STICK BOND DENTAL

DENTISTS

Recommended fee structure and medical aid codes - South Africa

HOW TO CLAIM

HOW TO CLAIM FROM THE MEDICAL AID – 2005

 Periodontal splint

 Clinical codes: 8352 x 2 (teeth 33 + 43)               R 332.80

                         8353 x 4 (teeth 32, 31, 41, 42)   R 795.60

             TOTAL PERIO SPLINT                                                                       R 1128.40

 Orthodontic Permanent Retainer

 Clinical code:            8849 +L                                                                                 R 192.30

Lab codes:             9301 (model)                                    R   13.95

                        9327 (infection control)            R     9.74

                        9617 (invisible retainer)            R   96.60

                        9759 (cost fibres)                  R 337.50 (R250+35%R87.50)

                        9760 (cost composite)                   R 150.00

                                                                         Total Lab (8099)                   R  607.79

              TOTAL Clinical + Lab                                                                  R 800.09

 Fixed Space Maintainer

 Clinical code: 8173 x 2 (per abutment) +L                            Value               R 225.00

Lab codes:            9301 (model)                                    R   13.95

                        9327 (infection control)            R     9.74

                        9572 (basic charge)               R 106.10

                        9622 (space maint. arch)    R   38.20

                        9759 (cost fibres)                  R 216.00(R160+35%R56)

                                                                        Total lab (8099)                    R 383.99

            TOTAL Clinical + Lab                                                                  R 608.99

   Reinforcement of large composite restorations

 Codes:  8354/8370, 8347 (Rule 007)

 Occlusal splinting

Recommended fee = R

Suggested med. aid codes: 8370 or 8369 (depending on the size of the cavity) per tooth

Patient’s contributions:                                                                                  R

Cost of everStick Perio fibre material : +/- 1,5 cm fibres (splint)                        R 130.00 

 TRAUMA SPLINT

Recommended fee = R

Suggested med. Aid codes 8727 x 4 + 8099 (9759+9760)*                         R

Patient’s contribution:                                                                                          R   Nil

Each additional tooth                               R                (8727+8099)

 ANATOMICAL POST

Recommended fee = R

 Suggested med. aid codes:  8345 +8379* R 245.10         

 Patient’s contribution: R

Cost of everStick® Post material: R126.00 (R100.00 + R26 handling fee code 8025)/post

R 50.00 (normal length used) to

R 100.00 (full post)

 ANATOMICAL POST AND CORE

Recommended fee = R

Suggested med. aid codes: 8376+8379* (or 8345+8398+8379*) R455.80/514.30

 Patient’s contribution:  R

Cost of everStick®Post material: R126.00 (R100.00 + R26 handling fee code 8025)/post:

R 50.00 (normal length used) to

R 100.00 (full post)

Direct Anterior Bridge

 Clinical codes: 8353 x 2, 8415/8417+L  (Rule 007)                                Value   R 897.90

Lab Codes:      9301 (model)                           R   13.95

 9327 (infection control)            R     9.74

 9557 (Composite crown)            R 435.30

 9759* (cost fibres)               R 324.00 (R 240+35% R84)

 9760* (cost composite)            R 300.00

 9502* metal substitute             R 391.75

 Total lab (8099)                                      (R850.74)         1082.99

TOTAL Clinical + Lab                           (R1748.64)      R1980.89

Direct Posterior Bridge

Clinical codes:            8368/9 x2, 8415/8417+L (Rule 007)                                Value R 994.10

Lab codes:             9301 (model)                                    R  13.95

                        9327 (infection control)            R    9.74

                        9557 (Composite crown) R 435.30

                        9759* (cost fibres)                  R 405.00(R300+35%R105)

                        9760* (cost composite)            R 350.00

                        9502* metal substitute            R 391.75

                        Total lab (8099)                                (R 850.74)                          1213.99

                        TOTAL Clinical + Lab                  (R 1844.84)                      R2208.09

 Additional Codes for Semi-direct Technique

1. Resin pontic code 8417 (no metal) or 8415 (resin) + L, rule 007 apply
2. Attachment to retainers:

Attaching the fibre: 8352/3 per retainer (direct acid etch), rule 007 apply

Or

8436/7 (Retainer, inlay, porcelain) or 8432/3 (Retainer inlay, metal) rule 007 modifier 8023

Or

8382/3 (inlay, resin) rule 007 modifier 8023

Or

8617 (Maryland type retainer) rule 007 modifier 8023 apply

  INDIRECT CROWN – LAB CODES

The lab fee is R 964.33 and is made up with the following lab codes from the Gov. Gazette:

9301 Model                                         R  13.95

9315 C&B Model                          R  59.20

9319 Extra die                                      R  13.51

9320 Pindex                                         R  13.51

9327 x 2 Infection control              R  19.48

9330 Delivery charge                          R  17.63

9557 Composite crown               R 435.30

9760 Cost of Fibres                           Material code

9759 Cost of composite                     Material code

                 or

9502 Metal substitute                                  R 391.75

 The associated clinical code is 8405 and the fee is R 653.80  Total R1618.13

NEW:   Sticky News, March 2006

 February 2005 Sticky News

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