Part II Regulations under the Regulations Act Printed by the Queen’s Printer Halifax, Nova Scotia Vol. 37, No. 7 April 5, 2013 Contents Act Reg. No.

Page Consumer Protection Act Proclamation of amendment to Act, S. 3, S.N.S. 2012, c. 19 ....................... 5 8 / 2013 298 Cellular Telephone Contracts Regulations–amendment ........................... 5 9 / 2013 299 Education Act Governor in Council Education Act Regulations–amendment ...................... 6 0 / 2013 300 Health Research Foundation Act Health Research Foundation Regulations–amendment ............................ 6 1 / 2013 302 Health Services and Insurance Act Insured Dental Services Tariff Regulations ..................................... 6 2 / 2013 303 Petroleum Products Pricing Act Prescribed Petroleum Products Prices ......................................... 5 6 / 2013 294 Prescribed Petroleum Products Prices ......................................... 5 7 / 2013 296 In force date of regulations: As of March 4, 2005*, the date a regulation comes into force is determined by subsection 3(6) of the Regulations Act.

The date a regulation is made, the date a regulation is approved, the date a regulation is filed and any date specified in a regulation are important to determine when the regulation is in force. *Date that subsections 3(6) and (7) and Sections 11 and 13 of the Regulations Act and amendments to the Regulations Act made by

Chapter 46 of the Acts of 2004 were proclaimed in force. © NS Registry of Regulations. Web version. 293

N.S. Reg. 56/2013 Royal Gazette

Part II - Regulations Vol. 37, No. 7 N.S. Reg. 56/2013 Made: March 14, 2013 Filed: March 15, 2013 Prescribed Petroleum Products Prices Order dated March 14, 2013 made by the Nova Scotia Utility and Review Board pursuant to

Section 14 of the Petroleum Products Pricing Act and Sections 16 to 19 of the Petroleum Products Pricing Regulations Order NSUARB-GAS-W-13-11 In the Matter of the Petroleum Products Pricing Act - and - In the Matter of Prescribing Prices for Petroleum Products pursuant to

Section 14 of the Petroleum Products Pricing Act and Sections 16 to 19 of the Petroleum Products Pricing Regulations Before: Peter W. Gurnham, Q.C., Chair Order

Whereas the purpose of the Petroleum Products Pricing Regulations is to ensure just and reasonable prices for specified petroleum products taking into consideration the objectives of preserving the availability of such products in rural areas, stabilizing prices of such products and minimizing the variances in prices of such products across the Province; And

whereas the Nova Scotia Utility and Review Board (“Board”) considered the manner in which it would proceed to set petroleum prices in its decision, 2006 NSUARB 108, issued on October 16, 2006; And

whereas the Board revised the retail margin and transportation allowance effective January 6, 2012, in its decision, 2011 NSUARB 181, issued on November 23, 2011; And

whereas the Board revised the wholesale margin effective January 4, 2013, in its decision 2012 NSUARB 213, issued on December 12, 2012; And

whereas the average of the average of the daily high and low reported product prices (in Canadian cents) for the week ended March 13, 203 [2013], are: Grade 1 Regular gasoline 79.5¢ per litre Ultra-low-sulfur diesel oil 82.6¢ per litre

Now therefore the Board prescribes the benchmark prices for petroleum products to be: Gasoline: Grade 1 79.5¢ per litre Grade 2 82.5¢ per litre Grade 3 85.5¢ per litre Ultra-low-sulfur diesel oil 82.6¢ per litre And

now therefore the Board has determined, based on historical data regarding price changes and to achieve revenue neutrality, it is appropriate to apply, and the Board so orders, forward averaging corrections of: Gasoline: nil Ultra-low-sulfur diesel oil: minus 0.6¢ per litre And

whereas a winter blending adjustment of plus 1.9¢ per litre is required for ultra-low-sulfur diesel oil; And

now therefore the Board prescribes the prices for petroleum products as set forth in

Schedule “A” effective on and after 12:01 a.m., March 15, 2013. 294 © NS Registry of Regulations. Web version.

N.S. Reg. 56/2013 Royal Gazette

Part II - Regulations Vol. 37, No. 7 Dated at Halifax, Nova Scotia, this 14th day of March, 2013. Sgd: Elaine Wagner Clerk of the Board

Schedule “A” Prices Prescribed for Petroleum Products under the Petroleum Products Pricing Act and the Petroleum Products Pricing Regulations effective on and after 12:01 a.m. on March 15, 2013 Nova Scotia Petroleum Price

Schedule Petroleum Prices in Cents/Litre Self-Service Pump Prices Full-Service Pump Prices (Pump Prices includes 15% HST) Base Wholesale Price Fed. Excise Tax Prov.

