Supplementary Health Services manages dental benefits for Hosmed 2013

Transcription

1 Supplementary Health Services manages dental benefits for Hosmed 2013 SHS Contact Detail Hosmed Dental : Tel: Dental Claim Submissions Electronic Claim submission via : Healthbridge 523P E-MED / e-md Medilink Lencom 560P MediSwitch 523P Switchonline 523P or THHM0000 QEDI/DHS 523P Datamax HOSMED01 I-KAT Dental Hospital Authorisations : hosmedhosp@shsdent.co.za Fax: Other Dental Authorisations : hosmedauth@shsdent.co.za Fax: Claims Call Centre : hosmedclaims@shsdent.co.za Fax: Pre-Auth Enquiry Call Centre : hosmedenquiry@shsdent.co.za Fax: Paper claims can be faxed to : Fax: or Posted to : PO Box 3095 Paarl 7620 Please visit our website at for: The dental tariff and procedure code list % increase The dental procedure code exclusions list 2013 Registration Form for the Dental Care Program Pre-Authorisation for Dental Procedures

2 2013 CONSERVATIVE DENTISTRY /BASIC DENTISTRY (No annual financial limit, protocol and quantity apply) Dental Consultation Annual check-up 2 annual checkups per beneficiary every 6 months 2 annual checkups per beneficiary every 6 months 2 annual checkups per beneficiary every 6 months Restorations/fillings (Amalgam and Resin) More than 4 fillings per member per year must be motivated and case management for extensive dental restorations will apply and must register on the dental care programme Diagnostics Benefits for fillings are available where such fillings are clinically indicated, and will be granted once per tooth in a 3 year period Benefits for fillings are available where such fillings are clinically indicated, and will be granted once per tooth in a 3 year period Benefits for fillings are available where such fillings are clinically indicated, and will be granted once per tooth in a 3 year period Intraoral radiographs complete series not covered 4 x Peri-apical X-Rays annually per member or 2 x Bite wings once a year Scale and polish once every 6 months Fluoride treatment only on members below 18 years Intraoral radiographs complete series not covered 4 x Peri-apical X-Rays annually per member or 2 x Bite wings once a year Scale and polish once every 6 months Fluoride treatment only on members below 18 years Intraoral radiographs complete series not covered 4 x Peri-apical X-Rays annually per member or 2 x Bite wings once a year Scale and polish once every 6 months Fluoride treatment only on members below 18 years Preventative Dentistry DENTAL THERAPIST Dental Therapist Limited to per person and per family per annum Limited to per person and per family per annum SPECIALISED DENTISTRY Crowns and Bridges Pre-authorisation is required X-Rays required Dentures Subject to pre-authorisation and treatment protocols If not pre-authorised 20% copayment on all options Orthodontics Limited to beneficiaries below the age of 18 years and apply to functional treatment only Pre authorisation required, including retainers Periodontics Pre-authorisation required Endodontic therapy (root canal treatment) 3 Peri-apical X-Rays covered, 8132 Pulp removal/ emergency root canal treatment not allowed on same day as root treatment Limited to per person and per family per annum 2 crowns or 2 bridge units per family per year. Benefit for crowns are granted once per tooth per 5 years 1 set of full,or upper, or lower plastic denture every 4 years Relines, rebase, soft base every 2 years Metal framework every 5 years Partial denture every 3 years Pre-authorisation is required for orthodontic treatment subject to available specialised dentistry limit Restricted to non surgical, root planning and periodontal procedures only Pre-authorisation is required Direct or indirect pulp capping 8301/8303 excluded from benefit Root canal treatment on primary and wisdom teeth excluded from benefit Limited to per person and per family per annum 2 crowns or 2 bridge units per family per year. Benefit for crowns are granted once per tooth per 5 years 1 set of full,or upper, or lower plastic denture every 4 years Relines, rebase, soft base every 2 years Metal framework every 5 years Partial denture every 3 years Pre-authorisation is required for orthodontic subject to available specialised dentistry limit Restricted to non surgical, root planning and periodontal procedures only Pre-authorisation is required Direct or indirect pulp capping 8301/8303 excluded from benefit Root canal treatment on primary and wisdom teeth excluded from benefit 1 set of full,or upper, or lower plastic denture per beneficiary every 4 years or 1 partial plastic denture per jaw per beneficiary every 4 years OVERALL ANNUAL LIMIT ON OUT OF HOSPITAL BENEFITS FOR SPECIALISED DENTISTRY SPECIALISED DENTISTRY Collectively limited, per family, per annum Subject to Pooled Benefit Limit Limited to per person and per family per annum Not applicable MAXILLO FACIAL AND ORAL/DENTAL SURGERY Not applicable Maxillo -Facial & Oral/Dental Surgery Pre-authorisation is required 100 % of scheme tariff Included in Specialised Dentistry limit Benefit only in cases of accidents, injury, congenital abnormalities and oncology related procedures / PMB 100 % of scheme tariff Included in Specialised Dentistry limit Benefit only in cases of accidents, injury, congenital abnormalities and oncology related procedures /PMB

