | |
00021 | frame - complete | ||
(i) | $20.00 | ||
(ii) | $17.00 | ||
00022 | frame - front only | ||
(i) | $ 5.50 | ||
(ii) | $ 1.50 | ||
00023 | frame - both temples | ||
(i) | $ 3.00 | ||
(ii) | $ 1.50 | ||
00024 | frame- one temple | ||
(i) | $ 2.00 | ||
(ii) | $ 1.00 | ||
00025 | case | $ 1.00 | |
00027 | Replacement frame, on and after July 29, 1991 | $15.80 | |
84-235; 85-61; 87-27; 89-138; 92-41; 92-42 | |||
Gross Fee on or after January 1, 1989 | 75% | |
Complete maxillary or mandibular, denture - reline | $66.00 | $49.50 |
Complete maxillary or mandibular, denture - rebase | $76.00 | $57.00 |
Complete maxillary or mandibular tissue conditioning | $20.00 | $15.00 |
Complete maxillary or mandibular, denture - repairs (no impression required) | $19.65 | $14.75 |
Complete maxillary or mandibular, denture - repairs (impression required) | $38.00 | $28.50 |
Replacement of lost or fractured tooth | $18.90 | $14.20 |
Minor adjustments - after three months | $ 9.50 | $ 7.10 |
House, nursing home or hospital call - (maximum of four per case per year) | $12.00 | $12.00 |