Tax Wholesale Selling Price Min Max Min Max Zone 1 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 86.7 89.7 92.7 91.0 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 112.2 115.2 118.2 110.4 134.6 138.0 141.4 132.5 136.6 140.1 143.5 134.6 134.6 138.0 141.4 132.5 999.9 999.9 999.9 999.9 Zone 2 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 87.2 90.2 93.2 91.5 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 112.7 115.7 118.7 110.9 135.1 138.6 142.0 133.1 137.2 140.6 144.1 135.1 135.1 138.6 142.0 133.1 999.9 999.9 999.9 999.9 Zone 3 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 87.6 90.6 93.6 91.9 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 113.1 116.1 119.1 111.3 135.6 139.0 142.5 133.5 137.7 141.1 144.6 135.6 135.6 139.0 142.5 133.5 999.9 999.9 999.9 999.9 Zone 4 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 87.7 90.7 93.7 92.0 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 113.2 116.2 119.2 111.4 135.7 139.2 142.6 133.6 137.8 141.2 144.7 135.7 135.7 139.2 142.6 133.6 999.9 999.9 999.9 999.9 Zone 5 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 87.7 90.7 93.7 92.0 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 113.2 116.2 119.2 111.4 135.7 139.2 142.6 133.6 137.8 141.2 144.7 135.7 135.7 139.2 142.6 133.6 999.9 999.9 999.9 999.9 Zone 6 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 88.4 91.4 94.4 92.7 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 113.9 116.9 119.9 112.1 136.5 140.0 143.4 134.4 138.6 142.0 145.5 136.5 136.5 140.0 143.4 134.4 999.9 999.9 999.9 999.9 © NS Registry of Regulations.

Web version. 295

N.S. Reg. 57/2013 Royal Gazette

Part II - Regulations Vol. 37, No. 7 N.S. Reg. 57/2013 Made: March 21, 2013 Filed: March 25, 2013 Prescribed Petroleum Products Prices Order dated March 21, 2013 made by the Nova Scotia Utility and Review Board pursuant to

Section 14 of the Petroleum Products Pricing Act and Sections 16 to 19 of the Petroleum Products Pricing Regulations Order NSUARB-GAS-W-13-12 In the Matter of the Petroleum Products Pricing Act - and - In the Matter of Prescribing Prices for Petroleum Products pursuant to

Section 14 of the Petroleum Products Pricing Act and Sections 16 to 19 of the Petroleum Products Pricing Regulations Before: Roberta J. Clarke, Q.C., Member Order

Whereas the purpose of the Petroleum Products Pricing Regulations is to ensure just and reasonable prices for specified petroleum products taking into consideration the objectives of preserving the availability of such products in rural areas, stabilizing prices of such products and minimizing the variances in prices of such products across the Province; And

whereas the Nova Scotia Utility and Review Board (“Board”) considered the manner in which it would proceed to set petroleum prices in its decision, 2006 NSUARB 108, issued on October 16, 2006; And

whereas the Board revised the retail margin and transportation allowance effective January 6, 2012, in its decision, 2011 NSUARB 181, issued on November 23, 2011; And

whereas the Board revised the wholesale margin effective January 4, 2013, in its decision 2012 NSUARB 213, issued on December 12, 2012; And

whereas the average of the average of the daily high and low reported product prices (in Canadian cents) for the week ended March 20, 2013, are: Grade 1 Regular gasoline 79.7¢ per litre Ultra-low-sulfur diesel oil 80.3¢ per litre

Now therefore the Board prescribes the benchmark prices for petroleum products to be: Gasoline: Grade 1 79.7¢ per litre Grade 2 82.7¢ per litre Grade 3 85.7¢ per litre Ultra-low-sulfur diesel oil 80.3¢ per litre And

now therefore the Board has determined, based on historical data regarding price changes and to achieve revenue neutrality, it is appropriate to apply, and the Board so orders, forward averaging corrections of: Gasoline: plus 0.5¢ per litre Ultra-low-sulfur diesel oil: minus 0.9¢ per litre And

whereas a winter blending adjustment of plus 1.7¢ per litre is required for ultra-low-sulfur diesel oil; And

now therefore the Board prescribes the prices for petroleum products as set forth in

Schedule “A” effective on and after 12:01 a.m., March 22, 2013. 296 © NS Registry of Regulations. Web version.

N.S. Reg. 57/2013 Royal Gazette

Part II - Regulations Vol. 37, No. 7 Dated at Halifax, Nova Scotia, this 21st day of March, 2013. Sgd: Elaine Wagner Clerk of the Board

Schedule “A” Prices Prescribed for Petroleum Products under the Petroleum Products Pricing Act and the Petroleum Products Pricing Regulations effective on and after 12:01 a.m. on March 22, 2013 Nova Scotia Petroleum Price

Schedule Petroleum Prices in Cents/Litre Self-Service Pump Prices Full-Service Pump Prices (Pump Prices includes 15% HST) Base Wholesale Price Fed. Excise Tax Prov.

Tax Wholesale Selling Price Min Max Min Max Zone 1 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 87.3 90.3 93.3 88.2 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 112.8 115.8 118.8 107.6 135.2 138.7 142.1 129.3 137.3 140.8 144.2 131.3 135.2 138.7 142.1 129.3 999.9 999.9 999.9 999.9 Zone 2 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 87.8 90.8 93.8 88.7 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 113.3 116.3 119.3 108.1 135.8 139.3 142.7 129.8 137.9 141.3 144.8 131.9 135.8 139.3 142.7 129.8 999.9 999.9 999.9 999.9 Zone 3 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 88.2 91.2 94.2 89.1 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 113.7 116.7 119.7 108.5 136.3 139.7 143.2 130.3 138.3 141.8 145.2 132.4 136.3 139.7 143.2 130.3 999.9 999.9 999.9 999.9 Zone 4 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 88.3 91.3 94.3 89.2 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 113.8 116.8 119.8 108.6 136.4 139.8 143.3 130.4 138.5 141.9 145.4 132.5 136.4 139.8 143.3 130.4 999.9 999.9 999.9 999.9 Zone 5 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 88.3 91.3 94.3 89.2 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 113.8 116.8 119.8 108.6 136.4 139.8 143.3 130.4 138.5 141.9 145.4 132.5 136.4 139.8 143.3 130.4 999.9 999.9 999.9 999.9 Zone 6 Regular Unleaded Mid-Grade Unleaded Premium Unleaded Ultra-Low-Sulfur Diesel 89.0 92.0 95.0 89.9 10.0 10.0 10.0 4.0 15.5 15.5 15.5 15.4 114.5 117.5 120.5 109.3 137.2 140.6 144.1 131.2 139.3 142.7 146.2 133.3 137.2 140.6 144.1 131.2 999.9 999.9 999.9 999.9 © NS Registry of Regulations.