3 2013 DENTAL HOSPITALISATION Dental Hospitalisation Subject to pre-authorisation, treatment protocols and PMB s Tel % of scheme tariff 100% of scheme tariff Benefit is only for cases of children Benefit is only for cases of children below below 7 years payable from basic 7 years payable from basic dentistry limit dentistry limit and restricted to and restricted to restorative procedures restorative procedures only only Multiple hospital admissions will not be Multiple hospital admissions will not be covered and will only be authorised covered and will only be authorised once once in a lifetime in a lifetime No benefit for preventative procedures No benefit for preventative procedures Benefit for removal of symptomatic Benefit for removal of symptomatic impacted wisdom teeth if preauthorised impacted wisdom teeth if pre-authorised as a day case only (payable as a day case only (payable from Maxillo from Maxillo Facial and Oral Surgery Facial and Oral Surgery limit) limit ) Dental Implants : Benefit is payable Dental Implants : Benefit is payable from hospitalisation only in authorised from hospitalisation only in authorised cases related to cancer surgery or cases related to cancer surgery or trauma of the mandible (PMB s) Related trauma of the mandible (PMB s) to bone augmentation phase Related to bone augmentation phase Excluded in hospital: Excluded in hospital: Placement of Implant Phase: Placement of Implant Phase: PMB s only Limited per family per annum PMB s only Limited per family per annum HOSMED DENTAL POLICY AND PROCEDURES PROTOCOL 2013 General Principles All dental procedures are covered as per the description of Rules for the specific scheme option concerned. The Clinical Protocols of Supplementary Health Services will take precedence and Hosmed tariff will apply. All treatment rendered by a dental specialist is regarded as Specialised treatment regardless of the treatment with the exception of treatment defined as falling within PMB. All specialised dentistry and hospitalisation for dental procedures are subject to pre-authorisation by Supplementary Health Services before treatment commences, except in the case of emergency hospital admissions. Such authorisation must be obtained within 48 hours or the following working day thereafter. A written authorisation is not a guarantee of payment and is issued subject to available benefit at the time when the claim/s is received. The authorisation includes a summary of benefit allocation. Hospital authorisations are only valid for one (1) month and all other authorisation are valid for three (3) months. All admissions to hospitals for dental procedures must be pre-authorised, or within 48 hours in the case of an emergency. Failure to comply with this rule will result in a levy of R500 per admission. Orthodontic treatment Benefits are only applicable to members below the age of 18 years. Benefits for all orthodontic treatment is subject to prior appraisal using the Index of Complexity, Outcome and Need (ICON Copyright University of Wales College of Medicine) other such recognised clinical index as determined by Supplementary Health Services. Once approved payment will be paid as an initial deposit and the balance over estimated time period. Payment paid according to member benefits. Removable appliances are limited to 2 appliances. Re-treatment of orthodontics is not covered. Lost appliances repair, remounting or replacement of fixed orthodontic brackets is not covered. Lingual orthodontics or ceramic orthodontics brackets are not covered. Invisible retainer material is not covered. Re-treatment of orthodontic cases is not covered and for transferred cases to a next provider; only the balance of the treatment plan will be covered. Retainers are limited to one per jaw. Orthognathic and associated hospitalisation is not covered. Preparatory orthodontic therapy prior to orthognathic surgery will be limited to the treatment required to achieve an outcome without such surgery. Apisectomies Benefit will not be considered unless a reasonable attempt has been made to drain the peri-apical infection via endodontic procedures and through re-treatment where applicable.

