A-25, r. 14 - Regulation respecting the reimbursement of certain expenses

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SCHEDULE II
(Revoked)
O.C. 1925-89, Sch. II; O.C. 789-93, s. 14; O.C. 879-2002, s. 2; 677-2017O.C. 677-2017, s. 17.
SCHEDULE II
(ss. 14, 19, 20, and 21)
In this Schedule, the expressions “+L” and “+M” mean that the maximum amount does not include laboratory fees and material cost.

General Dental Denturologists
practitioners specialists


DIVISION I
DIAGNOSTIC SERVICES

1. Clinical oral examination
(1) Complete oral examination:
a) History, medical and dental;
b) Clinical examination of hard and
soft tissues including carious lesions,
missing teeth, determination of depth
and location of periodontal pockets,
gingival contours,mobility of teeth,
interproximal tooth contact relationships,
occlusion of teeth, and any other
relevant factor to be noted.
Mixed dentition (including the analysis
of mixed dentition if necessary): $36 $56
Permanent dentition: $46 $56
(2) Recall of periodic oral examination: $23 $31
(3) Emergency examination: $23 $31
(4) Specific oral examination such as:
carious lesions, periodontal disease,
orthodontic status or other relevant
factor: $23 $31

2. Radiology
(1) Intra oral films
Single periapical film: $14 $16
2 periapical films: $20 $25
3 periapical films: $27 $34
4 periapical films or more: $33 $42
Single occlusal film: $17 $23
2 occlusal films or more: $20 $29
Bitewing, single film: $14 $16
Bitewings, 2 films: $20 $25
Bitewings, 3 films: $27 $34
Bitewings, 4 films: $33 $42
(2) Extra oral films
Extra oral, single film: $35 $43
Extra oral, 2 films or more: $55 $55
Sinus examination, minimum of 4 films,
identified as:
Waters, Caldwell, lateral skull, basal: $95 $128
Temporomandibular joint, 4 films: $95 $95
Panoramic film: $45 $57
(3) Cephalographic films
Single film: $43 $56
Two films or more: $64 $86
Request for duplicate radiograph
(including one or more duplicates): $26 $27
Tomography: $79 $84
Photography: $14 $14
(4) Diagnostic casts
Unmounted: $27 + L $49
Mounted: $46 + L $108 + L
Diagnostic wax-up to evaluate cosmetics,
preparation design and uncomplicated
occlusal consideration: $39 + L $51 + L

DIVISION II
BASIC RESTORATIVE SERVICES

1. Amalgam anteriors and bicuspids
Prophylactic odontotomy and/or
enameloplasty per tooth): $11 $11
1 surface: $34 $39
2 surfaces: $71 $79
3 surfaces: $85 $94
4 surfaces: $110 $123
5 surfaces or complete tooth
reconstruction: $139 $155

2. Amalgam molars
1 surface: $46 $49
2 surfaces: $80 $92
3 surfaces: $105 $109
4 surfaces: $128 $139
5 surfaces or complete tooth
reconstruction: $164 $170

3. Composite anteriors
Class I, V, VI: $60 $68
Class III: $70 $83
Class IV: $124 $150
Double class IV (involving mesial,
incisal, distal): $169 $199
Complete incisal edge: $169 $199
Complete tooth reconstruction in
composite: $169 $199
Prefabricated veneer application
(composite or porcelain): $169 + L $199 + L
Veneer - laboratory processed $283 + L $433 + L
Veneer application - chairside $169 $199
Veneer, ceramic from optical impression $361 $487

4. Composite bicuspids
1 surface: $60 $63
2 surfaces: $100 $110
3 surfaces: $117 $126
4 surfaces: $143 $151
5 surfaces or complete tooth
reconstruction: $180 $204

5. Composite molars
1 surface: $60 $68
2 surfaces: $106 $120
3 surfaces: $139 $151
4 surfaces: $169 $209
5 surfaces or complete tooth
reconstruction: $214 $234

6. Retentive pins
1 pin: $15 $25
2 pins: $27 $40
3 pins: $35 $53
4 pins or more: $44 $69

7. Inlays including temporization

(1) Metal inlays
1 surface: $240 + L $397 + L
2 surfaces: $336 + L $588 + L
3 surfaces: $385 + L $665 + L
3 surfaces with covering of cuspids (add.)
and reconstruction: $451 + L $764 + L

