SUBJECT: CHANGES TO DENTAL SCHEDULE OF BENEFITS - APRIL 1, 2005 (Year 4 of the multi-year funding agreement) Kenora Robertson St.

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Bulletin Bulletin Number 9075 Distribution Dental Surgeons Date April 8, 2005 Direct inquiries to Ministry of Health and Long-Term Care Processing Office (address below) SUBJECT: CHANGES TO DENTAL

1 Bulletin Bulletin Number 9075 Distribution Dental Surgeons Date April 8, 2005 Direct inquiries to Ministry of Health and Long-Term Care Processing Office (address below) SUBJECT: CHANGES TO DENTAL SCHEDULE OF BENEFITS - APRIL 1, 2005 (Year 4 of the multi-year funding agreement) 1) Fee Increases 2) New Fee Codes 3) Deleted Code 4) Hospitals billing OHIP under the Dental Schedule 5) List of Existing Codes with Fee Increases 6) List of New Fee Codes 1) Fee Increases The 5 year funding agreement between the Ministry of Health and Long-Term Care and the Ontario Dental Association (ODA) provides for an annual incremental fee increase of 2% plus an annual incremental repair to base amount of 1% which can also be applied to fees. This fee increase will be applied to 85 designated fee codes for year 4 of the agreement (commencing April 1, 2005). See Section #5 for details. 2) New Fee Codes The agreement provides for annual targeted funding to introduce new fee codes. 52 new fee codes being introduced on April 1, 2005 include codes in the distraction osteogenesis, neurological disturbances, cysts and tumors, lacerations and scar revisions, surgical assisting and maxillectomy/mandibulectomy sections of the schedule. See Section #6 for details. Office locations Barrie 34 Simcoe St. Suite 102 L4N 6T4 Etobicoke 3300 Bloor St. W., Unit 142 M8X 2W8 Hamilton 119 King St. W P.O. Box 2280, Stn. A L8N 4C8 Kenora Robertson St. P9N 1X9 Kingston 1055 Princess St. P.O. Box 9000 K7L 5A9 Kitchener 1400 Weber St. E. Unit B2 N2A 3Z8 London 217 York St., 5th Floor Station A N6A 4L6 Mississauga 201 City Centre Dr. P.O. Box 7020, Stn. A L5A 3M1 Newmarket 465 Davis Dr. Unit 108 L3Y 8T2 North Bay McKeown Ave. P1B 9S9 North York 4400 Dufferin St N M3H 6A8 Oakville Oakville Town Centre II 220 North Service Rd. W. L6M 2Y3 Oshawa Exec. Tower, Oshawa Centre. 419 King St. W. P.O. Box 635 L1H 8L4 Ottawa Fuller Building 75 Albert Street K1P 5Y9 Owen Sound st Ave. W Suite # 2. N4K 6Z9 Peterborough 550 Lansdowne St. W. K9J 8J8 St. Catharines 301 St. Paul St. Mezzanine Level L2R 3M8 Sarnia 452 Christina St. N. N7T 5W4 Sault Ste. Marie Roberta Bondar Place 70 Foster Dr., Ste. 100 P6A 6V4 Scarborough 2063 Lawrence Ave. E. M1R 2Z4 Sudbury 199 Larch St., Suite 801 P3E 5R1 Thunder Bay 435 James St. S., Suite 113 P7E 6T1 Timmins 38 Pine St. N., Suite 110 P4N 6K6 Toronto 47 Sheppard Ave.E. Suite 417 M2N 7E7 Windsor 1427 Ouellette Ave. N8X 1K1 Head Office P.O. Box 48 Kingston, ON K7L 5J3

