the denturist association of ontario...

Used Under License by the DAO

All Rights Reserved

The DAC Procedure Codes - Masterlist(s)

© 1990 - 2017 The Denturist Association of Canada, All Rights Reserved

Effective February 1, 2017

THIS GUIDE OF SUGGESTED FEES IS PUBLISHED BY

THE DENTURIST ASSOCIATION OF ONTARIO FOR

THE BENEFIT OF INSURANCE COMPANIES AND THIRD PARTY BILLING

Phone: 905-238-6090 or 1-800-284-7311

Fax: 905-238-7090

Email: [email protected]

THE DENTURIST ASSOCIATION

OF ONTARIO (DAO)

NOTE:

THE GUIDE COVERS PROFESSIONAL SERVICES AND SUGGESTED FEES

RENDERED BY A LICENSED DENTURIST. THE FEES FOR PROCEDURES DESCRIBED

ARE NOT OBLIGATORY; EACH LICENSED DENTURIST IS EXPECTED TO DETERMINE

INDEPENDENTLY THE FEES THAT WILL BE CHARGED.

Website: www.denturistassociation.ca

Revised January 2017

© 1990 - 2017 The Denturist Association of Ontario

Introduction

THE DENTURIST ASSOCIATION of ONTARIO (DAO) FEE GUIDE

The DAC PROCEDURE CODES

College of Denturists of Ontario

Services

The value of this service is in its effectiveness in replacing tooth function while preserving the oral tissues

supporting the prosthesis.

In fabricating removable prostheses, various steps and technical procedures are necessary in order to assure the

highest quality of service possible. Many different types of dentures can be fabricated, therefore the fees will vary

according to the technical procedures involved and the degree of skill required.

The work performed by a Denturist is based on the value of the service being provided. This fee schedule

establishes comparative norms for evaluating different prosthodontic services which enable the Denturist, patient

and insurance companies to better compare the value of service provided.

The Denturist Association of Ontario (the DAO) is committed to annually publishing and providing an up-to-date

DAO Fee Guide to our membership and collaborating with the insurance industry. Our annual Fee Guide is

copyrighted and available for use by DAO members only.

The DAO continues to work with The Denturist Association of Canada (The DAC) on any required annual updates

or other modifications to The DAC Procedure Codes Master List as part of our commitment to our members and

the profession. The many members of the DAO and The DAC rely upon the DAO's knowledge and enthusiasm to

advance the Fee Guide as technology changes.

As a member of the DAO, you are authorized and licensed to use this Fee Guide and to use and reproduce the

DAO Fee Guide and The DAC Procedure Codes as set out herein for your denturist services.

The Denturist Association of Ontario (the DAO) is licensed by The Denturist Association of Canada (The DAC) to

reproduce, use, display and distribute The DAC Procedure Codes in this Fee Guide. The DAC Procedure Codes

master list, as provided to the DAO, has been developed and maintained and is owned by The DAC, including any

and all intellectual property rights therein (© 1990 - 2017 The Denturist Association of Canada, All Rights

Reserved). As a member of the DAO, you are authorized and licensed to use this Fee Guide for your denturist

services.

The Regulated Health Professions Act, 1991 includes the profession of Denturism as one of the dental health

professions listed under the Act. The Denturism Act, 1991 defines the College of Denturists of Ontario

(CDO/College) as the self-governing regulatory body which oversees and governs the profession. The College

Council is comprised of licensed member Denturists, and members of the public. Denturists are one of 26 health

care professions recognized as self-regulating in the province of Ontario.

It is not an objective of the CDO to set the fees which are charged by Denturists. However, they can confirm

whether a practitioner is certified (licensed) with the College. Insurers and third party adjudicators wishing to

confirm the status of any Denturist submitting a claim should call the CDO at 416-925-6331 or 1-888-236-4326 or

visit their website at http://cdo.in1touch.org/.

Denturists are part of the dental health team which specifically provides denture care through independent

practitioners in the province of Ontario.

The quality of prosthodontic services offered by a Denturist contributes to the improvement of a patient's oral

health and quality of life.


All Rights Reserved2 of 33


Format:

Adjustments (LLLT) = Low Level Laser Therapy in conjunction with adjustment

ARM = Additional Repair Materials to be used in conjunction with repairs as required

Mouthguard type 3 = vacuum formed

Mouthguard type 4 = pressure laminate or injectable elastic acrylic resin

S.C. = Service Charge (Independent Charge)

1 unit of time = 15 minutes2 units of time = 30 minutes

3 units of time = 45 minutes4 units of time = 60 minutes

It is for each individual practitioner to determine what fee is appropriate for their units of

time.

+L = Variable lab fees. Effective January 1, 2016, Procedure Code 98889 formerly utilized

for Commercial Laboratory Fees, was inactivated from The DAC’s Masterlist of Procedure

Codes. Procedure Code 98888, formerly utilized for In-House Laboratory Fees, was

renamed and is now utilized as Laboratory Fees.

As a guideline for those codes that no longer have a defined Lab Fee, we have kept the

column named "ORIG" which makes reference to the suggested total original fee before

the above change was made in 2016. "ORIG" now includes the 3% fee increase for 2017.

Units of Time - UT: Some procedures listed in this Fee Guide are described in "Units of

Time - (UT)". Each unit of time is based on a 15 minute period of time, therefore:

Each additional unit of time (beyond 4 units of time) = 15 minutes.




IMPORTANT: See following 2 pages for examples of how to use Codes 71006 and 71007

IMPORTANT: See Appendix C for a complete set of examples of how to use these and

other codes and/or go to the DAO website: www.denturistassociation.ca, log-in as a Member, go to

'Services'.

NEW CODES FOR 2017

● Code 41145 for Reinforced Partial Maxillary Denture - Free-End or Tooth

Borne with or without clasps and/or rests. This partial is designed to be easily

added to or converted.

● Code 41146 for Reinforced Partial Mandibular Denture - Free-End or Tooth

Borne with or without clasps and/or rests. This partial is designed to be easily

added to or converted.

