Item 3 (Restorative) and Item 4 (Extra Coronal Restorations)

Section III – Restorative Treatment

• Materials used for direct restorations should be recorded in the patient record.
• The same items can be claimed for both children and adults on deciduous, retained deciduous and permanent teeth.
• The filling fees cover all items required to restore the tooth – pins can still be used if required but there is no separate fee for these.
• Codes under items 3-(a) to 3-(e) may only be claimed once per tooth.
• If there is more than one filling of different surfaces required in a tooth, then these should be claimed as individual codes on the same tooth:
  • For example, a tooth requiring mesio-incisal and separate buccal composite restorations should be claimed under codes C001, C002 and C014.
  • For example, a tooth requiring mesial-occlusal-distal amalgam and separate buccal composite restorations should be claimed under codes C001, C003 and C004.
• Amalgam fillings should not normally be provided for:
  • patients under 15 years of age
  • retained deciduous teeth
  • patients who are pregnant or breastfeeding
  • patients where there is a letter from secondary care recommending amalgam should not be used due to specific medical needs.
• If, in the clinical judgement of the dentist, resin cannot be provided for these patients, then alternative materials may be used in exceptional circumstances. The reasoning should be noted and recorded in the patient record.
• Amalgam fillings must not be used in incisors or canines.
• Paragraph 7 of the Terms of Service, Schedule 1 of the NHS (GDS)(Scotland) 2010 Regulations still applies – items 3-(a) to 3-(e) cannot be claimed again by the same dentist*(see same dentist interpretation in Section XII – Interpretation) for the same surface(s) within 11 complete calendar months of the original treatment, unless repair or replacement is required as a result of trauma.

3-(a) Filling (Single Surface)

• Code C001 is the code for one single surface filling.
• If you are claiming two single surface fillings on one tooth (where the fillings are not touching), you will need to claim code C012. You cannot claim code C001 multiple times on one tooth. If you are claiming three single surface fillings on one tooth, you will claim 1xC001 and 1xC012.
• Please note that the maximum number of single surface fillings that can be claimed per tooth is three, even if more were carried out. The number of charting records must match the number of single fillings claimed.

3-(b) Filling (2 Surfaces)

• Additional incisal fees for anterior teeth are no longer available.
• To claim a composite resin involving 2-surfaces (for example mesio-incisal), a claim under item 3-(b) Filling (2 surface) along with a claim under item 3-(d) Composite Supplement would be appropriate.
• The narrative for item 3-(b) is the same as for item 3-(a).

3-(c) Filling (3 Surfaces or More)

• The narrative for item 3-(c) is the same as for item 3-(a) and 3-(b).

3-(d) Composite Supplement

• This item can be claimed with 3-(a), 3-(b) or 3-(c) where the composite resin is in an incisor or canine or a premolar or molar that does not involve the occlusal surface.

3-(e) Posterior Composite Supplement

This item can be claimed with items 3-(a), 3-(b) and 3-(c) and can be claimed in connection with treatment involving the restoration of the occlusal and/or mesial and/or distal and marginal ridge of a premolar or molar tooth for:

• patients under 15 years of age
• patients who are pregnant or breastfeeding
• patients where there is a letter from secondary care recommending amalgam should not be used due to specific medical needs.

This item can also can be claimed in connection with treatment involving the occlusal surface of any posterior tooth, for all categories of patients where this is being provided for non-aesthetic reasons, such as tooth wear, but cannot include preventive resin restorations.

3-(f) Endodontic Treatment: Incisor/Canine/Lower Premolar; 3-(g) Endodontic Treatment: Upper Premolar; 3-(h) Endodontic Treatment: Molar

• These items encompass all access, extirpation, shaping, decontamination and filling of root canals, where this is a part of the routine provision of root treatment, except where access and extirpation has been completed in an unscheduled appointment under item 1-(c) at a separate emergency appointment.
• Appropriate radiographs must be available to support claims under this item.

3-(i) Pulpotomy

• This item is restricted to the treatment of deciduous and retained deciduous teeth.

3-(j) Root Canal Re-Treatment Supplement

• This item can only be claimed along with items 3-(f), 3-(g) or 3-(h) if doing a root canal re-treatment, but not for re-pulpotomy.
• This item can only be claimed where it is necessary to remove previously placed root filling material prior to undertaking treatment under items 3-(f), 3-(g) or 3-(h). It cannot be claimed where the same dentist*(see same dentist interpretation in Section XII – Interpretation)* has previously claimed items 3-(f), 3-(g) or 3-(h) for the same tooth within the last 11 complete calendar months.
• All claims under item 3-(j) must be able to be supported by a pre-operative radiograph showing the presence of radiopaque filling material within the root canal(s) of the relevant tooth.