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N.S. Reg. 58/2013 Royal Gazette

Part II - Regulations Vol. 37, No. 7 N.S. Reg. 58/2013 Made: March 26, 2013 Filed: March 26, 2013 Proclamation, S. 3, S.N.S. 2012, c. 19 Order in Council 2013-77 dated March 26, 2013 Proclamation made by the Governor in Council pursuant to

Section 3 of

An Act to Amend

Chapter 92 of the Revised Statutes, 1989, the Consumer Protection Act, to Ensure Fairness in Cellular Telephone Contracts The Governor in Council on the report and recommendation of the Minister of Service Nova Scotia and Municipal Relations dated March 6, 2013, and pursuant to

Section 3 of

Chapter 19 of the Acts of 2012,

An Act to Amend

Chapter 92 of the Revised Statutes, 1989, the Consumer Protection Act, to Ensure Fairness in Cellular Telephone Contracts, and subsection 3(7) of

Chapter 235 of the Revised Statutes, 1989, the

Interpretation Act, is pleased to order and declare by proclamation that subsection 25N(4) of the Consumer Protection Act, as enacted by

Section 1 of

Chapter 19 of the Acts of 2012,

An Act to Amend

Chapter 92 of the Revised Statutes, 1989, the Consumer Protection Act, to Ensure Fairness in Cellular Telephone Contracts, do come into force on and not before May 1, 2013. PROVINCE OF NOVA SCOTIA sgd: J. J. Grant G/S ELIZABETH THE SECOND, by the Grace of God, of the United Kingdom, Canada and Her Other Realms and Territories, Queen, Head of the Commonwealth, Defender of the Faith. TO ALL TO WHOM THESE PRESENTS SHALL COME, OR WHOM THE SAME MAY IN ANY WISE CONCERN, G R E E T I N G: A PROCLAMATION

WHEREAS in and by

Section 3 of

Chapter 19 of the Acts of 2012,

An Act to Amend

Chapter 92 of the Revised Statutes, 1989, the Consumer Protection Act, to Ensure Fairness in Cellular Telephone Contracts, it is enacted as follows: 3 This Act comes into force on such day as the Governor in Council orders and declares by proclamation. AND

WHEREAS it is deemed expedient that subsection 25N(4) of the Consumer Protection Act, as enacted by

Section 1 of

Chapter 19 of the Acts of 2012,

An Act to Amend

Chapter 92 of the Revised Statutes, 1989, the Consumer Protection Act, to Ensure Fairness in Cellular Telephone Contracts, do come into force on and not before May 1, 2013; NOW KNOW YE THAT WE, by and with the advice of the Executive Council of Nova Scotia, do by this Our Proclamation order and declare that subsection 25N(4) of the Consumer Protection Act, as enacted by

Section 1 of

Chapter 19 of the Acts of 2012,

An Act to Amend

Chapter 92 of the Revised Statutes, 1989, the Consumer Protection Act, to Ensure Fairness in Cellular Telephone Contracts, do come into force on and not before May 1, 2013, of which all persons concerned are to take notice and govern themselves accordingly. 298 © NS Registry of Regulations. Web version.

N.S. Reg. 58/2013 - 59/2013 Royal Gazette

Part II - Regulations Vol. 37, No. 7 IN TESTIMONY WHEREOF We have caused these our Letters to be made Patent and the Great Seal of Nova Scotia to be hereunto affixed. WITNESS, Our Trusty and Well Beloved His Honour Brigadier-General, the Honourable J. J. Grant (Retired), Lieutenant Governor of the Province of Nova Scotia. AT Our Government House in the Halifax Regional Municipality, this 26th day of March in the year of Our Lord two thousand and thirteen and in the sixty-second year of Our Reign. BY COMMAND: sgd: Ross Landry Provincial Secretary Minister of Justice and Attorney General N.S.

Reg. 59/2013 Made: March 26, 2013 Filed: March 26, 2013 Cellular Telephone Contracts Regulations Order in Council 2013-78 dated March 26, 2013 Amendment to regulations made by the Governor in Council pursuant to

Section 25AO of the Consumer Protection Act The Governor in Council on the report and recommendation of the Minister of Service Nova Scotia and Municipal Relations, dated March 6, 2013, and pursuant to

Section 25AO of

Chapter 92 of the Revised Statutes of Nova Scotia, 1989, the Consumer Protection Act, is pleased to amend the Cellular Telephone Contracts Regulations, N.S. Reg. 36/2013, made by the Governor in Council by Order in Council 2013-44 dated February 15, 2013, to add provisions respecting the requirement that cell phone suppliers provide customers with educational materials about responsible cellular telephone use, in the manner set forth in

Schedule “A” attached to and forming part of the report and recommendation, effective on and after May 1, 2013.