2 3) Deleted Code Fee code T617 (Suturing of a peripheral nerve fascicular-add) will be removed and replaced by T647 (Fascicular anastomosis-add) effective April 1, 2005 to provide a broader definition of service. 4) Hospitals billing OHIP under the Dental Schedule The April 1, 2005 schedule also clarifies that it is a condition for payment of these insured services that they be performed in a hospital classified as being in Group A, B, C and D (i.e. an acute care hospital) under Regulation 964 of the Public Hospitals Act; by a dentist who has been appointed to the dental/medical staff of the respective hospital. 5) List of Existing Codes with Fee Increases OHIP INTL. Description Revised Revised DDS Specialist T260 Bone intraoral T261 Bone extraoral maxillofacial T262 Bone rib T263 Bone iliac crest T264 Bone calvarial T265 Bone tibia T266 Cartilage T267 Skin T268 Mucosa T269 Fascia T270 Muscle T271 Dermis T272 Fat T273 Nerve intraoral T274 Nerve extraoral T359 Alveolar ridge reconstruction: with autogenous bone and/or alloplastic material per arch maxilla T360 Alveolar ridge reconstruction: with autogenous bone and/or alloplastic material per arch - mandible T361 Reconstruction of maxilla unilateral T362 Reconstruction of maxilla bilateral 1, Resection of benign soft tissue lesion under 1 cm (includes T biopsy) T Resection of benign soft tissue lesion 1 cm to 3 cm T Excision of benign tumour of bone 1 cm to 3 cm T Excision of benign tumour of bone over 3 cm T Excision malignant tumour, oral cavity or lip under 3 cm T375 Excision malignant tumour, soft tissue oral cavity over 3 cm T Excision malignant tumour of bone under 3 cm T Excision malignant tumour of bone over 3 cm T Cheiloplasty (lip shave) T382 Reconstruction of mandible unilateral, partial T384 Reconstruction of mandible bilateral, partial 1,

3 T Excision of cyst under 1 cm (includes biopsy) T Excision of cyst 1 cm to 3 cm (includes biopsy) T Excision of cyst over 3 cm (includes biopsy) T Marsupialization of cyst (includes 12 post surgical visits) T Open reduction 1, T425 Closed reduction 1, T426 With Rigid Internal Fixation add per side T Closed reduction (will not be paid with T431 T433) T Open reduction single T Open reduction double T Open reduction - multiple 1, T Closed reduction (will not be paid with T441 T443) T Open reduction single T Open reduction double T Open reduction multiple 1, T Closed reduction (will not be paid with T451 and T452) T Open reduction unilateral T Open reduction bilateral 1, T Open reduction transcutaneous approach T Open reduction transoral approach T Orbital blowout isolated injury T463 Closed reduction T464 Open reduction (including nasal septum) T465 Open reduction (including canthal ligament repair) T468 With antral packing - add T Reduction transoral approach T471 Reduction transcutaneous approach T Open reduction transoral approach T Transcutaneous approach T488 Fracture of alveolus closed T489 Fracture of alveolus open Reimplantation of avulsed or subluxated tooth (including root T canal therapy and surgery) T493 Anterior table and/or posterior table repair local access - add T494 With coronal incision and pericranial flap to obliterate sinus and nasal frontal duct to include cranialization - add T495 With fat to obliterate sinus and nasal frontal duct - add T496 Nasal frontal duct reconstruction with stent or creating opening into ethmoid sinuses - add Repair of uncomplicated laceration, intraoral or extraoral T under 2 cm T Involving both skin and mucosa - under 2 cm T505 Involving both skin and mucosa over 2 cm T507 Repair of uncomplicated laceration, intraoral or extraoral 2 cm 5 cm T508 Repair of uncomplicated laceration, intraoral or extraoral over 5 cm T (including local tissue shifts) - intraoral and extraoral under 2.5 cm 90.09