● Code 71006 for Maxillary Casting. This code is to be used when including

a Maxillary Casting to be fabricated by a commercial lab. Ensure you place the

cost of the Maxillary Casting under this code and not under code 98888. This

format only applies to a Maxillary Partial Denture.

● Code 71007 for Mandibular Casting. This code is to be used when

including a Mandibular Casting to be fabricated by a commercial lab. Ensure

you place the cost of the Mandibular Casting under this code and not under

code 98888. This format only applies to a Mandibular Partial Denture.




Code 71006

Date of Service Procedure Code Description Prof Fee Lab Fee Total

No Date 31320

Complete

Mandibular -

standard 709.00 425.00 1134.00

No Date 41114

Partial max.-free

end-standard 673.00 +L 673.00+L

1807.00+L


01/02/2017 31320

Complete

Mandibular -

standard 709.00 425.00 1134.00

01/02/2017 41114

Partial max.-free

end-standard 673.00 484.00 1157.00

2291.00

Please note:

OR


No Date 31320

Complete

Mandibular -

standard 709.00 425.00 1134.00

No Date 41114

Partial max.-free

end-standard 673.00 334.00 1007.00

No Date 71006 Maxillary Casting 150.00 150.00

2291.00


01/02/2017 31320

Complete

Mandibular -

standard 709.00 425.00 1134.00

01/02/2017 41114

Partial max.-free

end-standard 673.00 334.00 1007.00

01/02/2017 71006 Maxillary Casting 150.00 150.00

2291.00

Please note:

Total Fee Claimed

● How to submit the claim for the same treatment:

Total Fee Claimed

● This code is to be used when including a Maxillary Casting to be fabricated by a

commercial lab. Ensure you place the cost of the Maxillary Casting under Code 71006 and

not under Code 98888. This format only applies to a Maxillary Partial Denture.

● The date of service is now placed on the claim.


Total Fee Claimed

● The cost of the casting in this example is $150.00. That fee is added to your Lab Fee and

placed under the Lab Fee when submitting your claim.


Complete Mandibular and Cast Partial Maxillary Dentures (New option)

● How to submit a Pre-d for a complete mandibular and cast maxillary partial:

Examples of Codes 71006 and 71007

Complete Mandibular and Cast Partial Maxillary Dentures (Existing Format)

● How to submit a Pre-d for a complete mandibular and cast maxillary partial:

Total Fee Claimed




Code 71007


No Date 31310

Complete Maxillary

- standard 572.00 341.00 913.00

No Date 41124

Partial mand.-free

end-standard 703.00 +L 703.00+L

1616.00+L


01/02/2017 31310

Complete Maxillary

- standard 572.00 341.00 913.00

01/02/2017 41124

Partial mand.-free

end-standard 703.00 503.00 1206.00

2119.00

Please note:

OR


No Date 31310

Complete Maxillary

- standard 572.00 341.00 913.00

No Date 41124

Partial mand.-free

end-standard 703.00 353.00 1056.00

No Date 71007 Mandibular Casting 150.00 150.00

2119.00


01/02/2017 31310

Complete Maxillary

- standard 572.00 341.00 913.00

01/02/2017 41124

Partial mand.-free

end-standard 703.00 353.00 1056.00

01/02/2017 71007 Mandibular Casting 150.00 150.00

2119.00

Please note:


Complete Maxillary and Cast Partial Mandibular Dentures (New option)

● How to submit a Pre-d for a complete maxillary and cast mandibular partial:

Total Fee Claimed


Total Fee Claimed

● This code is to be used when including a Mandibular Casting to be fabricated by a

commercial lab. Ensure you place the cost of the Mandibular Casting under Code 71007 and

not under Code 98888. This format only applies to a Mandibular Partial Denture.

● How to submit a Pre-d for a complete maxillary and cast mandibular partial:

Total Fee Claimed


Total Fee Claimed

● The cost of the casting in this example is $150.00 each. That fee is added to the Lab Fee

and placed under the Lab Fee when submitting the claim.


Complete Maxillary and Cast Partial Mandibular Dentures (Existing Format)




Examinations

Examinations Are Not Inclusive in the “Fees” and Are Billed Separately.

EXAMINATIONS CODE PROF LAB TOTAL

General Oral Examination 10010 119.00 119.00

Oral Pathology Screening 10015 32.00 32.00

Limited Exam - New Patient 10020 63.00 63.00

Limited Exam - Previous Patient 10030 57.00 57.00

Emergency/Specific nature 10104 63.00 63.00

Annual/Recall/Recare 10105 57.00 57.00

10115 S.C.

10120 68.00 40.00 108.00

ALL EXAMINATIONS REQUIRE APPROPRIATE CHARTING OF FINDINGS.

* SEE INTRODUCTION/FORMAT

Examination with mirror of hard and soft tissues including checking

of occlusion and appliances.

Examination and evaluation of a specific situation in a localized

area.

Radiographic Interpretation - 1 unit of time (UT)*

Diagnostic Cast Model Required in Conjunction with

Exams/per modelStudy model used for determining denture design, rest prep

locations, occlusal contact points, etc.

Oral exams are an integral part of denture services provided by Denturists. Patients are assessed through the

appropriate examination to determine what services are required prior to developing a treatment plan.

Oral examinations for new denture patients entails a comprehensive regulatory approved investigation and

documentation of the oral cavity.

Extensive examination of the pre-prosthetic, edentulous, or partially

edentulous mouth, visual, digital and mirror examination of the oral

structures, head and neck (including the TMJ & lymph nodes), oral

mucosa, lips, tongue, oral pharynx, salivary glands, musculature,

and other associated stomatognathic structures. Also included in

this exam is a detailed Medical, Dental & Prosthetic history to be

completed on a regulatory approved form including a thorough

charting of the oral structures.