4 Periodontics Benefits for periodontal disease management is limited to conservative (non-surgical) management once every 2 years and is subject to pre-authorisation using the CPITN index. Surgical periodontal treatment is not covered. Implantology No benefits for implants and all procedures associated with implantology in and out of hospital on all option except for cancer surgery of the mandible or trauma resulting in bone loss of the mandible on Plus and Value Option as described below. Dental Implant Hospitalisation Hospitalisation related to bone augmentation phase only, will be covered from the hospital benefit. Implant phase Hospitalisation for the placement of implants will not be covered. Limited per family per annum on the Value and Plus option. Prosthetics phase Hospitalisation for the prosthetic phase of implants will not be covered. Limited per family per annum on the Value and Plus option. Procedure Limitations No benefits for placing of implants on all options. Benefits for dental check-ups as described in the schedule under code 8101 are allowed once per six-month period per dependant per practitioner. Further visits to the dentists in said period will be covered as per code Where high risk individuals require more regular check-ups such visits will attract benefit once risk has been clinically motivated and assessed by Supplementary Health Services. Benefits for conservative dental restorations/fillings are available where such fillings are clinically indicated, and will be granted once per tooth in a 3 year period. More than 4 fillings per member per year where clinically motivated, must register on the dental care programme and assessed by Supplementary Health Services. In the case of fillings on posterior teeth (molar and pre-molars) the Supplementary Health Services tariff for amalgam fillings will apply, regardless of the material used. Preventive visits are limited to one every six months. More regular visits will attract benefit once disease risk has been clinically motivated and assessed by Supplementary Health Services. Fissure sealants are covered once every 2 years, up to 18 years only on permanent molars and pre-molars. Extra-oral radiograph only for orthodontic treatment planning and removal of impacted teeth for beneficiaries above 18 years. One extra-oral radiograph per year, except for orthodontic treatment planning where 2 extra-oral radiographs will be covered. Hospitalisation and Intravenous Sedation Hospitalisation or Intravenous Sedation for dentistry is not automatically covered and is subject to pre-authorisation where the following protocols will apply: Hospitalisation cover is provided for children below the age of 7 years when the treatment envisaged is of such a nature that it can not performed without a general anaesthesia and will only be considered after other forms of sedation were administered unsuccessful. Fissure sealant, fluoride treatment and polishing of teeth for children below 7 years will not be authorised in hospital. Multiple restorative visits to theatre for children below the age of 7 years will not be covered i.e. a single hospital visit should suffice to stabilise the dentition there after routine dental treatment and preventative dentistry will only be covered in the dental rooms. Removal of impacted teeth will be covered when the tooth is associated with pathology or severe pain and the removal of such a tooth can not be reasonably performed outside of hospital as may be radiologically verified and not for orthodontic reasons. Single impaction extraction or soft tissue impactions will not be covered in Hospital. Theatre visits for persons above 7 years for conservative dentistry and extractions will not be covered. The requirement of a sterile facility is not on its own an acceptable reason for hospitalisation for dental treatment. Hospitalisation cover will only be considered where an underlying medical condition increases the risk of treating in the rooms or indicates