(2) Retentive pins in inlays
1 pin: $24 $32
2 pins: $42 $57
3 pins: $60 $81
4 pins or more: $77 $104

(3) Porcelain or resin inlay
One inlay: $451 + L $608 + L
Inlay (optical impression): $570 $769

8. Preformed steel crowns
Permanent, posterior: $124 $145

9. Preformed plastic crowns
Permanent, anterior: $138 $152
Permanent, posterior: $138 $152

DIVISION III
ENDODONTICS

1. GENERAL ENDODONTIC TREATMENTS
(1) Preparation of tooth for treatment
Removal of gingival tissue, necessary
for isolation of tooth with rubber dam: $40 $54
Removal of bone tissue, necessary to
expose additional tooth structure of
fractured of carious tooth: $49 $66
Banding of tooth to maintain sterile
operating field: $79 $102
Removal of tooth filling material or
foreign bodies from previously treated
root canal therapy: $105 $142
(2) Treatment
Canal therapy includes:
Treatment plan
Clinical procedures
Appropriate radiographs but excludes
final restoration.
1 canal, fully developed root: $298 $444
2 canals, fully developed roots: $425 $538
3 canals, fully developed roots: $545 $703
4 canals or more, fully developed roots: $632 $781

2. APEXIFICATION
1 canal, partially developed root: $328 $468
2 canals, partially developed roots: $461 $561
3 canals, partially developed roots: $591 $731
4 canals or more, partially developed
roots: $641 $785
Change of dentogenic medium: $86 $128

3. ENDODONTIC SURGERY
(1) Apectomy (as a separate procedure
from the root canal)

1 root uncomplicated: $178 $339
1 root complicated by anatomic and/or
pathologic conditions: $202 $414
2 roots: $250 $414
3 roots or more: $306 $414
(2) Apectomy and root canal performed in
conjunction with endodontic treatment,
global fee

1 root uncomplicated: $378 $510
1 root complicated by anatomic position: $400 $540
2 roots: $536 $724
3 roots or more: $677 $914
(3) Retrograde obturation (as a separate
procedure from the root canal), includes
apical curettage and/or apectomy

1 root uncomplicated: $238 $444
1 root complicated by anatomic position: $286 $518
Retrograde obturation on the lateral
aspects of the root: $286 $518
2 roots: $369 $425
(4) Root amputation
Specific treatment preceding this service
is considered as a separate entity.
1 root: $151 $286
2 roots: $176 $351
(5) Hemisection
Specific treatment preceding this service
is considered as a separate entity.
Madibular molar: $151 $328
(6) Intentional removal is:
- removal;
- apical filling;
- re-implantation;
- splinting not included;
Single rooted tooth: $128 $224
2-rooted tooth: $151 $288
3-rooted tooth: $176 $300
(7) Endo-osseous implants for root
stabilization

Specific treatment preceding this service
is considered as a separate entity.
For anteriors: $477 $536
For posteriors, per canal: $574 $647

4. MISCELLANEOUS
Bleaching (endodontically treated tooth)
Per tooth, first visit: $83 $167
Each additional visit: $83 $85

5. ENDODONTIC EMERGENCY
Pulpotomy
Permanent anterior or bicuspid: $61 $86
Permanent molar: $102 $136
Trephination through crown into root
without pulpectomy: $30 $40
Penetration of metal crown and/or of
porcelain: $47 $71
Emergency pulpectomy (trephination
through crown included) as a separate
procedure
Permanent tooth - 1 canal: $56 $93
Permanent tooth - 2 canals: $60 $110
Permanent tooth - 3 canals: $102 $144
Sedative (palliative) dressing: $35 $47

6. ENDODONTIC TRAUMATISM
Pupl capping - indirect: $35 $47
Relieving traumatic occlusion, as a
separate procedure: $41 $46
Reimplantation of luxated tooth: $42 $57
Repositioning of traumatically displaced
tooth: $42 $57

DIVISION IV
PERIODONTICS

1. Non surgical periodontal services
Postoperative visit for dressing change
(if done by a dentist other than the one
who performed the surgery): $47 $63
Periodontal scaling:
- 1 unit of time: $40 $43
- 2 units of time: $69 $76
- 3 units of time: $102 $110
- 4 units of time: $137 $147
Management of acute infections and other
oral lesions listed below:
- acute pericoronitis, ANUG, ulcers and
others: $44 $59
Desensitization per tooth: $15 $32