Oral exam using high intensity fluorescent light to locate, assess and

determine differentiated tissues throughout the oral cavity (eg: oral

cancer). This device is to be used in addition to a digital, visual

screening.

Examination with mirror of hard and soft tissues including checking

of occlusion and appliances.




a) Impressions preliminary and finals

final impressions - to include custom tray and muscle molded final impression

b) Bite Registration/Occlusal Records must include:

face bow transfer

semi adjustable articulator

centric relation may be determined by bite block technique establish vertical relation

premium quality teeth (tooth form should be of cusp or lingual contact occlusal morphology)

premium quality acrylic material

c) Try-In

includes full wax try-in verify centric occlusion and vertical dimension

verify protrusive and lateral movements

verify aesthetics and phonetics

fitting of cast framework

d) Insertion

verify centric and eccentric relations

check for pressure spots and denture base extensions

provide oral hygiene instruction and patient denture education

provide 3 months post insertion care

e) Opposing model included where required

NOTE: Clinical Protocol is a minimum standard. If procedures and/or materials are modified, then the fees should be

adjusted accordingly.

DESCRIPTION of PROCEDURES for PRECISION-EQUILIBRATED DENTURES -

COMPLETE AND PARTIAL DENTURES




PRECISION EQUILIBRATED DENTURE(S) - COMPLETE CODE PROF LAB TOTAL

Complete Maxillary 31110 729.00 437.00 1166.00

Complete Mandibular 31120 898.00 538.00 1436.00



COMPLETE DENTURE(S)

COMPLETE OVERDENTURE(S) (over naturally retained roots)




CODE PROF LAB TOTAL ORIG

PARTIAL (CAST FRAME)

Partial Maxillary 41110 859.00 +L 859.00 +L 1289.00

Partial Mandibular 41120 901.00 +L 901.00 +L 1352.00

Altered cast impression / with above codes 41140 109.00 65.00 174.00






OVERDENTURE(S) CAST FRAME (over naturally retained roots)

PRECISION EQUILIBRATED DENTURE(S)

FREE-END CAST FRAME

TOOTH BORNE CAST FRAME




a) Impressions

preliminary and finals

finals to be muscle molded

b) Bite Registration

to include centric and vertical relations

tooth selection

must be mounted in an articulator

c) Try-In full wax try-in

verify centric occlusion and vertical dimensions

check aesthetics and phonetics

fitting of cast framework

d) Insertion

verify centric and eccentric movements

check for pressure spots and denture base extensions

provide oral hygiene instruction and patient denture education

provide 3 months post insertion care

e) Opposing model included where required

DESCRIPTION of PROCEDURES for STANDARD DENTURES - COMPLETE

AND PARTIAL DENTURES

NOTE: Suggested Clinical Protocol - Minimum standard of acceptable denture construction. If procedures

are modified, then the fees should be adjusted accordingly.




STANDARD DENTURE(S) - COMPLETE CODE PROF LAB TOTAL







COMPLETE DENTURE(S)

COMPLETE TRANSITIONAL DENTURE(S)

COMPLETE OVERDENTURE(S) (over naturally retained roots)




STANDARD DENTURE(S) - PARTIAL (CAST FRAME) CODE PROF LAB TOTAL ORIG









FREE-END CAST FRAME






CODE PROF LAB TOTAL

Partial Maxillary 41610 531.00 318.00 849.00

Partial Mandibular 41620 560.00 336.00 896.00





OVERDENTURE(S) WITH CLASPS (over naturally retained roots)

STANDARD DENTURE(S) PARTIAL ACRYLIC BASE - WITH

CLASPS

STANDARD WITH CLASPS

TRANSITIONAL WITH CLASPS




CODE PROF LAB TOTAL







CODE PROF LAB TOTAL



STANDARD DENTURE(S) - PARTIAL RESILIENT BASE CODE PROF LAB TOTAL ORIG

Definition: Flexible (examples Flexite/Valplast)



STANDARD DENTURE(S) REINFORCED WITH ACRYLIC

BASE

FREE-END OR TOOTH BORNE WITH OR WITHOUT CLASPS AND/OR RESTS (This partial is designed to be

easily added to or converted.)

STANDARD DENTURE(S) PARTIAL ACRYLIC BASE - NO

CLASPS

STANDARD NO CLASPS (HEAT CURED)

TRANSITIONAL NO CLASPS (COLD CURED)

OVERDENTURE(S) NO CLASPS (over naturally retained roots)




IMMEDIATE DENTURES CODE PROF LAB TOTAL ORIG

Precision Equilibrated Denture(s)

COMPLETE IMMEDIATE DENTURES



COMPLETE IMMEDIATE OVERDENTURE(S) (over naturally retained roots)



FREE-END CAST FRAME









Standard Dentures

COMPLETE IMMEDIATE DENTURES



COMPLETE IMMEDIATE TRANSITIONAL DENTURES



COMPLETE IMMEDIATE OVERDENTURE (over naturally retained roots)



FREE-END CAST FRAME






Fees include 3 months post-insertion care. Fees do NOT include tissue conditioner and/or permanent reline.

Fees include 3 months post-insertion care. Fees do NOT include tissue conditioner and/or permanent reline.




IMMEDIATE DENTURES CODE PROF LAB ORIG




STANDARD ACRYLIC WITH CLASPS



TRANSITIONAL ACRYLIC WITH CLASPS



OVERDENTURE(S) ACRYLIC WITH CLASPS (over naturally retained roots)



STANDARD ACRYLIC NO CLASPS



TRANSITIONAL ACRYLIC NO CLASPS



OVERDENTURE(S) ACRYLIC NO CLASPS (over naturally retained roots)



On Implants

IMPLANT RETAINED/TISSUE SUPPORTED

To be converted at time of extractions



SCREW RETAINED REMOVABLE ACRYLIC TRANSITIONAL

To be converted to screw retained at time of extractions



TOTAL




RELINE(S) CODE PROF LAB TOTAL





















LAB PROCESSED/FUNCTIONAL IMPRESSION

SELF-POLYMERIZED/LAB PROCESSED

CHAIRSIDE/TEMPORARY ACRYLIC

CHAIRSIDE/PERMANENT ACRYLIC

LIGHT CURED




RELINE(S) CODE PROF LAB TOTAL







RELINE(S) WITH PERMANENT SOFT LINING CODE PROF LAB TOTAL









ON IMPLANTS - OVER BAR

ON IMPLANTS


CHAIRSIDE/PERMANENT SOFT LINING

ON IMPLANTS - BALL/INDEPENDENT




REBASE CODE PROF LAB TOTAL













Partial Maxillary* 46410 S.C.

