Ontario Seniors Dental Care Program Schedule of Dental Services for Non-Dentist Providers Ministry of Health Effective September 2020 - September ...
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Ontario Seniors Dental Care Program Schedule of Dental Services for Non- Dentist Providers Ministry of Health Effective September 2020 September 2020
Copyright
The Canadian Dental Hygienists Association is the owner of the copyright of the CDHA National List of Service Codes. The Denturist
Association of Canada is the owner of copyright of the Denturist Association of Canada Procedure Codes.
1|PageDisclaimer
The Ontario Seniors Dental Care Program Schedule of Dental Services for Non-Dentist Providers is not intended nor should it be
relied upon to determine the scope of practice of dental hygienists or denturists in Ontario. The Schedule is an administrative tool
distributed to providers by Public Health Units, Community Health Centres, and Aboriginal Health Access Centres, so that they may
provide services to clients in the Ontario Seniors Dental Care Program. Questions regarding the scope of practice should be referred
to the appropriate regulatory college.
2|PagePREAMBLE
The Schedule Explained
This schedule describes the services covered under the Ontario Seniors Dental Care Program (OSDCP) for non-dentist providers
recognized by the College of Dental Hygienists of Ontario or the College of Denturists of Ontario. Specific limitations are noted in the
“limit” column where applicable.
Ontario Seniors Dental Care Program
The OSDCP provides publicly-funded dental care for eligible seniors.
Eligibility for the OSDCP
Seniors are eligible for the Ontario Seniors Dental Care Program if they meet the following criteria:
• 65 years of age or older;
• Resident of Ontario;
• Meet income thresholds (annual net income of $19,300 or less for single senior, or combined annual net income of $32,300
or less for a couple); and
• No access to any other forms of dental benefits (e.g., private insurance or other government program).
Program Enrolment
To apply for dental coverage through the OSDCP, applicants must complete and submit an application to the OSDCP Program
Administrator either online or by mail. More details are available at www.ontario.ca/seniorsdental.
Applicants will receive a notification by mail once the application form has been processed.
Once a senior is enrolled in the OSDCP, they will be notified each year of their eligibility for continued participation in the program, or
about how to re-apply to the program if that is required.”
Length of Eligibility
The full benefit year runs from August 1 – July 31 each year. Applications may be submitted at any time during the year.
Each OSDCP dental card is issued for a full benefit year (August 1—July 31).
3|PageVerification of Eligibility: OSDCP Card Once a client has been deemed eligible for the program, an OSDCP dental card will be issued and mailed. In situations of misuse of a dental card by the client, the Program Administrator will immediately terminate the senior’s coverage under the program and may seek reimbursement directly from the client for services rendered. In these instances, the ministry is responsible for notifying the dental provider that the client is no longer eligible for dental services under the Program. For lost or stolen cards or to report misuse, contact the Program Administrator at 416-916-0204 or toll-free at 1-833-207-4435. TTY users can call toll-free at 1-800-855-0511. Providers will need to contact the Program Administrator with the client to confirm eligibility. Authorized Service Providers Seniors can receive services through a local Public Health Unit, Community Health Centre, or Aboriginal Health Access Centre community dental clinic. Participating providers include: • A dentist in good standing with the Royal College of Dental Surgeons of Ontario (RCDSO); • A registered dental hygienist in good standing with the College of Dental Hygienists of Ontario (CDHO); • A registered denturist in good standing with the College of Denturists of Ontario (CDO); or • A physician anaesthetist in good standing with the College of Physicians and Surgeons of Ontario (CPSO). Responsibility of the Program Administrator The Program Administrator is responsible for determining eligibility and enrolling seniors onto the OSDCP and issuing dental cards for enrolled clients. The Program Administrator also re-issues expired, lost or misplaced cards to eligible clients according to program policies. In addition to those responsibilities, the Program Administrator supports clients through the application process and answers questions about the program through a contact centre, mail and email. 4|Page