Schedule “A” Amendment to the Cellular Telephone Contracts Regulations made by the Governor in Council under

Section 25AO of

Chapter 92 of the Revised Statutes of Nova Scotia, 1989, the Consumer Protection Act The Cellular Telephone Contracts Regulations, N.S. Reg. 36/2013, made by the Governor in Council by Order in Council 2013-44 dated February 15, 2013, are amended by adding the following centred heading and

Section immediately after

Section 14: © NS Registry of Regulations. Web version. 299

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Part II - Regulations Vol. 37, No. 7 Educational Materials Educational materials to be provided to customer 15

(1) The educational materials provided by a supplier to each customer under subsection 25N(4) of the Act must be the educational materials developed by the Province.

(2) A copy of the required educational materials may be obtained from the Registrar of Credit. N.S. Reg. 60/2013 Made: March 26, 2013 Filed: March 26, 2013 Governor in Council Education Act Regulations Order in Council 2013-82 dated March 26, 2013 Amendment to regulations made by the Governor in Council pursuant to

Section 146 of the Education Act The Governor in Council on the report and recommendation of the Minister of Education dated February 20, 2013, and pursuant to

Section 146 of

Chapter 1 of the Acts of 1995-96, the Education Act, is pleased to amend the Governor in Council Education Act Regulations, N.S. Reg. 74/97, made by the Governor in Council by Order in Council 97-405 dated June 24, 1997, to provide for how the Minister may determine grants to school boards and to provide for the rate for the minimum municipal contribution commencing the 2012-2013 fiscal year, in the manner set forth in

Schedule “A” attached to and forming part of the report and recommendation, effective on and after April 1, 2012.

Schedule “A” Amendment to the Governor in Council Education Act Regulations made by the Governor in Council pursuant to

Section 146 of

Chapter 1 of the Acts of 1995-96, the Education Act 1 The Governor in Council Education Act Regulations, N.S. Reg.74/97, made by the Governor in Council by Order in Council 97-405 dated June 24, 2007 [1997], are amended by repealing

Section 8 and substituting the following Sections: Grants to school boards 8( 1 ) In this

Section and Sections 8A to 8D, (a) “eligible student” for a funding year means a student who meets all of the following criteria: (

i) they are enrolled in a public school on September 30 of the year immediately preceding the funding year, (ii) they attended school at least 50% of the time that the school was open for students to attend during the months of September and October of the year immediately preceding the funding year, 300 © NS Registry of Regulations. Web version.

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Part II - Regulations Vol. 37, No. 7 (iii) they are within the age range establis hed for the right to attend public school set out in subsection 5(2) of the Act, (iv) a school board does not receive funding from a source other than the Province or a municipality for them; (b) “funded enrolment” for a funding year means the total number of eligible students at all levels in the schools of a school board; (c) “funding year” means the 2012-2013 school board fiscal year and each fiscal year thereafter for which the Minister’s grants are being determined; (d) “textbook credit allocation” means the amount of credit with the Nova Scotia School Book Bureau assigned by the Minister to a school board in accordance with

Section 13 of the Ministerial Education Act Regulations made under the Act.

(2) Despite clauses (1)(

a) and (b), a school board may include a student who does not meet the criteria in subclause (1)(a)(iv) as an eligible student for a funding year, if written permission to do so is received from the Minister.

(3) The grants made by the Minister to school boards under

Section 72 of the Act are as determined by (

a) formula funding grants, as provided for in

Section 8A; (

b) transitional adjustments, as provided for in

Section 8B; and (

c) specific purpose grants, as provided for in

Section 8C.

(4) The Minister’s grants to school boards must be paid by instalments as determined by the Minister. Formula funding grants 8A In determining the formula funding grant for each school board, the Minister must use a methodology that incorporates the funded enrolment of the school board and all of the following factors: (

a) the requirements for delivering the public school program; (

b) the need for special education; (

c) the financial impact of changes in the funded enrolment; (

d) the financial impact related to the to tal number of eligible students at a school; (

e) the provision of student transportation; (

f) the provision of property services; (

g) the provision of school management; (

h) the provision of school board management; © NS Registry of Regulations. Web version. 301

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Part II - Regulations Vol. 37, No. 7 (

i) the provision for school board governance; (

j) the textbook credit allocation. Transitional adjustment 8B After the methodology for the funding formula grant is determined under

Section 8A for the funding year, the Minister may make a transitional adjustment to a school board’s funding formula grant taking into account all of the following factors: (

a) changes in the funded enrolment; (

b) the Minister’s assessment of the ability of th e school board to adjust to changes in the amount of the formula funding grant from the preceding funding year. Specific purpose grants 8C In determining the specific purpose grants for each school board for the funding year the Minister must take into account provincial initiatives to support students including provincial initiatives for student services and property maintenance.