Partial Mandibular* 46420 S.C.

DUPLICATE CODE PROF LAB TOTAL






ON IMPLANTS - OVER BAR

REMAKE – PARTIALS (USING EXISTING FRAMEWORK)


LAB PROCESSED/ACRYLIC (NO CASTING)


ON IMPLANTS - BALL/INDEPENDENT




REMOUNT & EQUILIBRATION CODE PROF LAB TOTAL









WITH IMPRESSION & RESET

RESET ONLY




REPAIRS

CODE PROF LAB TOTAL











ADDITIONAL REPAIR MATERIALS CODE PROF LAB TOTAL ORIG

Required / no impression 71309 22.00 22.00

Required / no impression 71310 22.00 22.00

Required for articulation 71311 76.00 76.00

Retentive post 71312 49.00 49.00

New Tooth each 71313 22.00 22.00

Per denture 71314 37.00 37.00

Cast each 71008 +L 0.00 +L 45.00

Wrought each 71010 45.00 45.00

Gold cast each 71020 +L 0.00 +L 45.00

Gold wrought each 71021 +L 0.00 +L 45.00

Thermal elastic friction each 71030 +L 0.00 +L 56.00

Thermal elastic gasket per tooth 71031 +L 0.00 +L 105.00

Per denture 71315 42.00 42.00

Soldering 71316 +L 0.00 +L 89.00

Laser weld 71322 +L 0.00 +L 89.00

Wire mesh screening 72001 +L 0.00 +L 68.00

Fiber mesh 72002 +L 0.00 +L 115.00

Cast mesh palate 72008 +L 0.00 +L 118.00

Cast palate (solid) 72010 +L 0.00 +L 190.00

Wire bar/Lingual bar 72021 63.00 63.00

Mandibular cast base (solid) 72030 +L 0.00 +L 190.00

Mandibular cast mesh 72031 +L 0.00 +L 118.00

REINFORCEMENTS

REPAIR MODEL

OPPOSING MODEL - IMPRESSION

ADDITIONAL

MULTIPLE FRACTURE

CLASP

FLANGE

Note: Repairs may include additional codes from the "Adjunctive Services/Additional Repair Materials" sections (series 71000-

73000 codes). Repairs may also require the use of a Commercial Laboratory. Laboratory services may not always be available in

every Denturist's office. When necessary, these fees are to now be added to the total Lab Fee once treatment is completed. ALL

Lab costs are to be placed under Lab Fee (98888).

NO IMPRESSION

WITH IMPRESSION

ADDITIONS – TOOTH OR CLASP

NOTE: Fees are inclusive of an addition of one tooth or an addition of one clasp (if additional teeth and/or clasps are

required, utilize appropriate 70,000 series codes)

MATRIX




TISSUE CONDITIONING CODE PROF LAB TOTAL

Complete Maxillary 37110 60.00 60.00

Complete Mandibular 37120 64.00 64.00

Partial Maxillary 47110 64.00 64.00

Partial Mandibular 47120 70.00 70.00




ADJUSTMENTS CODE PROF LAB TOTAL





Complete or Partial Adjustment (one unit of

time)*

58110 59.00 59.00

ADJUSTMENTS (LLLT) CODE PROF LAB TOTAL






PER VISIT

PER VISIT




ADJUNCTIVE SERVICES CODE PROF LAB TOTAL ORIG

Treatment not specified* as required 70000 S.C.

Cancelled appointment per appointment 70010 56.00 56.00

Out of office/House call* per visit 70020 S.C.

Travelling expense* per visit and/or

mileage

70030 S.C.

Emergency Office visit after hours 70040 56.00 56.00

Professional consultation per session 70050 59.00 59.00

Written report each 70060 56.00 56.00

Court appearance* per appearance 70080 S.C.

Name in denture per denture 70150 54.00 54.00

Prophylaxis & polish per denture 70160 54.00 54.00

Replace worn posteriors per denture 70170 212.00 128.00 340.00

Surgical stent maxillary 70201 153.00 +L 153.00 +L 245.00

Surgical stent mandibular 70202 153.00 +L 153.00 +L 245.00

Surgical template maxillary 70208 75.00 +L 75.00 +L 119.00

Surgical template mandibular 70209 75.00 +L 75.00 +L 119.00

Mouth guard type 3 * per arch 70210 70.00 41.00 111.00

Mouth guard type 4 * per arch 70218 106.00 +L 106.00 +L 171.00

Occlusal plane per arch 70220 75.00 44.00 119.00

Occlusal treatment splints per arch 70230 200.00 119.00 319.00

Palatal/Lingual bar (new denture) per arch 70240 110.00 110.00

Anti-snoring device (adjustable anterior

mandibular positioner) 70250 713.00 +L 713.00 +L1139.00

Teeth Whitening per arch (+cost of

kit) 70260 133.00 79.00 212.00

Oral hygiene instruction per visit 70308 72.00 72.00

Treatment of TMJ disorders* per session 70310 S.C.

T.E.N.S.* per application 70340 S.C.

Mandibular Kinesiograph* each photo 70360 S.C.

Non-Specific diagnosis and/or treatment* 70370 S.C.

