Eligible Denture Procedures

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 Code 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.

Partial denture reimbursement is limited to a maximum of the combined fee if the opposing partial was inserted within the previous nine months.

51012 Complete upper and lower $941.00 $941.00
51010 Complete upper $469.00 $469.00
51011 Complete lower $577.00 $577.00
52010 Partial upper $482.00 $482.00
52011 Partial lower $506.00 $506.00
52012 Partial upper and lower $890.00 $890.00
53310 Complete upper and partial lower $1,351.00 $1,351.00
53320 Complete lower and partial upper $1,351.00 $1,351.00

Repairs

Limited to a maximum of $88.00 per denture per 12 consecutive months.

55101 Maxillary +L Up to $58.00 Up to $58.00
55102 Mandibular +L Up to $58.00 Up to $58.00

Additions/ Repairs

Replacement of existing denture(s) will not be considered within six months from date of repair/addition

55010 Add one tooth $91.00 $91.00
55011 Add two teeth or more $131.00 $131.00
55012 Add one tooth and clasp $200.00 $200.00
55013 Add two teeth or more and clasp $215.00 $215.00

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.

56020 Complete upper $141.00 $141.00
56021 Complete lower $152.00 $152.00
56060 Partial upper $149.00 $149.00
56061 Partial lower $161.00 $161.00

 

Eligible Emergency Dental Procedures

The following table lists eligible emergency dental procedures available to recipients of Ontario Works (OW).

Please note:

  1. Lab fees are included in the fees listed in the schedule of covered emergency dental procedures.
  2. A differential rate will be paid to a licensed specialist for services performed within their specialty and when the patient was referred to the specialist by a general dentist.
Procedure Code Service GP Fee Specialist Fee

Diagnostic

Coverage is limited to one time unit (15 minute interval) only.

01204 Specific examination $13.29 $15.95
01205 Emergency examination $13.29 $15.95

Radiographs

Only six Intraoral radiographs will be considered in 12 consecutive months.

Periapical
02111 Single periapical $9.33 $11.20
02112 Two periapical $11.88 $14.25
02113 Three periapical $13.57 $16.28
Bitewing
02141 Single bitewing $9.33 $11.20
02142 Two bitewings $11.88 $14.25
02143 Three bitewings $13.57 $16.28

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* $26.58 $31.90
04312 Biopsy, soft oral tissue by incision +L* $26.58 $31.90
Histological, hard tissue
04321 Biopsy, hard oral tissue by puncture +L* $26.58 $31.90
04322 Biopsy, hard oral tissue by incision +L $26.58 $31.90
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 $8.90 $10.68
20139 Each additional tooth, same quadrant $8.90 $10.68
Amalgam Non-Bonded, Permanent Bicuspids and Anteriors
21211 One surface $17.72 $21.27
21212 Two surfaces $38.77 $46.52
21213 Three surfaces $44.31 $53.17
21214 Four surfaces $53.17 $63.80
21215 Five surfaces or maximum surfaces per tooth $53.17 $63.80
Non-bonded Permanent Molars
21221 One surface $22.16 $26.60
21222 Two surfaces $44.31 $53.17
21223 Three surfaces $55.40 $66.48
21224 Four surfaces $64.31 $77.17
21225 Five surfaces or maximum surfaces per tooth $64.31 $77.17
Bonded, Permanent Bicuspids and Anteriors
21231 One surface $17.72 $21.27
21232 Two surfaces $38.77 $46.52
21233 Three surfaces $44.31 $53.17
21234 Four surfaces $53.17 $63.80
21235 Five surfaces or maximum surfaces per tooth $53.17 $63.80
Bonded, Permanent Molars
21241 One surface $22.16 $26.60
21242 Two surfaces $44.31 $53.17
21243 Three surfaces $55.40 $66.48
21244 Four surfaces $64.31 $77.17
21245 Five surfaces or maximum surfaces per tooth $64.31 $77.17

Etch/Bond Technique

Coverage is provided for Permanent Anteriors and Bicuspids only.

 Permanent Anteriors
23111  One surface  $34.45  $42.54
 23112  Two surfaces  $44.31  $53.17
 23113  Three surfaces  $66.48  $79.77
 23114  Four surfaces  $88.63  $106.36
23115 Five surfaces $88.63 $106.36
Tooth-Coloured, Permanent Bicuspids
23311 One surface $35.45 $42.54
23312 Two surfaces $50.19 $60.23

Pulpectomy

Coverage is not provided for molar teeth including single or multiple canals.

Permanent Anteriors and Bicuspids
32311 One canal $44.53 $53.44
Edontics
Root Canal Therapy
33111 One canal: tooth # 12, 11, 21, 22, 32, 31, 41, 42 $253.39 $304.04
33121 Two canals: tooth # 12, 11, 21, 22, 32, 31, 41, 42 $316.74 $380.09
Extractions
Erupted Teeth
Uncomplicated
71101 Single tooth $26.58 $31.40
71109 Additional tooth, same quadrant $13.29 $15.95
Complicated, Surgical Approach
71201 Single tooth $62.04 $74.44
71209 Additional tooth, same quadrant $13.29 $15.95
Impactions Soft Tissue Coverage
72111 Single tooth $62.04 $74.44
72119 Additional tooth, same quadrant $13.29 $15.95
Bone Coverage (either removal of bone and tooth or sectioning and removal of tooth)
72211 Single tooth $93.06 $111.68
72219 Additional tooth, same quadrant $13.29 $15.95
Bone Covered Required (removal of bone and sectioning of tooth for removal)
72221 Sectioning single tooth $124.08 $148.89
72229 Sectioning additional tooth, same quadrant $13.29 $15.95
Residual Roots: Soft Tissue Coverage
72321 First tooth $53.17 $63.80
72329 Additional tooth, same quadrant $53.17 $63.80
Residual Roots: Bone Tissue Coverage
72331 First tooth $62.04 $74.44
72339 Additional tooth, same quadrant $62.04 $74.44
Intra-Oral Incision: Incision and Drainage
75111 Intra-oral incision and drainage $26.72 $32.06
Conscious Sedation Nitrous Oxide and Oxygen
92411 One units of time $11.88 $11.88
92412 Two unit of time $19.50 $19.50
92413 Three units of time $27.14 $27.14
92414 Four units of time $34.76 $34.76
92415 Five units of time $42.38 $42.38
92416 Six units of time $50.01 $50.01
92417 Seven units of time $57.64 $57.64
92418 Eight units of time $65.28 $65.28