2. Periodontal services, surgical
Note: postoperative care included.
Periodontic surgical procedure means
treatment of a sextant (1 to 6 teeth).
Gingivoplasty and/or gingivectomy
- per sextant: $218 $259
- three teeth or less: $89 $120
Osteoplasty and/or ostoectomy
(flap approach) per sextant: $378 $528
Exploratory surgery (flap approach) per
site: $263 $307
Osteoplasty and/or ostoectomy for crown
lengthening: $370 $485
Osseous tissue graft:
- harvesting autogenous bone from distant
site: $207 + M $431
- allogenous bone transplant and any other
filling material: $62 + M $85 + M
- periodontal guided tissue regeneration: $181 + M $216 + M
Pedicle soft tissue graft: $324 $387
Free soft tissue graft, per site: $324 + L $387
Free connective tissue graft for root
coverage: $361 $461
Free connective tissue graft for ridge
augmentation: $343 $491
Interproximal wedge (mesial or distal): $218 $284
Supra crestal fibrotomy, per tooth: $40 $54

3. Provisional splinting
Intracoronal splint per joint. $100 + L $135 + L
Extracoronal splint per joint:
- Acid etch splint, per joint: $96 + L $103 + L
- Acid etch splint, per tooth, with
metallic trellis: $48 $65
- Orthodontic band splint, per tooth: $49 + L $64
- Cast metal splint (Maryland type), per
tooth: $92 + L $134 + L
Removal or recimentation of provisional
splint, per tooth: $48 $64

4. Adjunctive periodontal services
Minor occlusal equilibration
(one or two teeth) per visit: $56 $68
Major occlusal equilibration (full mouth)
per visit: $230 $265
Root planing and gingival curettage per
tooth: $104 $140
Root planing and gingival curettage each
additional tooth: $24 $32
Appliance for bruxism: $273 + L $419 + L
Intra oral appliance for TMJ
(occlusal guard): $341 + L $433 + L
Repair, maintenance, ajustment after
3 months: $79 + L $100 + L
Reline of appliance: $95 + L $135 + L

DIVISION V
REMOVABLE DENTURES

1. Complete denture
Complete maxillary denture: $484 + L $653 + L $434 + L
Complete mandibular denture: $623 + L $841 + L $556 + L
Complete maxillary and mandibular
dentures: $855 + L $1154 + L $827 + L
Equilibrated, maxillary, complete denture: $596 + L $965 + L $524 + L
Equilibrated, mandibular, complete
denture: $746 + L $965 + L $669 + L
Equilibrated, maxillary and mandibular,
complete dentures: $1080 + L $1632 + L $1049 + L

2. Immediate complete dentures (including
three visits in the first three months
following insertion, including
conditioners, but does not include
permanent reline or rebase)

Complete maxillary denture: $452 + L $675 + L $391 + L
Complete mandibular denture: $508 + L $753 + L $515 + L
Complete maxillary and mandibular dentures: $861 + L $1225 + L $786 + L

3. Transitional complete dentures
Complete maxillary denture: $231 + L $312 + L $217 + L
Complete mandibular denture: $292 + L $394 + L $292 + L
Complete maxillary and mandibular dentures: $468 + L $632 + L $463 + L

4. Transitional partial denture
Acrylic base, with or without clasps
Maxillary: $185 + L $330 + L $197 + L
Mandibular: $185 + L $330 + L $219 + L

5. Partial dentures, cast (frame /
connector of chrome-cobalt with cast
and/or fashioned rests and clasps)

Maxillary: $623 + L $843 + L $556 + L
Mandibular: $623 + L $843 + L $591 + L
Palatal connector, rests, clasps and cast
chrome cobalt base (tooth-borne)
Maxillary: $582 + L $863 + L $523 + L
Mandibular: $582 + L $863 + L $556 + L

6. Removable partial denture with
precision

attachments
Maxillary: $745 + L $1005 + L $633 + L
Mandibular: $745 + L $1005 + L $633 + L