Maxillary Casting each 71006 +L 0.00 +L

Mandibular Casting each 71007 +L 0.00 +L

Precision attachments partial 71040 260.00 260.00

Overdenture complete or partial 71050 260.00 260.00

Mandibular – sublingual 71070 269.00 269.00

71075 241.00 145.00 386.00

71076 241.00 145.00 386.00

71073 430.00 430.00


ATTACHMENTS

DENTURE STABILIZER SYSTEM

BITE REGISTRATION DEVICES

Intraoral Pin Tracing Device (for bite registration)

Face-bow Transfer (for articulation)

Extra or intra oral electronic tracings of TMJ using

software/electronic guided device that registers the protrusive and

laterotrusive excursion movements of the TMJ

SERVICES

CASTINGS




ADJUNCTIVE SERVICES (cont'd) CODE PROF LAB TOTAL ORIG

Impact resistant acrylic per denture 72040 118.00 118.00

Injection processed acrylic per denture 72041 211.00 211.00

Non-acrylic denture base (nylon, vinyl,

composite)*

per denture 72044 +L S.C. +L

Non-acrylic denture base (thermo-flex nylon)* per denture 72045 +L S.C. +L

Metal posteriors per denture 72050 +L 0.00 +L 118.00

Cutter bars per denture 72051 +L 0.00 +L 123.00

Backings/facings per tooth 72060 +L 0.00 +L 53.00

Soft-lining new denture 73008 186.00 186.00

Soft-lining - elastic gasket per tooth 73012 53.00 53.00

Soft-lining rebase 73013 186.00 186.00

Custom tray per arch 73019 76.00 76.00

Clear palate maxillary 73020 138.00 138.00

Gingival toning per denture 73030 118.00 118.00

Gold inlays per surface 73040 +L 0.00 +L 138.00

Amalgam inlays per surface 73041 +L 0.00 +L 138.00


MATERIALS





No Date 31110

Complete Maxillary

- Precision 0.00 437.00 1166.00

No Date 31720

Complete

Mandibular 0.00 824.00 2060.00

No Date 74085

New Dentures (Placing

Components) 0.00 250.00 665.00

No Date 74085


Components) 0.00 250.00 665.00

4556.00


01/02/2017 31110

Complete Maxillary

- Precision 0.00 437.00 1166.00

01/02/2017 31720

Complete

Mandibular 0.00 824.00 2060.00

01/02/2017 74085


Components) 0.00 250.00 665.00

01/02/2017 74085


Components) 0.00 250.00 665.00

4556.00

Please note:

Total Fee Claimed

● If aditional implant components or lab fabricated parts are needed, that cost should be

added under code 98888.


Example of Implant Retained/Tissue Supported with Indepdendent Attachments

Complete Maxillary and Complete Mandibular Dentures Retained by 2 Locators

● How to submit a Pre-d for a complete maxillary and complete mandibular:

Total Fee Claimed





Note: +L may include implant components as well as other +L fabricated parts. For example:

This Section may include but is not limited to the following individual implant abutments/attachments:

Locators, Equators, Ball & Cap, SFI™, etc.

CODE PROF LAB TOTALCOMPLETE DENTURES



PARTIAL DENTURES



RELINES





REBASE





REPAIRS WITH IMPRESSION



REPAIRS NO IMPRESSON



Denture Reinforcements, Abutments, Processing Kits, Impression Copings, Impression Analogs, Verification Jigs, Duplication

of Master model with silicone material, etc.

IMPLANT RETAINED/TISSUE SUPPORTED WITH INDEPENDENT ATTACHMENTS

Implant retained/tissue supported dentures are often referred to as Implant retained or tissue supported - they are the

same thing.

Note: It is recommended that all Members receive specialized implant training and retain documentation of this training

prior to starting implant cases.




CODE PROF LAB TOTAL

NEW DENTURES

To be charged for each implant that the new

denture(s) are secured to.

Processing/placing of components are to be

changed at the time of new denture. 74085 415.00 250.00 665.00

RETROFITTING/RELINE BALL/CAP, LOCATOR/INDEPENDENT ABUTMENT

To be charged for each implant when an

existing denture is retrofitted/relined to

implants. Per Implant/Attachment 74090 415.00 250.00 665.00

RETROFITTING/RELINE BAR AND CLIP

To be charged for each implant when an

existing denture is retrofitted/relined to

implants. Per Implant/Attachment 74091 415.00 250.00 665.00

REPLACING IMPLANT COMPONENTS

The replacement of nylon, plastic inserts in

implant secured existing dentures. Fee is per

unit being replaced when worn out. Per Implant/Attachment 74095 34.00 0.00 34.00

IMPLANT RETAINED/TISSUE SUPPORTED WITH

INDEPENDENT ATTACHMENTS





No Date 31810 Complete Maxillary 1607.00 1071.00 2678.00

No Date 74016 Milled Bar +L

No Date 74085


Components) 415.00 250.00 665.00

No Date 74085


Components) 415.00 250.00 665.00

No Date 74085


Components) 415.00 250.00 665.00

No Date 74085


Components) 415.00 250.00 665.00

No Date 31120

Complete

Mandibular -

Precision 0.00 538.00 1436.00

6774.00+L



No Date 74016 Milled Bar 3500.00 3500.00

No Date 74085


Components) 415.00 250.00 665.00

No Date 74085


Components) 415.00 250.00 665.00

No Date 74085


Components) 415.00 250.00 665.00

No Date 74085


Components) 415.00 250.00 665.00

No Date 31120

Complete

Mandibular -

Precision 898.00 538.00 1436.00

10274.00

Please note:


Total Fee Claimed




Example of Implant Bar Overdenture

Complete Maxillary on 4 Implants (Milled Bar) and Complete Mandibular

● How to submit a Pre-d for a complete maxillary and complete mandibular:

Total Fee Claimed




Note: +L may include all components as well as other +L fabricated parts. For example:

This Section may include but is not limited to the following implant bar designs:

Milled Bar, Cast Bar, SFI/Bar™, etc.

