Child Dental Scheme Treatment Benefits – Part 3 – T’s and C’s – Examinations, X-rays, Cleans, Seals, and Gum Treatments

Yes there are always terms and conditions from Medicare and even item numbers that do not exist in the Australian Dental Association dental items schedule are created just to make life more interesting! In the following weeks we will explain the treatment benefits of each of the item numbers.

Also the restrictions cover the patient total eligibility of treatment. If you decide to change dentists the restrictions are carried. So the next dentist may not be able to perform certain items as they have already been performed. This why we always check your balance to see if you have been elsewhere and what items have been done. Otherwise Medicare will not pay for treatment and the patient will need to pay. Sorry, we do not make the rules!

Examinations

• 88011 Comprehensive or initial oral exam
  Limit of one (1) per provider every 24 months.
• 88012 Periodic oral examination
  Limit of one (1) per provider every 6 months. This literally means more than 6 months from the last examination and NOT twice year. A benefit does not apply if the service is provided within 6 months of a service under item 88011 by the same provider.
• 88013 Oral examinations – limited
  Limit of three (3) per 3 month period. Note: Limit of one (1) examination service (88011, 88012 or 88013) per day.

X-rays

• 88022 Intraoral periapical or bitewing radiograph – per exposure
  Limit of four (4) per day.
• 88025 Intraoral radiographs – occlusal, maxillary, mandibular – per exposure

Preventive Services

• 88111 Removal of plaque and/or stain or
• 88114 Removal of calculus – first visit
  Limit of one (1) per provider every 6 months. This literally means more than 6 months from the last examination and NOT twice year.
• 88115 Removal of calculus – subsequent visit
  Limit of two (2) per 12 month period. Note: Limit of one (1) dental prophylaxis service (88111, 88114 or 88115) per day.
• 88121 Topical application of remineralisation and/or cariostatic agents, one treatment
  Limit of one (1) per 6 month period.
• 88161 Fissure and/or tooth surface sealing – per tooth (first four services on a day)
  Limit of four (4) per day. For additional fissure sealing on the same day use item 88162.
• 88162 Fissure and/or tooth surface sealing – per tooth (subsequent services)
  Note: A benefit does not apply if a benefit has been paid for a restoration service (items 88511- 88535) on the same tooth on the same day.

Periodontics

• 88213 Treatment of acute periodontal infection – per visit
  Limit of two (2) per 12 month period. A benefit does not apply if a benefit has been paid for item 88415 on the same tooth on the same day.
• 88221 Clinical periodontal analysis and recording
  Limit of one (1) per 24 month period.

Next in the series: Child Dental Scheme Treatment Benefits – Part 4 – T’s and C’s – Extractions, surgery, Root canal treatments.

Next week: Trench Mouth – A Disease of the Great War (and now)

As we remember the Anzacs 1915.