7. Semi-precision cast partial denture
Maxillary: $745 + L $1005 + L $633 + L
Mandibular: $745 + L $1005 + L $633 + L

8. Denture adjustments
After the visits within 3 months
following insertion or performed by a
person other than the person who
originally inserted the appliances.
Minor adjustments: $32 $43 $23

9. Remount and equilibration
Maxillary and mandibular: $225 + L $535 $182
Single maxillary: $112 + L $267 $91
Single mandibular: $112 + L $267 $103

10. Denture repairs, no impression
required:
$37 + L $50 + L $56

11. Denture repairs, impression required: $37 + L $50 + L $56

12. Structure additions to a partial
denture:
$80 + L $108 + L $95

13. Denture duplication, rebasing, relining
Reline maxillary, complete denture,
self-polymerizing: $128 $163 $147
Reline mandibular, complete denture,
self-polymerizing: $128 $163 $156

14. Reline removable partial denture,
self-polymerizing (unilateral or bilateral)

Maxillary: $128 $163 $121
Mandibular: $128 $163 $124

15. Reline removable complete or partial
denture, laboratory processed

Maxillary complete denture: $149 + L $409 $181
Mandibular complete denture: $149 + L $409 $195
Maxillary partial denture: $149 + L $409 $242
Mandibular partial denture: $149 + L $409 $252

16. Rebase (jump)
Maxillary complete denture: $149 + L $409 $181
Mandibular complete denture: $149 + L $409 $195
Maxillary partial denture: $149 + L $409 $242
Mandibular partial denture: $149 + L $409 $252

17. Tissue conditioning, per appointment
Maxillary complete denture: $60 $85 $42
Mandibular complete denture: $60 $85 $44
Maxillary partial denture: $60 $85 $42
Mandibular partial denture: $60 $85 $44

18. Accessories for adjunctive denture
Metal base for maxillary or mandibular: $191 $191 $191

19. Complete denture and partial denture
Complete denture with partial denture
(opposing arch) chrome-cobalt, standard: $909 + L $1227 + L $866 + L
Complete denture with partial denture
(opposing arch) chrome-cobalt,
equilibrated: $1133 + L $1529 + L $1066 + L

DIVISION VI
FIXED PROSTHODONTICS

1. Individual crowns
Acrylic: $406 + L $548 + L
Acrylic processed to metal: $503 + L $702 + L
Acrylic or plastic, transitional, direct,
chairside: $117 $158
Acrylic or plastic, transitional, direct,
chairside, with radicular retention: $138 $157
Porcelain (including injected porcelain): $503 + L $702 + L
Porcelain fused to metal base: $503 + L $702 + L
Metal (full cast): $503 + L $702 + L
Metal (3/4 cast): $503 + L $702 + L

2. Cast post
Retentive cast post as part of crown: $116 + L $157 + L
Cast metal post and core as a separate
procedure or coping technique for
overdenture or crown: $224 + L $400 + L
Cast post, two sections: $227 + L $400 + L
Cast metal post and core concurrent with
impression for crown (when possible): $116 + L $157 + L
Cast metal post and core concurrent with
impression for crown (when possible),
two sections: $184 + L $248 + L

3. Other restorative services
Recement inlay or crown: $42 + L $71 + L
Removal of crown or inlay: $42 $71
Stabilization of a fixed bridge with
resin at contact point in order to solder
a broken contact point: $96 + L $130 + L
For initial removal of bridge:
Removal of fixed bridge to be reinserted,
per unit of abutment: $49 $49
Recementation of fixed bridge, per
abutment, including Butterfly bridge
(Maryland, Rochette, etc.): $56 + L $76 + L
Porcelain repair of fixed bridge, indirect: $49 + L $66 + L

4. Abutments
Acrylic crown processed, transitional
during healing: $121 + L $163 + L
Acrylic-metal: $533 + L $720 + L
Porcelain: $533 + L $720 + L
Porcelain fused to metal: $533 + L $720 + L
Metal, full cast: $533 + L $720 + L

5. Other prosthetic services
Precision attachment: $81 + L $224

6. Prefabricated metal post
One unit: $115 $155
Two units: $142 $192
Three units: $174 $235
Pin-reinforced core for crown restoration: $105 $152