OSDCP Service Schedule for Dental Hygienists
DENTAL HYGIENE EXAMINATION/ASSESSMENT AND DIAGNOSIS
Examination and Assessment
Code Description Limit
00113 Permanent, complete 1 per 60 months, per patient, per dental hygienist,
00114 Edentulous, complete per dental office address
00121 Routine reassessment/recall (previous client) 1 per 12 months, per patient, per dental hygienists,
per dental office address
00123 Emergency There is no limit on the number of emergency exams
that will be covered
00125 Specific (new or existing client) 1 per 12 months, per patient, per dental hygienist,
per dental office address
Radiographs
Code Description Limit
00211 1 image - Intraoral bitewing Maximum 8 images per 12 months, per client, per
00212 2 images - Intraoral bitewing dental hygienist, per dental office address
00221 1 image - Intraoral periapical
00222 2 images - Intraoral periapical
00223 3 images - Intraoral periapical
00224 4 images - Intraoral periapical
00225 5 images - Intraoral periapical
00226 6 images - Intraoral periapical
5|PageRadiographs
Code Description Limit
00241 Panoramic 2 per lifetime
Covered when required due to:
- facial trauma with symptoms of possible jaw
fracture
- facial swelling of unknown etiology
- severe gag reflex with multiple carious lesions
- diagnosis cannot be made using periapical
film
- special circumstances clearly substantiated by
the practitioner
6|PagePERIODONTAL TREATMENT (EACH UNIT OF TIME IS 15 MINUTES)
Code Description Limit
00511 1 unit of time - Debridement Maximum 6 units of debridement and/or root
00512 2 units of time - Debridement planing per 12 months, per patient, per dental
00513 3 units of time - Debridement hygienist, per dental office address
00514 4 units of time - Debridement
00515 5 units of time - Debridement
00516 6 units of time - Debridement
00517 One half unit of time - Debridement
00521 1 unit of time - Root planing
00522 2 units of time - Root planing
00523 3 units of time - Root planing
00524 4 units of time - Root planing
00525 5 units of time - Root planing
00526 6 units of time - Root planing
00527 One half unit of time – Root planing
00531 1 unit of time - Stain removal 1 per 12 months, per patient, per dental hygienist,
00537 One half unit of time - Stain removal per dental office address
00551 1 unit of time - Management of oral mucosal disorders
00561 1 unit of time - Management of oral manifestations of systemic
disease
00562 2 units of time - Management of oral manifestations of systemic
disease
00563 3 units of time - Management of oral manifestations of systemic
disease
7|PagePERIODONTAL TREATMENT (EACH UNIT OF TIME IS 15 MINUTES)
Code Description Limit
00571 1 sextant - Gingival curettage Maximum 6 different sextants per 12 months, per
00572 2 sextants - Gingival curettage patient, per dental hygienist, per office address
00573 3 sextants - Gingival curettage
00574 4 sextants - Gingival curettage
00575 5 sextants - Gingival curettage
00576 6 sextants - Gingival curettage
00581 1 unit of time - Chemotherapeutic / photodisinfection therapy 1 unit per visit, 2 visits per 12 months, per patient,
per dental hygienist, per office address
8|PageOTHER ORAL SERVICES (EACH UNIT OF TIME IS 15 MINUTES)
Code Description Limit
00606 1 unit of time - Application of anticariogenic/antimicrobial agents
to hard tissues
00611 Topical varnish in-office
00612 Supervised, self-administered in-office
00613 Home - custom maxillary arch
00614 Home - custom mandibular arch
00616 Topical fluoride in-office, all products except varnish
00634 Mouth protector custom – maxillary arch 1 per 60 months, per patient, per dental hygienist,
per dental office address
00638 Labeling removable prosthesis
00666 Placement temporary restorations – must include tooth number(s)
- Interim Stabilization
Therapy (IST) – 1st tooth in quadrant
00667 Placement temporary restorations – must include tooth number(s)
- each additional tooth same quadrant
00671 1 unit of time - Temporary recementation
00672 2 units of time - Temporary recementation
00691 1 unit of time - Denture/removable prosthesis prophylaxis and