4 T (including local tissue shifts) intraoral or extraoral cm to 5 cm T (including local tissue shifts) intraoral or extraoral over 5 cm T Unilateral repair T Reconstruction with lip switch flap T Palatorrhaphy - anterior T Palatorrhaphy - posterior T Palatorrhaphy - total 1, T Injection of nerve (lytic destruction or steroid) T Peripheral nerve avulsion - partial T Peripheral nerve avulsion - total T Transposition of mental nerve T Decompression of inferior alveolar nerve T When operating microscope required for any of the above procedures 6) List of New Fee Codes 4 Add 40% to basic fee The following is a list of all new fee codes for Year 4 of the Schedule. These codes can be billed for services rendered on or after April 1, Code Description D.D.S Specialist T363 Nasal reconstruction 1, T364 Stabilization with plating or crib add per side T368 Resection of benign soft tissue lesion over 3 cm T369 Excision of benign tumour of bone under 1 cm T383 Reconstruction of mandible, complete (including condyle) unilateral T385 Reconstruction of mandible, complete (including condyles) bilateral T386 Construction of developmentally absent condyle and vertical ramus - bilateral T445 Interim stabilization with bone plate add per side 1, , , T510 Primary closure at time of initial surgery T511 Secondary closure with palatal flap T512 Secondary closure with pharyngeal flap 1, T513 Secondary closure with tongue flap 1, T514 Secondary closure with buccal flap T526 Complex reconstruction or revision bilateral 1, T530 Split thickness skin graft to face T605 When injury older than eight weeks - add Add 30% to basic fee T607 Decompression of infraorbital nerve intraoral facial approach anterior T608 Decompression of infraorbital nerve transantral approach 1, posterior T609 With laser coagulation add T619 Physiologic monitoring (eg. Stimulation and recording evoked

5 potentials) T633 Primary repair T634 Secondary repair T635 Neuroma excision and biopsy add T636 With nerve graft (includes harvesting ) add T637 With conduit up to 3 cm. add T638 With conduit over 3 cm. add T639 With fibrin adhesive per anastomosis add T644 Assisting at physician s surgery 30% of surgical fee as per physicians schedule T645 Trigger point injection for chronic pain per site T646 Diagnostic or therapeutic nerve block per site T647 Fascicular anastomosis - add T670 Mandible intraoral unilateral add T671 Mandible extraoral bilateral add 1, T672 Mandible intraoral unilateral add T673 Mandible extraoral bilateral add 1, T674 Maxilla - intraoral unilateral - add T675 Maxilla - intraoral bilateral - add 1, T676 Maxilla - extraoral unilateral - add T677 Maxilla - extraoral bilateral - add 1, T678 Mandibular alveolus unilateral add T679 Mandibular alveolus bilateral add 1, T680 Maxillary alveolus unilateral add T681 Maxillary alveolus bilateral - add 1, T682 Temporomandibular joint unilateral add T683 Temporomandibular joint bilateral - add 1, T684 Cranium unilateral - add T685 Cranium bilateral - add 1, T686 Orbit unilateral add T687 Orbit bilateral - add 1, T688 Zygoma unilateral add T689 Zygoma bilateral - add 1, T690 Removal of device per device add This Bulletin is a general summary provided for information purposes only. Physicians, dental surgeons, hospitals and other health care providers are directed to review the Health Insurance Act, Regulation 552 and the Schedules under that regulation, for the complete text of the provisions. You can access this information on-line at: HYPERLINK http In the event of a discrepancy between this bulletin and the Act or regulations and/or Schedules under regulations, the text of the Act, regulations and/or Schedules prevail. 5

CHAPTER 8 SECTION 1.4 ORAL SURGERY TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 SPECIAL BENEFIT INFORMATION

CHAPTER 8 SECTION 1.4 ORAL SURGERY TRICARE/CHAMPUS POLICY MANUAL M DEC 1998 SPECIAL BENEFIT INFORMATION TRICARE/CHAMPUS POLICY MANUAL 6010.47-M DEC 1998 SPECIAL BENEFIT INFORMATION CHAPTER 8 SECTION 1.4 Issue Date: October 8, 1986 Authority: 32 CFR 199.4(e)(10) I. DESCRIPTION There are certain oral surgical