that higher level of care is required. Benefit only in cases of accidents, injury, congenital abnormalities and oncology related procedures only (PMB). Apicectomies on premolar canine, anterior and 3rd Molars procedures in hospital will not be considered for benefit unless retreatment of root cannel has been attempted and is restricted to molars and lower pre molars. Hospitalisation benefits are not available for dental implantology and associated procedures e.g. sinus lift, bone harvest and tissue regeneration procedures on all option except for cancer surgery of the mandible or trauma resulting in bone loss of the mandible on Plus and Value Option as described under Implantology above. The following will not be covered in hospital: Dentectomies Frenectomies Conservative dental treatments e.g. fillings on adults, fissure sealant, fluoride treatment and polishing of teeth

5 Periodontal procedures are not covered in hospital Periodontal surgery Genioplasty Implants Gingivectomy Root canal therapy Patient anxiety control Where a dental practitioner requires a medical colleague to administer sedatives intravenously (not general anaesthetic) to assist in difficult cases in the dental rooms, the fee charged by the second professional will be covered by the scheme only if preauthorised by Supplementary Health Services. Such authorisation will only be considered if the administering nitrous oxide (laughing gas) has been unsuccessful. No limits are placed on the use of oral sedatives or nitrous oxide administered by dental practitioners in their rooms. Restrictions and Exclusions The treatments and procedure codes listed below are not covered by the scheme. The member is liable for the total cost of these procedures. In the event of a dispute regarding exclusions and benefits, the rules of Hosmed will prevail. Cosmetic dentistry Bite plate below 25 years old Mouthwash and toothpastes Fissure sealants on patients older than 18 years Professionally applied topical fluoride in adults 18 years and above Oral/facial image of dentist work not covered only for orthodontics Perio chip Ozone therapy Therapy of healed extraction sites Vascular surgery for treatment of headaches Oral appliance or the ligation of temporal arteries for treatment of headaches Restorative treatment of attrition or abrasion Tariff for amalgam fillings will apply, regardless of the material used Endodontic procedures are not covered on third molars (wisdom teeth) or on primary teeth Endodontic re-treatment is not covered within 2 years of initial endodontic treatment Emergency root canal / Pulp removal (pulpectomy) charged on the same day as complete therapy Crowns used to restore teeth for cosmetic reasons Crowns where the tooth has been recently restored to function Composite or porcelain veneers Laboratory fabricated crowns are not covered on primary teeth or third molars (wisdom teeth) Crowning of teeth involving failed R.C.T Temporary /provisional and emergency crowns including lab costs Acrylic crowns, including laboratory aspects, placed for any reason are excluded from benefits Fixed prosthodontics (crowns) where a reasonable attempt has not been made to restore/replace the tooth conservatively Fixed prosthodontics where the members mouth is periodontally compromised Fixed prosthodontics used to restore teeth for cosmetic reasons Fixed prosthodontics used to repair occlusal wear (teeth damaged due to bruxism) erosions or fluorosis Fixed prosthodontics where the tooth has been recently restored to function Benefit for the cost of metal would be in accordance to the tooth type Cost of gold, precious metal, semi-precious metal and platinum foil For metal free crowns, metal substitute coping material will be paid at the same rate as metal Metal substitute coping material for laboratory cost for crowns Lab costs where the associated dental procedure is not covered Cantilevers bridges Pontics on second molars Inlays and onlays regardless of material used, will not be covered Diagnostic dentures Basic denture rate would apply to Complicated Dentures High impact acrylic Metal base to full dentures Diagnostic models (Study models-unmounted) will only be covered with orthodontic treatment Adult orthodontics over 18 years Orthodontics to align teeth for cosmetic reasons Orthodontic re-treatment Orthodontic retainer/fixed/removable appliance repairs Lingual orthodontics/ceramic brackets