Rate to be used to determine minimum municipal contribution 8D The rate to be used to determine the minimum municipal contribution for a school board effective April 1, 2012, is $0.3048 per $100 of the uniform assessment of the municipalities served by the school board, as determined under the Municipal Grants Act and

Section 73 of the Act. 2 The regulations are further amended by repealing

Schedule “A” to the regulations. N.S. Reg. 61/2013 Made: March 26, 2013 Filed: March 26, 2013 Health Research Foundation Regulations Order in Council 2013-84 dated March 26, 2013 Amendment to regulations made by the Governor in Council pursuant to

Section 21 of the Health Research Foundation Act The Governor in Council on the report and recommendation of the Minister of Health and Wellness dated February 22, 2013, and pursuant to

Section 21 of

Chapter 14 of the Acts of 1998, the Health Research Foundation Act, is pleased to amend the Health Research Foundation Regulations, N.S. Reg. 7/2000, made by the Governor in Council by Order in Council 1999-667 dated December 31, 1999, to change the required accounting practices of the Foundation, in the manner set forth in

Schedule “A” attached to and forming part of the report and recommendation, effective on and after March 31, 2013. 302 © NS Registry of Regulations. Web version.

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Part II - Regulations Vol. 37, No. 7

Schedule “A” Amendment to the Health Research Foundation Regulations made by the Governor in Council under

Section 21 of

Chapter 14 of the Acts of 1998, the Health Research Foundation Act Subsection 5(2) of the Health Research Foundation Regulations, N.S. Reg. 7/2000, made by the Governor in Council by Order in Council 1999-667 dated December 31, 1999, is repealed and the following subsection substituted:

(2) The Board shall prepare the financial statements of the Foundation required pursuant to subsection 17(1) of the Act in accordance with the accounting policies and procedures for not-for-profit organizations prescribed by the Minister of Finance under subsection 70(3) of the Finance Act. N.S. Reg. 62/2013 Made: March 26, 2013 Filed: March 26, 2013 Insured Dental Services Tariff Regulations Order in Council 2013-85 dated March 26, 2013 Repeal and replacement of regulations made by the Governor in Council and the Minister of Health and Wellness pursuant to clause 13(1)(

c) and subsection 17(2) of the Health Services and Insurance Act The Governor in Council on the report and recommendation of the Minister of Health and Wellness dated February 26, 2013, and pursuant to

Section 8, clause 13(1)(

c) and subsection 17(2) of

Chapter 197 of the Revised Statutes of Nova Scotia, 1989, the Health Services and Insurance Act, is pleased, effective on and after March 31, 2013, to (

a) pursuant to subsection 17(2) of the Act, (

i) repeal the Insured Dental Services Tariff Regulations, N.S. Reg. 87/2001, made by the Minister of Health and the Governor in Council by Order in Council 2001-327 dated July 5, 2001, and (ii) make new regulations respecting the dental services tariff, in accordance with the new dental services tariff established by the Minister of Health and Wellness pursuant to clause 13(1)(

c) of the Act, in the form set forth in

Schedule “A” attached to and forming part of the report and recommendation; (

b) in accordance with clause 13(1)(

c) of the Act, approve the authorization by the Minister of Health of Health and Wellness of payments in respect of (

i) the tariff amounts referred to in subclause (a)(ii), and (ii) a one-time payment of $143,100.00 to be divi ded among participating dentists for services performed in accordance with the Insured Dental Services Tariff Regulations during the period from April 1, 2011, to March 30, 2013; and [Clause (

b) not filed as a regulation.] © NS Registry of Regulations. Web version. 303

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c) in accordance with

Section 8 of the Act, give approval to the Minister of Health and Wellness to enter into an agreement set out in Appendix “A” attached to and forming part of the report and recommendation, or a form of agreement to like form and effect, with the Nova Scotia Dental Association dealing with the insured dental services tariff. [Clause (

c) not filed as a regulation.] Order In the matter of the replacement of the Insured Dental Services Tariff Regulations, N.S. Reg. 87/2001, made pursuant to clause 13(1)(

c) and subsection 17(2) of the Health Services Insurance Act - and - In the matter of an increase to the tariff of fees established by the Minister of Health and Wellness pursuant to clause 13(1)(

c) of the Health Services Insurance Act with respect to dental services I, David Wilson, Minister of Health and Wellness for the Province of Nova Scotia, pursuant to clause 13(1)(

c) of

Chapter 197 of the Revised Statutes of Nova Scotia, 1989, the Health Services and Insurance Act, hereby repeal the tariff of fees for insured dental services as established in the Insured Dental Services Tariff Regulations, N.S. Reg. 87/2001, made by Order in Council 2001-327 dated July 5, 2001, and establish a new tariff of fees for insured dental services as set out in the attached regulations, and I authorize payments in respect of the tariff.

This Order comes into effect on and after the making by the Governor in Council of new regulations respecting the tariff for insured dental services as set out in this Schedule. Dated and made at Halifax, Province of Nova Scotia, February 26th, 2013. Sgd.: David Wilson Honourable David Wilson Minister of Health and Wellness

Schedule “A” Regulations Respecting the Tariff for Insured Dental Services made by the Minister of Health and Wellness and the Governor in Council under

Section 13 and subsection 17(2) of

Chapter 197 of the Revised Statutes of Nova Scotia, 1989, the Health Services and Insurance Act Citation 1 These regulations may be cited as the Insured Dental Services Tariff Regulations. Insured dental services tariff 2 The tariff of fees for insured dental services is as set out in the following schedules: (

a) Schedule A: Cleft Palate/Craniofacial Program; 304 © NS Registry of Regulations. Web version.

