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Pensioners' Dental Services Plan - Rules (June 1, 2010)


Schedule 2 - Eligible Dental Services

Subject to the provisions of the Plan, Eligible Dental Services are the dental services listed in this Schedule, if they are rendered

  1. by a dentist, dental specialist, or dental mechanic;
  2. by a dental hygienist, dental assistant or any other similarly qualified person under the direct supervision of one of a dentist or dental specialist; or
  3. by a dental hygienist if the dental service is performed in a province or territory of Canada in which dental hygienists are licensed to provide such services without the direct supervision of a dentist or dental specialist; and

if they meet generally accepted industry standards, guidelines developed for the purposes of this Plan, and adjudication practices agreed between the Administrator and the Treasury Board Secretariat.  Some covered expense limitations are listed in Schedule 3 to these Rules.

The Treasury Board may add to or remove from this Schedule any dental service or part thereof and give notice to the Administrator.

  1. Diagnostic Services
    1. examination and diagnostic
      1. complete oral examination
      2. recall oral examination, once every 9 months
      3. specific oral examination
      4. emergency oral examination
      5. treatment planning
    2. radiographs
      1. complete series of periapical films required to support a proper course of treatment, but not more frequently than  once every 36 months
      2. occlusal films
      3. bitewings required to support a proper course of treatment, but not more frequently than once every 9 months
      4. extra-oral films
      5. sialography, use of dyes
      6. panoramic film required to support a proper course of treatment, but not more frequently than once every 36 months
      7. interpretation of radiographs from another source
      8. tomography
    3. tests, laboratory examinations
      1. biopsy of oral tissue
      2. pulp vitality tests
  2. Preventive Services
    1. routine services
      1. dental polishing, up to once every 9 months
      2. topical application of fluoride required to support a proper  course of treatment, but not more frequently than once every 9 months
      3. pit and fissure sealants for covered Children prior to reaching age 15 
      4. caries control
      5. enameloplasty
      6. oral hygiene instructions (once per calendar year)
    2. space maintainers (not involving movement of teeth)
  3. Restorative
    1. minor restorations
      1. amalgam
      2. silicate
      3. acrylic or composite
      4. pin reinforcements for these restorations
    2. Note:   Replacement fillings for the same tooth and surface are covered once every 24 months regardless of the age of the original filling.
    3. major restorations, where warranted because there is extensive loss of tooth structure and the tooth cannot be adequately restored by a filling
      1. gold foil
      2. gold inlays
      3. porcelain inlays
      4. retention pins, posts and cores
      5. crowns
      6. inlays and veneers
      7. other restorative services
  4. Endodontics
    1. pulp capping
    2. pulpotomy
    3. root canal therapy
    4. periapical services
    5. other endodontic procedures
  5. Periodontics
    1. non surgical services
    2. surgical services
    3. post surgical treatment
    4. occlusal equilibration, not exceeding 8 time units every 12-month period
    5. scaling and root planing, not exceeding 6 time units every calendar year; except in documented cases and with pre-approval by the Administrator of a Treatment Plan, not exceeding 12 time units every calendar year
    6. other periodontic services
  6. Prosthodontics
    1. minor services for removable dentures
      1. repairs
      2. adjustment
      3. relining or rebasing, limited to once every 36 months
    2. major
      1. exams, films and diagnostic casts
      2. addition of a tooth to a removable denture
      3. complete dentures
      4. partial dentures
      5. pontics (fixed bridges)
      6. retainers
      7. abutments (pontics)
      8. retentive pins in abutments
      9. repairs of fixed appliances
      10. other prosthodontic services
  7. Oral surgery
    1. uncomplicated removal
    2. surgical removal and tooth repositioning
    3. alveopoplasty, gingivoplasty, stomatoplasty, osteoplasty, tuberoplasty
    4. removal of excess mucosa
    5. surgical excision
    6. removal of cyst
    7. surgical incision
    8. removal of impacted teeth
    9. repair of soft tissue
    10. frenectomy, dislocations
    11. miscellaneous surgical services
  8. Orthodontic services
    1. Diagnostic Services
      1. orthodontic exam
      2. films
      3. orthodontic diagnostic casts
    2. observation and adjustment
      1. surgical services
      2. observation and adjustment
      3. repairs, alterations
    3. appliances
      1. removable appliances
      2. fixed appliances
      3. retention appliances
      4. appliances to control harmful habits
  9. Adjunctive General Services
    1. emergency services not otherwise specified
    2. anaesthesia in connection with oral surgery and drug injections
    3. consultation
    4. house call, hospital call and special office visit
    5. laboratory fees associated with eligible dental services


Date Modified: 2010-06-01
 
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