6 Diagnostic setup (orthodontics) Orthognathic (jaw correction) surgery and related hospital costs Osteotomy Surgical periodontal services Gingivectomy Dentectomies in hospital Frenectomies in hospital Removal of asymptomatic wisdom teeth Fillings, extractions and root canal therapy in hospital over age of 7 years Preventative dentistry procedures in hospital Assistant fee to be assessed on individual cases MRI and CAT scans for any dento-aleolar procedures will not be covered Extra-oral radiograph only for orthodontic treatment planning and removal of impacted teeth for beneficiaries above 18 years. Dental implants in or out of hospital and associated surgical procedures listed below are excluded, except for when oncology related Implant tooth replacement all phases Cost of implant components Bone augmentation, or tissue regeneration or cost of bone regeneration material Sinus lifts Tariff Code Description 8106 Special report 8108 Intraoral radiographs - complete series 8111 Dental testimony 8113 Intraoral radiograph - occlusal 8114 Extraoral radiograph - hand-wrist 8118 Extraoral radiograph - skull/facial bone 8119 Diagnostic models mounted 8120 Treatment plan completed 8122 Microbiological studies 8123 Caries susceptibility tests 8124 Pulp tests 8129 Additional fee/benefit for emergency treatment rendered outside normal 8131 Emergency dental treatment 8139 Appointment not kept 8146 Resin bonding for restorations 8149 Nutritional counseling 8150 Tobacco counseling 8151 Oral hygiene instruction 8153 Oral hygiene instruction - each additional visit 8157 Re-burnishing and polishing of restorations 8158 Enamel microabrasion 8160 Removal of gross calculus 8162 Topical application of fluoride for adults ( 18 years and above) 8168 Behavior management 8171 Mouth guard 8172 Cost of orthotic appliance (only payable for 62 discipline- no lab fee applicable) 8179 Periodontal screening 8177 Oral hygiene instruction (periodontally compromised patient) 8178 Oral hygiene instruction - each additional visit (periodontally compromised patient) 8183 Therapeutic drug injection 8189 Re-examination - existing condition 8251 Clasp or rest - cast gold 8253 Clasp or rest - wrought gold 8257 Bar - lingual or palatal 8265 Tissues conditioning per arch (including soft self-cure reline) 8266 Adjust complete or partial dentures (remounting) 8277 Inlay in denture 8663 Metal base to complete denture 8301 Pulp cap - direct 8303 Pulp cap - indirect 8304 Rubber dam per arch 8306 Cost of Mineral Trioxide Aggregate (MTA) 8308 External bleaching - per arch 8309 Home bleaching - instructions and applicator 8310 Supply of bleaching materials

7 8311 Home bleaching - subsequent visit 8325 Internal bleaching - per tooth 8327 Internal bleaching - each additional visit 8355 Veneer - resin (chair-side) 8357 Prefabricated metal crown Inlays/onlays metal one or more surfaces 8366 Pin retention as part of cast restoration, irrespective of number of pins Inlay/onlay - porcelain - one or more surfaces Inlay/onlay - resin - one or more surfaces Crown - 3/4 cast metal or porcelain/ceramic 8405 Crown - resin laboratory 8407 Crown - resin with metal 8410 Provisional crown 8419 Provisional pontic 8447 Provisional crown retainer 8499 General anaesthetic 8503 Occlusion analysis mounted 8505 Pantographic recording 8506 Detailed consultation - Prosthodontist 8507 Comprehensive consultation - Prosthodontist 8508 Electrognathographic recording 8509 Electrognathographic recording with computer analysis Implant supported removable complete or partial overdenture 8551 & 8553 Occlusal adjustment