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Part II - Regulations Vol. 37, No. 7 (

b) Schedule B: Children’s Oral Health Program; (

c) Schedule C: Dental Surgical Program; (

d) Schedule D: Maxillofacial Prosthodontics Program; and (

e) Schedule E: Mentally Challenged Program. Limited coverage under Cleft Palate/Craniofacial Program, Children’s Oral Health Program and Mentally Challenged Program 3( 1 ) No amount is payable for any of the following services if rendered to a resident to whom or for whom a benefit in respect of those services has been paid or would be payable if claimed under any contract or plan of insurance that applies to that resident: (

a) services listed in

Schedule A: Cleft Palate/C raniofacial Program that are rendered under the Children’s Oral Health Program; (

b) services listed in

Schedule B: Children’s Oral Health Program; (

c) services listed in

Schedule E: Mentally Challenged Program.

(2) For further clarification, if a partial benefit for a service referred to in subsection (1) has been paid or would be payable if claimed under any contract or plan of insurance that applies to that resident, any outstanding costs are billable directly to the Province and are payable by the Province. Tariff of Fees for Insured Dental Services

Schedule A: Cleft Palate/Craniofacial Program The Cleft Palate/Craniofacial Program provides insured services for residents (as defined in the MSI Regulations) with craniofacial anomalies that directly influence the growth and development of the dentoalveolar and craniofacial structures. From birth to age 10, these residents are eligible for insured coverage for basic dental services through the Children’s Oral Health Program (Schedule

B) and other services under this

Schedule as considered necessary as a result of the anomaly. From age 10 to 23, additional services are insured under this

Schedule on a pre-authorization basis depending on the treatment required. Specifically, treatment made necessary as a result of the anomaly is considered for coverage. There is no coverage for re-treatment under this program. Additional funding is considered only under extenuating circumstances, if the Department’s Cleft Palate/Craniofacial Team determines that a condition requiring re-treatment has resulted directly from the progression of the congenital or developmental craniofacial anomaly. There is no coverage for a service listed in this

Schedule that is performed outside of the Province. © NS Registry of Regulations. Web version. 305

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Part II - Regulations Vol. 37, No. 7 Fee Code G.P. Fee ($) Specialist Fee ($)

Part 1: Diagnostic—01000–09999 Examinations 1 Examinations and diagnosis, complete oral, including: - History, medical and dental - Clinical examination and diagnosis of hard and soft tissues, including carious lesions, missing teeth, determination of pocket depth and location of periodontal pockets, gingival contours, mobility of teeth, interproximal tooth contact relationships, occlusion of teeth, pulp vitality tests, if necessary, and any other pertinent factors. - Radiographs extra, as required 01101 Examination and diagnosis, complete, primary dentition, including extended examination and diagnosis on primary dentition, recording history, charting, treatment planning and case presentation, including above description ................................... 39.00 50.37 This service (01101) is allowed once in a patient’s lifetime, when continuity of treatment is maintained.

If there is a gap in treatment of 2 years or more, a further complete oral examination is warranted and is covered under the Plan.

A complete oral examination performed by another dentist is permitted under the Plan, unless performed by a dentist who is established in a group practice with the dentist who performed the first examination. (A group practice in this case means a mode of practice in which patient records are available to all dentists in the group.) If a patient has been referred to a specialist in the same group practice, complete oral examinations by both the dentist and dental specialist are allowed. 01102 Examination and diagnosis, comp lete, mixed dentition, including extended examination and diagnosis on mixed dentition, recording history, charting, treatment planning and case presentation, including above description, and eruption sequence, tooth size–jaw size assessment ................................................ 39.00 50.37 01103 Examination and diagnosis, complete, permanent dentition, including extended examination and diagnosis on permanent dentition, recording history, charting, treatment planning and case presentation, including above description ........................................ 65.45 73.04 2 Examinations and diagnosis, limited oral 01201 Examination and diagnosis, limited, oral, new patient: examination with mirror and explorer of hard and soft tissues, including checking occlusion and appliances, but not including specific tests as for 01100 ............................................. 28.91 35.49 306 © NS Registry of Regulations.

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Part II - Regulations Vol. 37, No. 7 01202 Examination and diagnosis, limited oral, previous patient (recall): examination and diagnosis with mirror and explorer of hard and soft tissues, including checking occlusion and appliances, but not including specific tests, as for 01100 .................................................. 22.08 27.97 MSI: This service (01202) is allowed after a 335-day period has elapsed from the previous complete or recall examination.

A recall is accepted if rendered more than 335 days following the complete or previous recall examination, but is rejected if the service is rendered any time within the 335 days. If procedures or treatment services are provided during the same appointment, the fees for both the examination and the procedure(

s) or treatment service(

s) are allowed. 01204 Examination and diagnosis, specific: examination, diagnosis and evaluation of a specific situation in a localized area (MSI: includes x-rays) .................................. 34.51 46.94 01205 Examination and diagnosis, emergency: examination to investigate discomfort and/or infection in a localized area (MSI: includes x-rays) .................................. 34.51 46.94 The fee for either a specific (01204) or emergency (01205) oral examination applies only when no treatment is rendered during the appointment.

If a procedure or treatment service is also provided, only the fee for the procedure or treatment service is allowed (unless otherwise specified). 05201 Consultation, MSI—specialist—in office ................................................... NA 77.91 05202 Two units of time .......................................................................................... NA 148.00 05209 Each additional unit of time ......................................................................... NA 74.00 Radiographs (including radiographic examination and

interpretation) The fees are intended to include both the technical and professional components of an x-ray service; however, non-readable films are not insured. Procedural x-rays in connection with root canal therapy are not allowed separately as the fees for root canal therapy include procedural x-rays.