7. Pontics
Acrylic pontic processed: $121 + L $163 + L
Metal cast pontic: $240 + L $324 + L
Porcelain fused to metal: $306 + L $413 + L
Acrylic processed to metal pontic: $242 + L $327
Acrylic pontic processed, transitional
during healing: $81 + L $109 + L
Acrylic pontic, temporary, acid etched to
adjacent teeth: $168 $227

8. Butterfly bridge (Maryland, Rochette,
etc.)

Metal onlay - acid etch bonded per
abutment: $128 + L $399 + L

9. Retentive pins in crowns
Retentive pins, additional, one pin, per
abutment: $22 $30
Retentive pins, additional, two pins, per
abutment: $42 $57
Retentive pins, additional, three pins, per
abutment: $60 $81
Retentive pins, additional, four pins, per
abutment: $77 $104

DIVISION VII
ORAL SURGERY
The following surgical services include
necessary suturing and one post-operative
treatment, when required.

1. Removal of erupted tooth (uncomplicated),
per quadrant

Single tooth: $42 $66
Each additional tooth: $25 $38

2. Surgical removal (complicated)
Erupted tooth: $105 $124
Tooth, soft tissue coverage: $105 $124
Tooth, partial bone tissue coverage: $154 $202
Tooth, complete bone tissue coverage: $209 $231
Tooth in unusual position or age factor
(including supernumerary): $234 $242
Transplantation of tooth, including
splinting: $324 $437
Surgical repositioning of tooth, including
splinting: $324 $437
Enucleation of an unerupted tooth and
follicle: $202 $273

3. Alveolectomy
This service includes removal of bony tissue,
alveoloplasty and correction of mucous
membrane. Alveolectomy consists of removal
of alveolar process for correction of height
and width of the ridge to obtain normal
conformation.
Alveolectomy, per sextant: $216 + L $291

4. Alveoloplasty
Service involves incising and reflecting a
flap, bone contouring and suturing.
In conjunction with multiple tooth removal:
Independent procedure, per sextant: $131 $153
Surgical removal of palatal papillomatosis: $169 $175

5. Osteoplasty
Excision torus palatinus: $344 + L $330 + L
Excision torus mandibularis, unilateral: $286 + L $220
Excision torus mandibularis, bilateral: $402 + L $440
Removal of multiple exostosis, per sextant: $131 $153

6. Removal of hyperplasic tissue (by
electrosurgery or dissection)

1 cm or less: $77 $104
More than 1 cm to 3 cm: $88 $119
More than 3 cm to 6 cm: $128 $173
More than 6 cm to 9 cm: $164 $221
More than 9 cm to 12 cm: $206 $278
More than 12 cm: $242 $326

7. Removal of excess mucosa (by
electrosurgery or dissection)

1 cm or less: $77 $104
More than 1 cm to 3 cm: $87 $119
More than 3 cm to 6 cm: $117 $158
More than 6 cm to 9 cm: $153 $207
More than 9 cm to 12 cm: $195 $263
More than 12 cm: $230 $310

8. Alveolar ridge reconstruction
- with alloplastic material: $694 + M $660 + L
- with alloplastic material (complete
alveolar crest): $694 + M $1800

9. Extension of mucous folds with
secondary epithelization

1 cm to 3 cm: $138 $186
More than 3 cm to 6 cm: $195 $207
More than 6 cm to 9 cm: $271 $366
More than 9 cm: $384 $518

10. Extension of mucous folds with mucosa
or skin graft

1 cm to 3 cm: $195 $207
More than 3 cm to 6 cm: $271 $366
More than 6 cm to 9 cm: $384 $518
More than 9 cm: $502 $678

11. Removal of tumor
Soft tissue
a) 1 cm or less including biopsy: $151 $175
b) Each additional cm: $76 $88

12. Removal & curettage of intra-osseous
cyst or granuloma

1 cm or less: $143 $309

13. Tuberoplasty (including removal of
hyperplastic tissue and bony tissue)

a) Unilateral: $177 $226
b) Bilateral: $315 $400

14. Alveolectomy (Alveoloplasty)
Removal of exostosis in a specific area: $131 $153

15. Surgical incision and drainage
Intra-oral incision at the alveolar or
palatine site with or without drain: $42 $98
Intra- or extra-oral incision located in a
major anatomical space and installation of
a drain: $172 $199
Trephination and drainage, hard tissue,
intra-oral: $96 $144

16. Alveolar fracture
This fee includes the reduction of the
fracture, unbridling, necessary extractions.
Stabilization is not included.
More than 1 cm to 3 cm: $306 $306
More than 3 cm to 6 cm: $421 $421
More than 6 cm to 9 cm: $515 $515
More than 9 cm: $623 $623

17. Repair of soft tissue laceration
1 cm or less: $50 $96
Each additional cm: $27 $34
Note: Treatment of external or internal
lacerations is subject to the same fee:
this procedure includes additional
dessings as required.