minor and major 8552 Veneer - porcelain (laboratory) 8554 Veneer - resin (laboratory) Gold foil class I to V 8578 Prefabricated abutment 8579 Custom abutment 8584 Connector bar - implant supported 8585 Connector bar 8586 Stress breaker 8597 Locks and milled rests 8599 Precision attachment (removable denture) 8654 Implant supported fixed-detachable complete overdenture 8655 Implant supported fixed-detachable partial overdenture 8657 Replacement of precision attachment 8658 Interim complete denture 8659 Interim partial denture 8660 Additional fee to implant supported fixed-detachable denture - per implant 8661 Diagnostic dentures (including tissue conditioning) 8662 Adjust complete or partial dentures (remounting) 8663 Metal base to complete denture 8664 Remount crown or bridge for prosthetics 8667 Soft base to denture (heat cured) 8672 Altered cast technique (in addition to partial denture) 8674 Additive partial denture 8703 Detailed Periodontist Consultation 8707 Periodontal screening - Periodontist Provisional splinting ( intracoronal & extracoronal) 8741 Gingivectomy/gingivoplasty - four or more teeth per quadrant 8743 Gingivectomy or gingivoplasty - one to three teeth per quadrant 8749 Flap procedure, root planing and one to three surgical services - per quadrant 8751 Flap procedure, root planing and one to three surgical services - per sextant 8753 Flap procedure, root planing and four or more surgical services - per quadrant 8755 Flap procedure, root planing and four or more surgical services - per sextant 8759 Pedicle flapped graft (isolated procedure) 8761 Masticatory mucosal autograft - one to four teeth (isolated procedure) 8762 Masticatory mucosal autograft - four or more teeth (isolated procedure) 8765 Hemisection of a tooth, resection of a root or tunnel preparation (isolated procedure) Bone regeneration/repair procedure - as part of a flap operation or at a single site 8768 Unlisted periodontal procedure 8769 Membrane removal (used for guided tissue regeneration) 8770 Cost of bone regenerative/repair material 8772 Submucosal connective tissue autograft (isolated procedure)

8 8773 Cost of intrapocket chemotherapeutic agent Consultation - oral medicine (simple,complex or subsequent) 8805 Appointment not kept - per half-hour (by arrangement with patient) 8839 Diagnostic setup (orthodontics) 8840 Treatment planning for orthognathic surgery Lingual Orthodontics Repair/ Replace orthodontic appliance removable or fixed 8892 Orthodontic re-treatment Biopsy of oral tissue - soft,bone - needle or extra-oral bone/soft tissue 8933 Treatment of hemorrhage (blood dyscrasias) 8957 Alveolotomy or alveolectomy (including extractions) 8961 Tooth transplantation 8962 Harvest iliac crest graft 8963 Harvest rib graft 8964 Harvest cranium graft 8979 Harvesting of autogenous grafts (intra-oral) 8892 Orthodontic re-treatment 8995 Gingivectomy - per jaw 8997 Sulcoplast / Vestibuloplasty 9005 Alveolar ridge augmentation - total (by bone graft) 9007 Alveolar ridge augmentation - total (by alloplastic material) 9008 Alveolar ridge augmentation - one to two tooth sites 9009 Alveolar ridge augmentation - three across 3 or more tooth sites 9010 Sinus lift procedure 9021 Suture - reconstruction, minor (excludes closure of surgical incisions) 9023 Suture - reconstruction, major (excludes closure of surgical incisions) Osteotomy 9069 Glossectomy - partial 9071 Geiohyoidotomy 9072 Close secondary oro-nasal fistula w/ bone grafting (complete procedure) 9074 TMJ arthroscopy diagnostic 9075 Condylectomy, coronoidectomy or both 9076 TMJ artrocentesis 9077 Intra-articular injection per injection 9081 Condylectomy (Ward/Kostecka) 9083 TMJ srthroplasty 9085 Reduction of TMJ disloc w/o anaesthetic 9087 Reduction of TMJ disloc w/ anaesthetic 9089 Reduction of TMJ disloc w/ anaesthetic and immobobilisation 9091 Reduction of TMJ dislocation - open reduction 9092 Joint reconstruction 9093 Removal of salivary stone (Sialolithotomy) 9095 Excision of sublinglual salivary