The Plan requires that an x-ray be made available on request and be retained for that purpose for at least 18 months following the date it was taken. 1 Radiographs, intra-oral 02101 Radiographs, intra-oral, pedodontic, complete series (minimum of 12 films including bitewings) .............................................. 99.97 101.97 02102 Radiographs, intra-oral, adult, complete series (minimum of 16 films including bitewings) .............................................. 99.97 101.97 2 Radiographs, intra-oral, periapical 02111 Single film ................................................................................................. 12.26 12.51 02112 2 films ........................................................................................................ 16.10 16.42 02113 3 films ........................................................................................................ 23.68 24.15 02114 4 films ........................................................................................................ 28.29 28.86 02115 5 films ........................................................................................................ 32.89 33.55 © NS Registry of Regulations.

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Part II - Regulations Vol. 37, No. 7 02116 6 films ........................................................................................................ 37.63 38.38 02117 7 films ........................................................................................................ 42.16 43.00 02118 8 films ........................................................................................................ 46.84 47.78 02119 9 films ........................................................................................................ 51.44 52.47 02120 10 films ...................................................................................................... 56.12 57.24 02121 11 films ...................................................................................................... 61.17 62.39 02122 12 films ...................................................................................................... 66.65 67.98 02123 13 films ...................................................................................................... 72.66 74.11 02124 14 films ...................................................................................................... 79.19 80.77 02125 15 films ...................................................................................................... 83.93 85.61 3 Radiographs, intra-oral, occlusal 02131 Single film ................................................................................................. 29.97 30.57 02132 2 films ........................................................................................................ 46.84 47.78 02133 3 films ........................................................................................................ 63.70 58.00 02134 4 films ........................................................................................................ 80.50 70.00 4 Radiographs, intra-oral, bitewing 02141 Single film ................................................................................................. 12.26 12.51 02142 2 films ........................................................................................................ 16.10 16.42 02143 3 films ........................................................................................................ 23.68 24.15 02144 4 films ........................................................................................................ 28.29 28.86 5 Radiographs, extra-oral 02201 Single film ................................................................................................. 29.97 30.57 02202 2 films ........................................................................................................ 46.84 47.78 02203 3 films ........................................................................................................ 63.70 64.97 02204 4 films ........................................................................................................ 80.50 82.11 6 Radiographs, postero-anterior and lateral skull and facial bone 02301 Single film .....................................................................................................

PA 30.57 02302 2 films ............................................................................................................ PA 47.78 02303 3 films ............................................................................................................ PA 64.97 02304 Sinus examination: minimum 4 films identified as:

(1) Waters

(2) Calwell

(3) Lateral Skull

(4) Basal .................................. PA 82.11 7 Radiographs, sialography 02401 Single film ..................................................................................................... PA PA 02402 2 films ............................................................................................................ PA PA 02409 Each additional film over 2 ........................................................................... PA PA 8 Radiopaque dyes, use of, to demonstrate lesions 02411 1 unit of time .................................................................................................

PA PA 02412 2 units of time ................................................................................................ PA PA 02419 Each additional unit of time over 2 ............................................................... PA PA 9 Radiographs, temporomandibular joint 02501 Single film ..................................................................................................... PA 30.57 02502 2 films ............................................................................................................

PA 47.78 02503 3 films ............................................................................................................ PA 64.97 02504 4 films (minimum examination closed and open each side) .......................... PA 82.11 02509 Each additional film over 4 ........................................................................... PA PA 308 © NS Registry of Regulations. Web version.

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Part II - Regulations Vol. 37, No. 7 10 Radiographs, panoramic 02601 Single film ................................................................................................. 51.51 52.54 11 Radiographs, cephalometric 02701 Single film ................................................................................................. 51.51 52.54 02702 2 films ........................................................................................................ 83.87 85.55 12 Radiographs, cephalometric, tracing and

interpretation 02751 1 unit of time ................................................................................................. PA PA 02752 2 units of time ................................................................................................ PA PA 02759 Each additional unit of time over 2 ............................................................... PA PA 13 Radiographs,

interpretation (MSI: for radiographs exposed on hospital equipment) 02801 MSI: paid at 1/2 regular fee 14 Radiographs, hand and wrist 02921 Radiographs, hand and wrist (as a duplicate aid for dental treatment) per case ......................................................................................... PA PA 15 Radiographs, tomography 02931 Single view .................................................................................................... PA PA 02932 2 views ...........................................................................................................

PA PA 02933 3 views ........................................................................................................... PA PA 02934 4 views ........................................................................................................... PA PA 02939 Each additional view over 4 ..........................................................................

PA PA Tests and Laboratory Examinations Pulp vitality tests (general and specific) are intended to be included in the fee for an initial examination; therefore, no additional allowance is made for these tests when performed in conjunction with an initial examination. Applicable fees for all tests and laboratory examinations, other than pulp vitality tests (general and specific), are payable in addition to the fee for an initial examination.

The Plan requires that a diagnostic cast be made available on request and be retained for that purpose for at least 18 months following the date it was taken 1 Tests, microbiological 04101 Microbiological test for the determination of pathological agents + L ............................................................................. 30.97 31.59 2 Tests, caries susceptibility 04201 Bacteriological test for the determination of dental caries susceptibility + L ....................................................................................... 30.29 30.90 3 Tests, histological Test, histological, soft tissue 04311 Biopsy, soft oral tissue—by puncture + L ................................................. 72.36 73.81 04312 Biopsy, soft oral tissue—by incision + L .................................................. 72.36 73.81 04313 Biopsy, soft oral tissue—by aspiration + L ............................................... 72.36 73.81 © NS Registry of Regulations.

