The following table lists eligible denture procedures available to recipients of Ontario Works (OW) and Ontario Disability Support Program (ODSP). Please note lab fees, exams, cleaning and other services necessary for the placement, repair addition or reline of the denture are included in the fees.
| Procedure | Service | GP Fee | Specialist Fee |
|---|---|---|---|
|
Dentures Replacement of denture(s) is limited to once in a five-year period. Complete/partial over dentures are not a covered benefit.
|
|||
| Complete upper | $469.00 | $469.00 | |
| Complete lower | $577.00 | $577.00 | |
| Partial upper | $482.00 | $482.00 | |
| Partial lower | $506.00 | $506.00 | |
|
Repairs – Complete Denture Limited to a maximum of $88.00 per denture per 12 consecutive months. |
Maxillary +L | Up to $58.00 | Up to $58.00 |
| Mandibular +L | Up to $58.00 | Up to $58.00 | |
|
Additions/ Repairs – Partial Denture Replacement of existing denture(s) will not be considered within six months from date of repair/addition |
No impression required upper | $91.00 | $91.00 |
| No impression required lower | $91.00 | $91.00 | |
| Impression required upper | Up to $200.00 | Up to $200.00 | |
| Impression required lower | Up to $200.00 | Up to $200.00 | |
|
Reline Relines are limited to once every 36 months. Relines within three months of insertion are not covered. Replacement of existing denture(s) will not be considered within six months from date of reline. |
Complete upper | $141.00 | $141.00 |
| Complete lower | $152.00 | $152.00 | |
| Partial upper | $149.00 | $149.00 | |
| Partial lower | $161.00 | $161.00 |
The following table lists eligible emergency dental procedures available to recipients of Ontario Works (OW).
Please note:
| Procedure | Code | Service | GP Fee | Specialist Fee |
|---|---|---|---|---|
| Preventive | 13601 | Topical application to hard tissue lesions of antimicrobial or remineralization agent. One unit only. | $25.18 | $29.86 |
|
Diagnostic Coverage is limited to one time unit (15 minute interval) only. |
01204 | Specific examination | $19 | $22.81 |
| 01205 | Emergency examination | $19 | $22.81 | |
|
Radiographs Only six Intraoral radiographs will be considered in 12 consecutive months. |
Periapical | |||
| 02111 | Single periapical | $13.35 | $16.02 | |
| 02112 | Two periapical | $16.33 | $19.60 | |
| 02113 | Three periapical | $20.12 | $24.14 | |
| Bitewing | ||||
| 02141 | Single bitewing | $13.35 | $16.02 | |
| 02142 | Two bitewings | $16.33 | $19.60 | |
| 02143 | Three bitewings | $16.39 | $19.50 | |
| Panoramic | ||||
| 02601 | Single film | $31.54 | $37.85 | |
|
Tests The lab codes are eligible only in conjunction with codes 04311, 04312, 04321, 04322. Lab costs are included in the fees listed in the Schedule of Covered Emergency Dental Procedures for all other procedures. |
Histological, soft tissue | |||
| 04311 | Biopsy, soft oral tissue by puncture +L* | $38.01 | $45.61 | |
| 04312 | Biopsy, soft oral tissue by incision +L* | $38.01 | $45.61 | |
| Histological, hard tissue | ||||
| 04321 | Biopsy, hard oral tissue by puncture +L* | $88.69 | $106.42 | |
| 04322 | Biopsy, hard oral tissue by incision +L | $88.69 | $106.42 | |
| Lab Codes | ||||
| *99222 | Commercial lab fee (up to a maximum of fee listed) | $94.12 | $94.12 | |
| *99333 | In office lab fee (up to a maximum of fee listed) | $26.58 | $31.90 | |
|
Restorative Coverage for the codes is provided only when treatment is rendered within 30 days of accident. Coverage is not provided for surfaces re-treated within two years. |
Trauma, Control, Smoothing Teeth | |||
| 20131 | First tooth | $13.56 | $15.60 | |
| 20139 | Each additional tooth, same quadrant | $13.56 | $15.60 | |
| Caries, Trauma, Pain Control | ||||
| 20111 | First Tooth | $31.68 | $38.01 | |
| 20119 | Each additional tooth, same quadrant | $31.68 | $38.01 | |
| Amalgam | Non-Bonded, Permanent Bicuspids and Anteriors | |||
| 21211 | One surface | $25.34 | $30.41 | |
| 21212 | Two surfaces | $55.49 | $66.59 | |
| 21213 | Three surfaces | $63.35 | $76.02 | |