stain removal
9|PageOSDCP Service Schedule for Denturists
EXAMINATIONS
Code Description Limit
10010 General Oral Examination 1 per 60 months, per patient, per denturist, per
dental office address
10020 Limited Exam - New Patient 1 per 12 months, per patient, per denturist, per
dental office address
10030 Limited Exam - Previous Patient 1 per 12 months, per patient, per denturist, per
dental office address
10104 Emergency/Specific nature There is no limit on the number of emergency exams
that will be covered
10105 Annual Recall/Recare 1 per 12 months, per patient, per denturist, per
dental office address
STANDARD DENTURES
Code Description Limit
31310 Complete Maxillary Complete dentures are covered once in any 8-year
31320 Complete Mandibular period per arch
10 | P a g eSTANDARD DENTURES
Code Description Limit
41114 Free-End Cast Frame - Partial Maxillary Removable partial cast dentures are covered once in
41124 Free-End Cast Frame - Partial Mandibular any 8-year period per arch
41254 Toothborne Cast Frame - Partial Maxillary
41264 Toothborne Cast Frame - Partial Mandibular Removable partial acrylic dentures are covered once
41610 Partial Acrylic Base - With Clasps And/Or Rests Or Resilient in any 5-year period per arch
Retainers - Partial Maxillary
41620 Partial Acrylic Base - With Clasps And/Or Rests Or Resilient Coverage for a partial denture is for teeth 16 to 26
Retainers - Partial Mandibular and 36 to 46 inclusive
All basic treatment must be completed including:
- control of caries and of periodontal and
periapical disease for all teeth and restoration
of major structural defects in the abutment
teeth
- the space to be replaced is greater than or
equal to the corresponding natural teeth
(vertically and horizontally)
All abutment teeth must have:
- adequate periodontal support, based on
alveolar bone levels (crown to root ratio of at
least 1:1) visible on submitted radiographs
- absence of active periodontal disease
There must be one or more missing teeth in the
anterior sextant or two or more missing posterior
teeth in a quadrant excluding second and third
molars
11 | P a g eRELINES Code Description Limit 32110 Lab Processed - Heat Cured - Complete Maxillary Maximum of 1 reline per patient, per arch, per 3 32120 Lab Processed - Heat Cured - Complete Mandibular years, per denturist, per dental office address 42116 Lab Processed - Heat Cured - Partial Maxillary 42126 Lab Processed - Heat Cured - Partial Mandibular 32215 Lab Processed - Self-Polymerized - Complete Maxillary 32225 Lab Processed - Self-Polymerized - Complete Mandibular 42210 Lab Processed - Self-Polymerized - Partial Maxillary 42220 Lab Processed - Self-Polymerized - Partial Mandibular 32418 Chairside - Acrylic - Complete Maxillary 32428 Chairside - Acrylic - Complete Mandibular 42418 Chairside - Acrylic - Partial Maxillary 42428 Chairside - Acrylic - Partial Mandibular 32410 Chairside - Light Cured - Complete Maxillary 32420 Chairside - Light Cured - Complete Mandibular 42416 Chairside - Light Cured - Partial Maxillary 42426 Chairside - Light Cured - Partial Mandibular 12 | P a g e
REPAIRS Code Description Limit 36110 No Impression - Complete Maxillary Maximum of 2 repairs/additions per patient, per 36120 No Impression - Complete Mandibular arch, per year, per denturist, per dental office 46110 No Impression - Partial Maxillary address 46120 No Impression - Partial Mandibular 36210 With Impression - Complete Maxillary 36220 With Impression - Complete Mandibular 46210 With Impression - Partial Maxillary 46220 With Impression - Partial Mandibular 46310 Addition To Existing Partial - Partial Maxillary 46320 Addition To Existing Partial - Partial Mandibular TISSUE CONDITIONING/TEMPORARY LINER Code Description Limit 37110 Complete Maxillary 37120 Complete Mandibular 47110 Partial Maxillary 47120 Partial Mandibular 13 | P a g e
ADJUSTMENTS Code Description Limit 38110 Complete Maxillary Maximum of 2 adjustments per patient, per arch, per 38120 Complete Mandibular year, per denturist, per dental office address 48110 Partial Maxillary 48120 Partial Mandibular ADJUNCTIVE SERVICES Code Description Limit 70150 Denture Identification (name in denture) 70210 Mouth Guard Type 3 - vacuum formed Maxillary arch only 71006 Maxillary Casting 71007 Mandibular Casting 98888 Laboratory Fees 14 | P a g e
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