CODE PROF LAB TOTAL

COMPLETE DENTURES



RELINES



REBASE






REPAIRS NO IMPRESSION



REMOVAL OF BAR PROSTHESIS

To be reinserted

One unit of time 74054 67.00 67.00

Two units of time 74154 134.00 134.00

Three units of time 74254 201.00 201.00

Four units of time 74354 268.00 268.00

Each additional unit of time over four 74454 67.00 67.00

REMOVAL OF BAR PROSTHESIS FOR PROPHYLAXIS



RETENTIVE BAR PREFABRICATED OR CUSTOM BAR

To be ordered/or prescribed by Denturist* 74016 +L S.C +L

NEW DENTURES

To be charged for each implant that the new

denture(s) are secured to.

Processing/placing of components are to be

changed at the time of new denture. 74085 415.00 250.00 665.00

REPLACING IMPLANT COMPONENTS

The replacement of nylon, plastic inserts in

implant secured existing dentures. Fee is per

unit being replaced when worn out. Per

Implant/Attachment 74095 34.00 0.00 34.00


Denture Reinforcements, Abutments, Impression Copings, Impression Analogs, Verification Jigs, Screws, etc.

IMPLANT BAR OVERDENTURE








No Date 74016 Milled Bar +L +L

9591.00+L


01/02/2017 74024 Complete Maxillary 5994.00 3597.00 9591.00

01/02/2017 74016 Milled Bar 3500.00 3500.00

13091.00

Please note:

Total Fee Claimed




Example of Implant Supported Screw Retained Removable Prosthesis

Complete Maxillary (Occluding with Natural Lower Dentition)

● How to submit a Pre-d for a complete maxillary:

Total Fee Claimed





Note: +L may include all components as well as other +L fabricated parts. For example:

Denture Reinforcements, Abutments, Impression Copings, Impression Analogs, Verification Jigs, Screws, etc.

CODE PROF LAB TOTAL

COMPLETE DENTURES WITH ACRYLIC TEETH



COMPLETE DENTURES WITH PORCELAIN TEETH



RELINES






REPAIRS WITH NO IMPRESSION



REMOVAL OF SCREW RETAINED PROSTHESIS

To be reinserted

One unit of time 74054 67.00 67.00

Two units of time 74154 134.00 134.00

Three units of time 74254 201.00 201.00

Four units of time 74354 268.00 268.00

Each additional unit of time over four 74454 67.00 67.00

REMOVAL OF SCREW RETAINED PROSTHESIS FOR PROPHYLAXIS



RETENTIVE BAR REPFABRICATED OR CUSTOM BAR

To be ordered/or prescribed by Denturist* 74016 +L S.C. +L


IMPLANT SUPPORTED SCREW RETAINED REMOVABLE PROSTHESIS






A. Denturist Association of Ontario – ORAL HEALTH CHART

Date: Patient’s Name (or case #):

Oral Health Care Team

Denturist’s Name:

Dentist’s Name:

Consultants Name (i.e. - oral surgeon, periodontist, etc.):

Other (i.e. – commercial lab, implant company, etc):

Lesions, abnormalities, tooth mobility, special considerations:

12 11 21 22

13 23

14 24

15 25

16 26

17 MAXILLA 27

18 28

48 38

47 MANDIBLE 37

46 36

45 35

44 34

43 33

42 41 31

32

18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28

48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38

1

B. RECOGNIZED RECORDING SHORT-FORMS

The Denturist Association of Ontario (DAO)recognizes that keeping very thorough patient records may be considered time consuming by some, yet the value and necessity of doing so over-rides such concerns. In an effort to assist members in satisfying their obligations to meet standards for record keeping the DAO recommends that members consider the use of accepted short forms for recording many procedures, findings, materials and treatments. The short-forms listed below may serve as a key/legend for members who wish to use these abbreviations. Short-forms developed by members individually are acceptable so long as they can reasonably be understood by someone else reviewing the patient health/dental record and so long as they are used consistently.

Record Keeping Short-Forms Record Keeping Short-Forms continued

Descriptive Terms Abbreviation Health Care Providers Abbreviation

Anterior ant. Denturist DD

Posterior post. Dentist DDS

Left lt. Dental Hygienist RDH

Right rt. Dental Technician DT / RDT

Distal dis. Chiropractor Chiro.

Mesial mes. Physician MD

Lingual ling. Buccal buc. Miscellaneous Abbreviation

Palatal pal. Required req’d

Labial lab. Lower ./l

Lip Support l.s. Upper u/.

Smile Line sm.ln. Upper & Lower u/l

Vertical Dimension v.d. Patient Pt.

Class I Occlusion Cls. I No Charge n/c

Class II Occlusion Cls. II No Show N/S

Class III Occlusion Cls. III Division Div Dental Materials Abbreviation

Crossbite X/B Alginate alg

Sore Spot SS Vinyl polysiloxane VPS

Border Molding BM

Bite Block BB

Procedures Abbreviation Pressure Indicating Paste pip

Reline rel Poly Ether PE

Rebase reb Zinc Oxide ZOE

Adjustment adj Impression imp Dental Charting Key / Legend Bite Registration Bite reg Descriptive Terms Abbreviation

Selection sel Missing Tooth X

Soft Liner Srel Unerupted / Impacted Circle tooth

Insertion ins. Drift & Migration Repair rep. Diastema II (between teeth)

Preliminary Impressions prelim Rotation Temporary Soft Liner tsl Sight Tooth Mobility (1mm) M1

Tissue Conditioner t/c Moderate Tooth Mobility (2mm) M2

Post Insertion Check-up PIC / PI√ Severe Tooth Mobility (3mm) M3

Will Call Us wcu Very Severe Tooth Mobility (+3mm) M (#mm)

Watch and Wait w/w Follow up f/u Restorations Abbreviation

Try In T/I Amalgam AG

Composite Resin CR

Types of Prostheses Abbreviation Porcelain Bonded to Metal CV

Acrylic Partial Upper Denture apud Porcelain Crown PC

Acrylic Partial Lower Denture apld Porcelain Onlay / Inlay PO / PI

Cast / Chrome Partial Upper Denture cpud Porcelain Veneer PV

Cast / Chrome Partial Lower Denture cpld Gold Crown GC

Complete Upper Denture cud Gold Onlay / Inlay GO / GI

Complete Lower Denture cld Stainless Steel Crown SSC

Immediate Denture Imm. Crown & Bridge C/B

NOTE: When performing adjustments, the specification of the location and nature of the adjustment is required.