18. Repair through & through laceration
1 cm or less: $105 $173
Each additional cm: $50 $65

19. Frenectomy
Upper labial frenectomy: $143 $189
Lower labial frenectomy: $151 $193

20. Dislocation of mandible
Closed reduction without anaesthesia: $75 $90

21. Treatment of salivary glands
Dilatation of duct, per session: $125 $125
Excision of mucocele: $89 $167
Excision of ranula: $234 $240

22. Miscellaneous
Infiltration of a branch of the trigeminal
nerve for diagnostic purposes (one or
more not followed by a surgical procedure
during the same session): $26 $63

23. Hemorrhage control
Primary: $42 $66
Secondary: $85 $90

24. Post-surgical treatment
Minor, per session: $24 $32
Major, per session: $42 $57

25. Anaesthesia
Intravenous sedation: $93 $93

DIVISION VIII
ORTHODONTICS

1. Miscellaneous
Diagnostic: $154 $208
Stainless steel band with intra-alveolar
attachment: $93 + L $126 + L
Soldered lingual arch (bilateral): $172 + L $232 + L
Fixed partial pontics attached to soldered
lingual arch to replace missing anterior
teeth: $250 + L $337 + L
Removable lingual arch (with locking wires),
Ellis arch: $1172 + L $232 + L
Stainless steel crown with wire attachment: $172 + L $232 + L
Stainless steel crown with intra-alveolar
attachment: $201 + L $271 + L
Removable acrylic space maintainer: $107 + L $144 + L
Repairs: $43 + L $58 + L
Alterations: $43 + L $58 + L
Recementation: $43 + L $58 + L
The suggested fee for all orthodontic
appliances includes design, fabrication,
insertion and/or cementation and
maintenance of appliances.

2. Removable appliances
Space regaining - bilateral: $427 + L $576 + L
Space regaining - unilateral: $384 + L $518 + L
Anterior or posterior crossbite
correction - maxillary appliance: $384 + L $518 + L
Anterior or posterior crossbite
correction - mandibular appliance: $384 + L $518 + L
Dental arch expansion - maxillary: $384 + L $518 + L
Dental arch expansion - mandibular: $384 + L $518 + L
Closure of diastemas - maxillary: $306 + L $413 + L
Closure of diastemas - mandibular: $306 + L $413 + L
Simple alignment of incisors - maxillary: $306 + L $413 + L
Simple alignment of incisors - mandibular: $306 + L $413 + L

3. Appliances, removable, mechanical
eruption of impacted tooth/teeth

Appliance, maxillary: $306 + L $413 + L
Appliance, mandibular: $306 + L $413 + L

4. Orthopedic and/or myofunctional
treatment

Orthopedic appliance (Bionator,
Activator, Frankel, L.S.U., etc.),
including maintenance of appliances $616 + L $831 + L

5. Fixed appliances - bilateral
Space regaining (lingual or labial arch
with molar bands, tubes, locks, etc.)
- maxillary: $461 + L $622 + L
Space regaining (lingual or labial arch
with molar bands, tubes, locks, etc.)
- mandibular: $461 + L $622 + L
Crossbite correction - anterior,
maxillary appliance: $245 + L $330 + L
Crossbite correction - anterior,
mandibular appliance: $245 + L $330 + L
Crossbite correction - posterior,
maxillary appliance: $245 + L $330 + L
Crossbite correction - posterior,
mandibular appliance: $245 + L $330 + L
Dental arch expansion, `W´ appliance -
maxillary: $348 + L $469 + L
Dental arch expansion, `W´ appliance -
mandibular: $348 + L $469 + L
Headgear: $348 + L $469 + L
Rapid maxillary expansion: $337 + L $454 + L
Closure of diastemas - maxillary: $562 + L $758 + L
Closure of diastemas - mandibular: $562 + L $758 + L
Simple alignment of incisors (6 or $8 bands
and labial lightwire arch) - maxillary: $562 + L $758 + L
Simple alignment of incisors (6 or $8 bands
and labial lightwire arch) - mandibular: $562 + L $758 + L