3-(k) Internal Bleaching

• This item is exclusively for the internal bleaching of successfully root filled permanent incisor or canine teeth.
• This item must be supported by a pre-operative clinical photograph showing the discolouration and a pre-operative radiograph showing the presence of an adequate radiopaque filling within the root canal(s) of the relevant tooth.
• Patients must be 18 years or older at the start of any course of treatment that includes item 3-(k).
• This cannot be claimed alongside crowns, posts, inlays/onlays, conventional bridges or resin retained bridges on the same tooth.
• If internal/external bleaching is required for a successfully root filled tooth, then an external bleaching tray can be claimed for the specific tooth under item 7-(h).

Section IV – Extra Coronal Restorations

• Materials used for indirect restorations should be recorded in the patient record.

4-(a) Stainless Steel Crown and Provisional Crown/Bridge (per unit)

• Stainless steel crowns and provisional crowns are all part of the same item as the process of preparing and cementing a stainless-steel crown is similar to that of a provisional crown.
• Stainless steel crowns can be claimed for use on:
  • deciduous molar teeth
  • permanent 1st molars as part of orthodontic treatment
  • permanent 1st molar teeth with hypomineralisation as provisional restoration
  • provisional measure on molars for patients undergoing palliative care.
• A laboratory made crown or bridge may be used, at the practitioner’s discretion, only as a necessary palliative.
• It should be noted that a temporary crown or bridge cannot be claimed under item 4-(a) as part of the normal process of constructing an indirect restoration.
• A claim for the replacement of a failed temporary bridge or crown cannot be made where the original temporary crown was provided by the same dentist (see same dentist interpretation in Section XII – Interpretation) within the last 11 complete calendar months, unless repair or replacement is required as a result of trauma.
• Any appropriate material is allowable for provisional crowns and bridges.
• Prior approval submissions regarding bridgework should contain information regarding the design of the proposed bridgework including the relative abutment and pontic units.

4-(b) Crown Placement

• Tooth coloured crowns may not be placed on teeth distal to the second premolar.
• The only exception to this is if it is a first permanent molar tooth that occupies the position of the second permanent premolar tooth in that quadrant.
• Normally only provided for patients who are 17 years or over.
• More clinical freedom in choosing crown materials:
  • Cast metal
  • Porcelain bonded to metal
  • Ceramic/porcelain
• Crowns can be constructed using appropriate laboratory services or in-house design and construction services registered with the Medicines & Healthcare products Regulatory Agency (MHRA).

4-(c) Post and/or Core Retention for Crowns or Bridges

• Item 4-(c) covers all post and/or core retention for crowns and bridges.

4-(d) Inlay/Onlay Placement

• Tooth coloured inlays/onlays may not be placed on teeth distal to the second premolar
• The only exception to this is if it is a first permanent molar tooth that occupies the position of the second permanent premolar tooth in that quadrant.
• Normally only provided for patients who are 17 years or over
• Can use any suitable material deemed clinically necessary
• For cases requiring prior approval, the material used should be detailed in observations.
• Inlays/onlays can be constructed using appropriate laboratory services or in-house design and construction services Registered with the Medicines & Healthcare products Regulatory Agency (MHRA).

4-(e) Replacement Veneer

• Veneers can only be claimed as replacements to existing veneers that have failed and only on upper canines and incisors. A veneer may not be placed as a new restoration. The appropriateness of providing a replacement for a failed restoration is subject to the dentist’s clinical judgment.

4-(f) Conventional Bridge (per unit); 4-(g) Resin-Retained Bridge (per unit)

• There is no change to the principles around provision of bridges under NHS arrangements.
• Subject to the conditions:
  • Normally for patients 17 years or over
  • At least 6 months after extraction of any tooth to be replaced by the bridge
  • Satisfactory periapical condition of the abutment teeth
  • Satisfactory periodontal status
  • Satisfactory general standard of oral hygiene
  • Satisfactory occlusion
• Bridges to replace molar teeth should only be provided where they are required for the stability of the occlusion.
• If the total value of the treatment plan exceeds £660, prior approval will be required. Appropriate radiographs and study models should be available
• Bridges can be constructed using appropriate laboratory services or in-house design and construction services registered with the Medicines & Healthcare products Regulatory Agency (MHRA).
• There is no longer a distinction between retainers and pontics, however, prior approval submissions that include bridgework should contain information regarding the design of the proposed bridgework including the relative abutment and pontic units.
• It is important that you ensure that the dental charting submitted to Practitioner Services is accurate to ensure efficient processing of claims and Prior Approval requests.
• Post and core, under item 4-(c), is claimable alongside claims for bridge retainers, where appropriate. This is the same fee for crowns.

Recementing a Conventional Bridge

• Claimed under item 1-(c)
• Cannot be claimed by the same dentist (see same dentist interpretation in Section XII – Interpretation) who claimed the original bridge within the previous 11 complete calendar months.

4-(h) Recementing of a Resin-Retained Bridge

• Cannot be claimed by the same dentist (see same dentist interpretation in Section XII – Interpretation) who claimed the original resin retained bridge within the previous 11 complete calendar months.