2

In the event of misunderstanding by a patient, or if legal questions should arise, the patient’s medical / dental record can prove invaluable in a member’s defense if charts and patients’ medical / dental records are thorough and complete

All charting must be done in ink. George Brown College has recommended that practitioners consider the use of multiple ink colours for partial denture designs such as red ink to indicate rests and blue ink to designate designs. While members might find multi-colour charting both useful and more readable, it is not mandatory to do so.

Any finding should be noted in the patient’s medical / dental record where the denturist believes that the finding may be significant to the outcome of the case. Missing or misplaced teeth must be charted. Abnormal surfaces of teeth should also be noted where the abnormality may effect the success of treatment. Such abnormalities should be tracked over time in order to reflect retrogressive changes, such as Attrition, Abrasion, Erosion, Resorption and Discolouration.

The clinical mobility of teeth provides a method of determining the presence or absence of supporting bone for the root or roots of the teeth. Mobility of teeth is referred to by a numerical index related to millimeters of tooth movement within the socket. It is highly recommended that changes in tooth mobility be tracked over time.

Members should chart what restorative treatments have been performed by other care providers in circumstances where the case design may have effects on the natural dentition, for example clasping crowns or heavily restored teeth.

The outcome and success of treatment can be measured by comparing the findings of initial examinations with the findings of periodic / regular follow-up examinations.

Patient health records provide a means of communication between the health team as well as with the patient. Comprehensive health histories, informed consent forms and accurate documentation are essential to the operation of a safe, thorough and patient focused practice. Health records are both business and legal documents that can serve as protection for the health care provider should concerns regarding care and treatment arise at a later date. Radiographs, study casts and all other documentation collected during the initial examination and during continued care are official parts of the patient’s medical / dental record.

A filing system is needed that has accessibility to the health records by authorized personnel only. The privacy of patient records must be maintained.

These abbreviations have been compiled from several sources including George Brown College, Clinical

Practice of the Dental Hygienist by Esther Wilkins (8th Edition), and the Federation Dentaire Internationale Identification System.

Sample charting for natural dentition:

C. SUBMITTING ESTIMATES AND CLAIMS

1. The below changes were made effective January 1, 2016 and were included in the 2016 DAO Fee Guide. We are including the explanations from The DAC regarding these changes for your information. If you have questions/concerns please call the DAO office or email to: [email protected].

The DAC together with its Procedure Code Committee announced that the Procedure Code 98889, formerly utilized for Commercial Laboratory Fees, has been inactivated from The DAC’s Masterlist of Procedure Codes and the Procedure Code 98888, formerly utilized for In-House Laboratory Fees, is renamed and utilized as Laboratory Fees effective January 1, 2016.

As of January 1, 2016 Denturists across Canada are required to submit pre-determinations to insurance companies as follows:

Professional Fee with Laboratory Fee outlined for Procedure Codes with no variable laboratory fee

Example: COMPLETE DENTURE(S)

Code Procedure Prof Lab Total

31310 - Complete Maxillary $572.00 $341.00 $913.00

Professional Fee with +L designation for Procedure Codes with variable laboratory fees i.e. +L is the total laboratory fee, the fee guides would use the designation +L for the lab component for procedure codes with variable laboratory fees - example below for ease of reference. This process will replace the +CL process that was previously used by Denturists when submitting procedure codes with variable laboratory fees using 2 separate laboratory fee procedure codes i.e. in-house lab 98888 and commercial lab 98889 Example: PARTIAL DENTURE(S)

Code Procedure Prof Lab Total

41114 - Partial Maxillary Free End $673.00 +L $673.00 +L

Thus example 2 would be not to include a dollar figure for the laboratory fee in the fee guides that are provided to the insurance industry for the procedure codes with a variable laboratory fee only (i.e. the current procedures that have

+CL). These procedures would have the professional fee with the designation +L.

The DAC feels that by not having a defined laboratory fee stated in the fee guides, for procedure codes with variable laboratory fees, there would be no conflicting dollar values between the laboratory fee in the insurer's systems and the laboratory fee submitted in the claim by the Denturist.

CLHIA (Canadian Life and Health Insurance Association) members did point out that insurers set maximum reasonable and customary (R&C) limits for laboratory fee charges based on a % of the professional fee and that, by combining two fees into one field, the maximum R&C limit may be reached more frequently, thereby increasing patient out-of-pocket costs. The DAC explained that in cases where there is a variable laboratory fee that would cause the laboratory fee to exceed the R&C, Denturists would utilize the necessary 70,000 series procedure codes, which would allow for the proper adjudication of Denturist claims in order to be fair to dental insurance subscribers and equitable to the professions of Denturism and Dentistry. This will alleviate a lot of paperwork and unnecessary administrative hours on all parties involved.

When preparing to send in the claim once treatment is completed Denturists would add any additional Lab cost to the total Lab fee under code 98888. It is advisable to keep any proof of lab costs in the patient's chart. We also added the column named “ORIG” that makes reference to the total original fee from the 2016 Fee Guide. It will only be with the codes that no longer have a Lab Fee defined.

C. SUBMITTING ESTIMATES AND CLAIMS (cont’d)

It is recommended that a treatment plan should be supplied to the patient in advance of treatment being rendered and the patient should receive written confirmation of insurance carrier liability before treatment begins. Please keep the following points in mind when submitting estimates /pre-determinations (pre-d):

do not enter a date of service on estimates, it leads the insurer to believe that a service has been completed;

do not sign an estimate form; do not submit a claim and an estimate on the same form e.g. if you are submitting a claim for a new patient

exam and an estimate for new dentures, submit the claim for the exam on one form and the estimate for new dentures on a second form;

clearly indicate on the form ‘for pre-determination’ or ‘estimate only’;

if you receive a cheque in reply to a pre-determination, do not cash the cheque and immediately advise the insurance company about the mistake.