6. Fixed appliances - unilateral
Crossbite correction - posterior (2 molar
bands, hooks, elastics): $199 + L $268 + L

7. Appliances, fixed, mechanical eruption
of impacted teeth

Appliance, maxillary: $306 + L $413 + L
Appliance, mandibular: $306 + L $413 + L

8. Appliances to control harmful oral habits
Myofunctional evaluation to correct mouth
breathing, abnormal swallowing, tongue
thrusting, etc.: $101 $136
Removable appliance (ex. oral screen): $154 + L $208 + L
Removable appliance - maxillary (ex. Lip
bumper maxillary): $245 + L $330 + L
Removable appliance - mandibular (ex. Lip
bumper): $245 + L $330 + L
Fixed appliance - maxillary: $245 + L $330 + L
Fixed appliance - mandibular: $245 + L $330 + L
Myofunctional therapy to correct mouth
breathing, abnormal swallowing, tongue
thrusting, hypotonic lip, per visit: $67 $90

9. Comprehensive major orthodontic
treatment
$3954 $5338
Typical case - Appliances include
diagnostic procedures, formal full-banded
treatment, retention appliances and
maintenance of appliances.Orthodontic
treatment in 2 stages:
- first stage: $1614 $2179
- second stage: $1977 $2669

10. Retention appliances
Removable appliance (ex. positioner,
Hawley, etc.): $230 + L $310 + L
Removable - maxillary: $230 + L $310 + L
Removable - mandibular: $230 + L $310 + L
Fixed cemented or acid etch bonded: $92 + L $124 + L

DIVISION IX
IMPLANT

1. Surgical phase
Endo-osseous implant: First implant $1500 $1650
Each additionnal implant: $1000 $1150
Removal of implant (including gingival
plasty) - simple per implant: $75 $85
Removal of implant (including gingival
plasty) - complex per implant: $150 $185
Surgical guide: $131 + L $131 + L
Radiologic guide: $131 + L $131 + L

2. Prosthodontics phase
Crown fixed to an implant: $503 + L $766 + L
Fixed prosthodontics resting on
osteointegrated implants Abutments: $503 + L $766 + L
Pontics: $306 + L $550 + L
Removable dentures resting on
osteointegrated implants
Unconnected attachments: $1500 + L $2250 + L $1275 + L
Connected attachments + (only the
laboratory fee is payable for the bar
uniting the implants): $1500 + L $2250 + L $1275 + L

DIVISION X
MAXILLO-FACIAL SURGERY

1. Splints
Intra- or peri-osseous splint: $135 $135
Acrylic prosthesis or cap splint: $165 $165
Arch: $180 $180

2. Removal of splints
Intra- or peri-osseous splint: $135 $135
Acrylic prosthesis or cap splint: $80 $80
Arch: $95 $95
Wire, plate or screws used in
osteosynthesis: $215 $215

3. Reduction of fracture
Simple fracture of the mandible
Closed reduction: $664 $664
This reduction includes post-operative
care within $60 days following treatment.
Simple fracture of the maxilla
Closed reduction: $664 $664
This reduction includes post-operative
care within $60 days following treatment.

4. Cheiloplasty
Partial: $340 $340
Complete: $680 $680
As concerns an act done by any of the professionals that is not stated in this Schedule or not included in the acts that are indicated herein, the related expenses incurred qualify for reimbursement up to the amount set forth for the act:
(1) in the document entitled “Nomenclature et tarifs des actes buccodentaires”, published by the Association des chirurgiens dentistes du Québec, as it read on 1 January 2000, where the act is done by a dentist in general practice;
(2) in the document “Guide des honoraires”, published by the Fédération des dentistes spécialistes du Québec, as it read on 1 January 2000, where the act is done by a specialist dentist;
(3) in the “Guide de services”, published by the Association des denturologistes du Québec, as it read on 1 January 2000, where the act is done by a denturologist.
O.C. 1925-89, Sch. II; O.C. 789-93, s. 14; O.C. 879-2002, s. 2.