| 21214 | Four surfaces | $76.02 | $91.22 | |
| 21215 | Five surfaces or maximum surfaces per tooth | $76.02 | $91.22 | |
| Non-bonded Permanent Molars | ||||
| 21221 | One surface | $31.68 | $38.01 | |
| 21222 | Two surfaces | $63.35 | $76.02 | |
| 21223 | Three surfaces | $79.32 | $95.17 | |
| 21224 | Four surfaces | $79.32 | $95.17 | |
| 21225 | Five surfaces or maximum surfaces per tooth | $79.32 | $95.17 | |
| Bonded, Permanent Bicuspids and Anteriors | ||||
| 21231 | One surface | $25.34 | $30.41 | |
| 21232 | Two surfaces | $55.49 | $66.59 | |
| 21233 | Three surfaces | $63.35 | $76.02 | |
| 21234 | Four surfaces | $76.02 | $91.22 | |
| 21235 | Five surfaces or maximum surfaces per tooth | $76.02 | $91.22 | |
| Bonded, Permanent Molars | ||||
| 21241 | One surface | $31.68 | $38.01 | |
| 21242 | Two surfaces | $63.35 | $76.02 | |
| 21243 | Three surfaces | $79.32 | $95.17 | |
| 21244 | Four surfaces | $79.32 | $95.17 | |
| 21245 | Five surfaces or maximum surfaces per tooth | $79.32 | $95.17 | |
|
Etch/Bond Technique Coverage is provided for Permanent Anteriors and Bicuspids only. |
Permanent Anteriors | |||
| 23111 | One surface | $50.68 | $60.81 | |
| 23112 | Two surfaces | $63.35 | $76.02 | |
| 23113 | Three surfaces | $95.02 | $114.03 | |
| 23114 | Four surfaces | $95.02 | $114.03 | |
| 23115 | Five surfaces | $106.42 | $127.71 | |
| Tooth-Coloured, Permanent Bicuspids | ||||
| 23311 | One surface | $50.68 | $60.81 | |
| 23312 | Two surfaces | $87.17 | $104.59 | |
| 23313 | Three surfaces | $95.02 | $114.03 | |
| 23314 | Four surfaces | $114.03 | $136.83 | |
| 23315 | Five surfaces | $114.03 | $136.83 | |
|
Pulpectomy Coverage is not provided for molar teeth including single or multiple canals. |
Permanent Anteriors and Bicuspids | |||
| 32311 | One canal | $63.35 | $76.02 | |
| 32312 | Two canals | $76.02 | $91.22 | |
| Endontics Root Canal Therapy |
33111 | One canal: tooth # 13, 12, 11, 21, 22, 23, 33, 32, 31, 41, 42, 43 | $253.39 | $304.04 |
| 33121 | Two canals: tooth # 13, 12, 11, 21, 22, 23, 33, 32, 31, 41, 42, 43 | $316.74 | $380.09 | |
| Extractions Erupted Teeth |
Uncomplicated | |||
| 71101 | Single tooth | $39.01 | $45.61 | |
| 71109 | Additional tooth, same quadrant | $19 | $22.81 | |
| Complicated, Surgical Approach | ||||
| 71201 | Single tooth | $88.69 | $106.42 | |
| 71209 | Additional tooth, same quadrant | $88.69 | $106.42 | |
| Removal of Residual Roots – Erupted | ||||
| 72311 | First tooth in arch | $38.01 | $45.61 | |
| 72319 | Each additional tooth, same quadrant | $38.01 | $45.61 | |
| Impactions | Soft Tissue Coverage | |||
| 72111 | Single tooth | $88.69 | $106.42 | |
| 72119 | Additional tooth, same quadrant | $88.69 | $106.42 | |
| Bone Coverage (either removal of bone and tooth or sectioning and removal of tooth) | ||||
| 72211 | Single tooth | $133.03 | $159.64 | |
| 72219 | Additional tooth, same quadrant | $133.03 | $159.64 | |
| Bone Covered Required (removal of bone and sectioning of tooth for removal) | ||||
| 72221 | Sectioning single tooth | $177.37 | $212.84 | |
| 72229 | Sectioning additional tooth, same quadrant | $177.37 | $212.84 | |
| Residual Roots: Soft Tissue Coverage | ||||
| 72321 | First tooth | $76.02 | $91.22 | |
| 72329 | Additional tooth, same quadrant | $76.02 | $91.22 | |
| Residual Roots: Bone Tissue Coverage | ||||
| 72331 | First tooth | $88.69 | $106.42 | |
| 72339 | Additional tooth, same quadrant | $88.69 | $106.42 | |
| Intra-Oral Incision: Incision and Drainage | ||||
| 75111 | Intra-oral incision and drainage | $40.56 | $104.13 | |
| Conscious Sedation | Nitrous Oxide and Oxygen | |||
| 92411 | One units of time | $16.98 | $20.38 | |
| 92412 | Two unit of time | $29.66 | $35.58 | |
| 92413 | Three units of time | $42.34 | $50.81 | |
| 92414 | Four units of time | $55.01 | $66 | |
| 92415 | Five units of time | $67.69 | $81.24 | |
| 92416 | Six units of time | $80.37 | $96.44 | |
| 92417 | Seven units of time | $93.03 | $111.64 | |
| 92418 | Eight units of time | $105.72 | $126.85 |