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Stick Bond Dental
HOW TO CLAIM FROM THE MEDICAL AID – 2007
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1. SECTION 1: SPLINTING
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Periodontal splint Diagnostic code: K05.3 Clinical
codes: 8768 (per tooth) R201.70 X 6 No
Perio benefits: 8352x2, 8353x4
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TOTAL PERIO SPLINT R1210.20 No Perio benefits: DENIS: R1230.00 Other: R1266.00 |
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Orthodontic Permanent
Retainer Diagnostic
code: K07.3 (or original treatment code) Clinical
code: 8849 +L R
212.00 Lab
codes: 9301
(model) R 19.00 9327
(infection control) R 13.00 9617
(invisible retainer) R 111.00 9758
(cost of fibre) R 180.00 9760
(cost of composite) R 120.00 Total
Lab (8099) R 443.00 |
TOTAL Clinical + Lab R 655.00 DENIS: 8849 pay only
R202.00+L |
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Fixed Space
Maintainer Diagnostic
code(s): K00.5/9; K08.1; K01.0 Clinical
code: 8173 x 2 (per abutment)+L R 248.00.00 Lab
codes: 9301
(model) R 19.00 9327
(infection control) R 13.00 9572
(basic charge) R 122.00 9622
(space maint./arch) R 44.00 9758
(cost of fibre) R 120.00 9760
(cost of composite) R 55.00 Total
lab (8099) R 373.00 |
TOTAL Clinical + Lab R
621.00 DENIS: 8849 pay only R118.00
(per abutment)+L |
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Occlusal splinting Diagnostic
code(s); K02.1/K05.3 Suggested med. aid codes: 8370
or 8369 or 8768 Fee according to clinical code Cost of
everStick Perio fibre material: ± 1 cm fibres (splint) = ± R 100.00 Consider
creating own code (COF1) value ± R 125.00 (Patient
to pay) |
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Trauma Splint Diagnostic code: S03.2 Recommended
fee R 636.00 Suggested
med. Aid codes 8768 (per tooth) R 212.00X 3 Each
additional tooth R 212.00 No
Perio benefits: consider 8352/3 |
2.
SECTION 2:
POSTS
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Anatomical
Fibre Post Diagnostic
codes: K04.2/3; K02.1/8 Clinical
codes: 8345 + 8379 (r007) R
316.60 8379:
Cost per post = R 130.00 + 8025 (R 26.00) = R156.00 DENIS:
benefit 8345 = R 125.00 only |
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Anatomical
post and core Diagnostic
codes: K04.2/3; K02.1/8 Clinical
codes: 8376 + 8379 (r007) R
521.00 Add
code 8355/8409+L depending on rest of the procedure DENIS:
benefit 8376 = R 346.00 |
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Note:
Code 8379 is
paid ‘by arrangement”. Not all funds
pay for it |
3.
SECTION 3: DIRECT
BRIDGES
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Direct Bridge
(Remember to take an impression) Diagnostic
codes: K08.1/9 (congenital) Clinical
codes: Retainers: 8383 x 2 R 1190.00 (DENIS no
benefit) Pontic: 8415+ L (Rule
007) R
625.00 (DENIS R 500.00) Lab
Codes: 9301 (model) R 19.00 9327 (infection control) R 13.00 9524 x 2 (comp inlays) R
280.00 9557 Indirect
comp cr/pontic R 498.00 9758
Cost of fibres
R 250.00 9760
Cost of composite R
160.00 Total lab (8099) R 1220.00 TOTAL Clinical + Lab R3035.00 DENIS retainer code 8437
r007 |
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Additional Codes Attaching the fibre: 8352/3 per retainer (direct acid
etch), rule 007 apply (?ICD10 not compatible – cannot use filling code for
retainer)) Or 8436/7 (Retainer, inlay, porcelain) or 8432/3 (Retainer
inlay, metal) rule 007 Or 8382/3 (Retainer, inlay, resin) modifier 8023 – no lab
state 8099(m8023) value = 25% of value 8382/3 (Recommended code) Or 8617 ( |
4.
REINFORCING
HUGE COMPOSITE RESTORATIONS
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Reinforcement of large composite restorations Diagnostic code: K02.1 Clinical codes: 8354/8370 R 284.00 Charge for fibres: 8347/8348 or your own code COF1 (cost
of fibres) R 135.00 TOTAL R 419.00 Recommended charge for fibres ± R125.00 DENIS: 8370 = R275.00 |
5.
Indirect Techniques - LAB CODES
INDIRECT
CROWN
Diagnostic codes: K02.1;
K03.0; K03.9 Clinical code: 8409+L R 765.00 (DENIS R 720.00) Lab codes: 9301
Model R 19.00 9315
C&B Model R 79.00 9319
Extra die R 18.00 9320
Pindex R 18.00 9327 x 2 Infection control R 26.00 9330 Delivery charge R 36.00 9557 Indirect comp cr/pontic R 498.00 9758 Cost of fibre R 150.00 9760 Cost of composite R 60.00 Total
Lab (8099) R 904.00 TOTAL R 1669.00 |
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Indirect Bridge
Construction Diagnostic
codes: K08.1/9 (congenital) Clinical
codes: retainer 8382/3, pontic 8415 +L (Fee according to clinical code) Lab codes: 9301
Model R 19.00 9315
C&B Model R 79.00 9319
Extra die R 18.00 9320
Pindex R 18.00 9327 x 2 Infection control R 26.00 9330 Delivery charge R 36.00 9524 Indirect
comp inlay x 2 R 280.00 9557
Indirect comp cr/pontic R 498.00 9758
Cost of fibre R 250.00 9760
Cost of composite R 160.00 Total
Lab (8099) R
1384.00 LAB FEES FOR 3-UNIT BRIDGE DENIS retainer code 8437 r 007 |
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Indirect Anatomical
Fibre Post Diagnostic
codes: K04.2/3; K02.1/8 Clinical codes: 8581+L (r007) R
226.00 Lab codes (8099): 9301
Model R 19.00 9315
C&B Model R 79.00 9319
Extra die R 18.00 9320
Pindex R 18.00 9327 x 2 Infection control R 26.00 9330 Delivery charge R 36.00 9545 Post R 255.00 9535 Coping R 358.00 9758 Cost of fbre post material R 160.00 Total
Lab (8099) R 969.00 TOTAL Clinical + Lab R 1195.00 |
Other applicable clinical codes:
Section 5: Indirect bridges - retainers
Retainer full cover (crowns) code 8443 (r007) corresponding lab code 9557
Retainer
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Revised: 18/03/2007
All rights reserved: Stick Bond Ltd.