IMPORTANT NOTE: Claims cannot be submitted until after a service has been completed. The following are examples of how to submit a Pre-d and a claim for the same treatment plan.

2. Addition to a partial:

How to submit a Pre-d for an addition to a partial denture: EXAMPLE: Addition to a partial mandibular, cast mesh retention welded by a commercial lab. Two teeth and one wrought clasp added in your clinic. Upper and lower impressions taken.

Date

Service Completed

Procedure Code

Description of Service Prof Fee Lab Fee Total Charges

No Date 46320 Partial Mandibular-addition of tooth or clasp

110.00 67.00 177.00

No Date 71311 Opposing Model - impression 47.00 29.00 76.00 No Date 71313 New tooth (each) 22.00 22.00 No Date 72031 Mandibular cash mesh +L +L No Date 71010 Clasp - wrought 45.00 45.00

Total Fee Claimed 320.00+L

How to submit the claim for the same treatment plan:

Date

Service Completed

Procedure Code


01/01/2017 46320 Partial Mandibular-addition of tooth or clasp

110.00 67.00 177.00

01/02/2017 71311 Opposing Model - impression 47.00 29.00 76.00 01/02/2017 71313 New tooth (each) 22.00 22.00 01/02/2017 72031 Mandibular cash mesh 67.00 67.00 01/02/2017 71010 Clasp - wrought 45.00 45.00

Total Fee Claimed 387.00

Please note:

Fees are inclusive of an addition of one tooth or an addition of one clasp (if additional teeth and/or clasps are required utilize appropriate 70,000 series codes) The cost for the cast mesh from the commercial lab was 65.00. That fee is added with your Lab Fee (if

applicable) and placed under the Lab Fee when submitting your claim.

The date of service is now placed on the claim.

For repairs, record on the patient’s chart the type of repair and the additional materials used. In the repair example given above (example #1), the chart might read, ‘repair – with impression, model and two teeth.

C. SUBMITTING ESTIMATES AND CLAIMS (cont’d)

3. Code 71006: Complete Mandibular and Cast Partial Maxillary Dentures

(Existing Format)

How to submit a Pre-d for a complete mandibular and cast maxillary partial: Date

Service Completed

Procedure Code


No Date 31320 Complete Mandibular-standard 709.00 425.00 1134.00

No Date 41114 Partial Max.-free end-standard 673.00 +L 673.00+L


How to submit the claim for the same treatment: Date

Service Completed

Procedure Code


01/02/2017 31320 Complete Mandibular-standard 709.00 425.00 1134.00

01/02/2017 41114 Partial Max.-free end-standard 673.00 484.00 1157.00


Please note:

The cost of the casting in this example is $150.00. That fee is added with your Lab Fee and placed under the Lab Fee when submitting your claim.


OR

Complete Mandibular and Cast Partial Maxillary Dentures (New option)

How to submit a Pre-d for a complete mandibular and cast maxillary partial:

Date Service

Completed

Procedure Code



No Date 41114 Partial Max.-free end-standard 673.00 325.00 1007.00

No Date 71006 Maxillary Casting 150.00 150.00



Service Completed

Procedure Code



01/02/2017 41114 Partial Max.-free end-standard 673.00 334.00 1007.00

01/02/2017 71006 Maxillary Casting 150.00 150.00


Please note:

This code is to be used when including a Maxillary Casting to be fabricated by a commercial lab. Ensure you place the cost of the Maxillary Casting under code 71006 and not under code 98888. This format only applies to a Maxillary Partial Denture.


C. SUBMITTING ESTIMATES AND CLAIMS (cont’d) 4. Code 71007: Complete Maxillary and Cast Partial Mandibular Dentures

(Existing Format)

How to submit a Pre-d for a complete maxillary and cast mandibular partial: Date

Service Completed

Procedure Code


No Date 31310 Complete Maxillary-standard 572.00 341.00 913.00

No Date 41124 Partial Mand.-free end-standard 703.00 +L 703.00+L



Service Completed

Procedure Code


01/02/2017 31310 Complete Maxillary-standard 572.00 341.00 913.00

01/02/2017 41124 Partial Mand.-free end-standard 703.00 503.00 1206.00


Please note:

The cost of the castings in this example is $150.00 each. That fee is added with your Lab Fee and placed under the Lab Fee when submitting your claim.


OR

Complete Maxillary and Cast Partial Mandibular Dentures (New option)

How to submit a Pre-d for a complete maxillary and cast mandibular partial: Date

Service Completed

Procedure Code



No Date 41124 Partial Mand.-free end-standard 703.00 353.00 1056.00

No Date 71007 Mandibular Casting 150.00 150.00



Service Completed

Procedure Code



01/02/2017 41124 Partial Mand.-free end-standard 703.00 353.00 1056.00

01/02/2017 71007 Mandibular Casting 150.00 150.00


Please note:

This code is to be used when including a Mandibular Casting to be fabricated by a commercial lab. Ensure you place the cost of the Mandibular Casting under code 71007 and not under code 98888. This format only applies to a Mandibular Partial Denture.


5. Complete Maxillary and Mandibular Dentures

How to submit Pre-d for a new complete maxillary and complete mandibular: Date

Service Completed

Procedure Code






Service Completed

Procedure Code





Please note:

When submitting a claim for a procedure where there is a Lab Fee, it is important to keep good records.

You must be able to verify the Lab Fees should an insurance company make inquiries.

Keep the invoices from the commercial lab for all Lab Fees.

If you have further questions or concerns please call the DAO office or visit the DAO website or email to: [email protected].

mailto:[email protected]

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