gland 9096 Excision of salivary gland - extra oral approach 9051 Genioplasty 9099 Unlisted dental procedure or service (By report) 9307 Casting and trimming of gnathostatic model, per model New trimmed base to supplied model, per model 9311 Trimming of supplied model, per model 9312 Gingival tissue mask per implant 9329 Fit and supply of disposable articulator 9343 Additional fee for dentures on fully adjustable articulator at request of dentist 9347 Additional fee for each retry at an agreed quantum of time to be calculated at hourly rate 9383 Additional fee for finishing denture in tooth colour material, per tooth 9385 Additional fee for supplying finished denture on duplicate model 9393 Additional charge for each additional fracture, or tooth, or clasp 9395 Additional fee for using wire strengthener 9397 Additional fee for using pre-formed strengthener 9398 Additional fee for using mesh strengthener in repair procedure 9401 Clear base 9403 Dox grinding of upper and lower dentures Inlay to artificial tooth, one surface or multi-surfaces, per inlay 9407 Heka base technique per upper or lower denture 9409 Frego frame 9410 Bleaching tray

9 9411 Template per upper or lower denture 9421 Gum tinting per denture 9425 Cleaning and polishing of existing denture, per denture 9432 Special Tray Light Cure, each 9448 Casting and trimming of Model from impression inside occlusion block or wax try in 9451 Metal base for full upper or full lower denture each 9467 Additional charge for onlay 9502 Ceramic metal substitute coping 9507 Post-solder invested joint, per joint 9511 Inlay in porcelain veneer crown 9524 Indirect composite resin inlay 9531 Pin-ledge inlay 9537 Precision lock and rest cast 9538 Lock and rest cast 9541 Metal inlay or post, cast direct 9543 Gold/pre-solder invested joint 9549 C.S.P. attachment (steiger) 9550 Milling milled edge per unit 9551 Telescope crown Composite/acrylic veneer crown/pontic, jacket crown, veneer post crown, indirect or indirect 9560 Indirect composite resin veneer 9561 Composite/acrylic jacket crown, direct 9563 Temporary acrylic/composite crown per unit 9564 Heat formed template supplied to dentist for the manufacture of temporary restorations 9565 Composite/acrylic-facing replaced 9570 Additional fee for each remake at an agreed quantum of time to be calculated at an hourly rate 9617 Invisible retainer 9631 Mouth protector (gum guard) 9633 Oral Screen 9646 Diagnostic set-up 9647 Snoring appliance 9662 Additional fee for each remake at an agreed quantum of time to be calculated at an hourly rate 9706 Cost of bleaching tray material 9720 Soft base material per denture 9724 Cost of precision attachment, per attachment 9732 Cost of other attachment components e.g. nylon caps, sleeves etc 9734 Cost of dolder bar and clips, per gram or per clip 9736 Cost of implant components 9739 Additional charge gold plating 9740 Cost of gold wire, per gram 9742 Cost of specialised cobalt chrome casting metal e.g. vitallium, titanium 9744 Cost of precious casting alloy 9746 Cost of semi-precious casting alloy 9752 Cost of platinum foil 9754 Cost of gold solder, per gram 9755 Etching for bonding (metal or ceramic) 9758 Fiber re-enforced material per unit 9757 Ceromer material - per unit 9760 Composite restoration material 9761 Ceramic material 9774 Cost of invisible retainer material 9775 Removable appliance case 9776 Cost of mouth protector material 9779 Dual laminate material 9780 Positioning and finishing of complete (male and female) prefabricated burn-out attachment 9782 Positioning and soldering of complete (male and female) precision attachment 9783 Implant stent per unit 9784 Alignment of dolder bar and clips 9786 Trimming, waxing and finishing of implant abutment - crown and bridge work only, per abutment 9787 Waxing, milling and finishing of a custom abutment 9788 Implant superstructure (edentulous cases) including placing of preformed parts, per section cast 9789 Finishing of prosthesis on implant structure per arch