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Part II - Regulations Vol. 37, No. 7 Tests, histological, hard tissue 04321 Biopsy, hard oral tissue—by puncture + L ................................................ 83.33 85.00 04322 Biopsy, hard oral tissue—by incision + L ................................................. 83.33 85.00 04323 Biopsy, hard oral tissue—by aspiration + L .............................................. 83.33 85.00 4 Tests, cytological 04401 Cytological smear from the oral cavity + L ............................................... 30.29 30.90 5 Tests, pulp vitality 04501 1 unit of time ............................................................................................. 25.61 26.12 04509 Each additional unit of time ...................................................................... 25.61 26.12 6 Reports, laboratory 04601 Report, microbiological by oral microbiologist ............................................

PA PA 04602 Report, histological by oral pathologist ......................................................... PA PA 04603 Report, cytological by oral pathologist ......................................................... PA PA 04604 Reports, other ................................................................................................

PA PA 7 Tests and laboratory examinations, miscellaneous (All available by preauthorization) Equilibration, casts, diagnostic (pilot equilibration) for extensive or complicated restorative dentistry + L 04711 1 unit of time ................................................................................................. PA PA 04712 2 units of time ................................................................................................ PA PA 04713 3 units of time ................................................................................................

PA PA 04714 4 units of time ................................................................................................ PA PA 04719 Each additional unit of time over 4 ............................................................... PA PA Wax-up, diagnostic (to evaluate cosmetic and/or preparation design and/or occlusal considerations) (gnathological wax-up) + L 04721 1 unit of time ................................................................................................. PA PA 04722 2 units of time ................................................................................................

PA PA 04723 3 units of time ................................................................................................ PA PA 04724 4 units of time ................................................................................................ PA PA 04729 Each additional unit of time over 4 ............................................................... PA PA Split cast mounting, diagnostic + L 04731 1 unit of time .................................................................................................

PA PA 04732 2 units of time ................................................................................................ PA PA 04733 3 units of time ................................................................................................ PA PA 04734 4 units of time ................................................................................................ PA PA 04739 Each additional unit of time over 4 ............................................................... PA PA

Interpretation of models from another source 04741 First unit of time ............................................................................................ PA PA 04749 Each additional unit of time ..........................................................................

PA PA Photographs, Diagnostic 04801 Single photograph ...................................................................................... 15.88 16.20 04802 2 photographs ............................................................................................ 31.74 32.00 04803 3 photographs ............................................................................................ 47.63 37.00 04809 Each additional photograph over 3 ............................................................ 15.88 7.00 310 © NS Registry of Regulations. Web version.

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Part II - Regulations Vol. 37, No. 7 Casts, Diagnostic 1 Cast, diagnostic, unmounted 04911 Cast, diagnostic, unmounted + L ............................................................... 30.97 43.45 04912 Cast, diagnostic, unmounted, duplicate + L ..................................................

PA PA 2 Cast, diagnostic, mounted 04921 Cast, diagnostic, mounted + L ................................................................... 39.00 PA 04922 Cast, diagnostic, mounted using face bow transfer + L ............................. 64.00 PA 04923 Cast, diagnostic, mounted, using face bow + occlusal records + L ........... 87.14 PA 04924 Cast, diagnostic, mounted using fully adjustable articulator + L (used with 04942) .........................................................................................

PA PA 3 Casts, diagnostic, orthodontic 04931 Cast, diagnostic, orthodontic (unmounted, angle trimmed and soaped) + L ............................................................................................. PA 43.45

Part 2: Endodontics—30000–39999 Pulp Chamber, Treatment of (excluding final restoration) 1 Pulpotomy Pulpotomy vital, permanent teeth (as a separate emergency procedure) 32221 Anterior and bicuspid teeth ....................................................................... 71.74 87.74 32222 Molar teeth ................................................................................................. 71.74 87.74 Pulpotomy, vital, primary teeth 32231 Primary tooth as a separate procedure ...................................................... 57.66 73.12 32232 Primary tooth, concurrent with restorations (but excluding final restoration) ........................................................................ 57.66 71.69 2 Pulpectomy (as a separate emergency procedure) Pulpectomy, permanent teeth/retained primary teeth 32311 1 canal ........................................................................................................ 82.64 84.29 32312 2 canals .................................................................................................... 128.02 130.58 32313 3 canals ..........................................................................................................

PA PA 32314 4 canals or more .............................................................................................

PA PA Pulpectomy, primary teeth 32321 Anterior tooth ............................................................................................ 75.00 84.29 32322 Posterior tooth ......................................................................................... 111.00 122.35 Root Canal Therapy Includes treatment plan, clinical procedures (e.g., pulpectomy, biomechanical preparation, chemotherapeutic treatment and obturation), with appropriate radiographs and follow-up care, excluding final restoration. 1 Root canals, permanent teeth, retained primary teeth (including clinical procedures with appropriate radiographs, excluding final restoration) 33111 1 canal ...................................................................................................... 326.42 399.57 33121 2 canals .................................................................................................... 478.12 575.33 © NS Registry of Regulations.

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Part II - Regulations Vol. 37, No. 7 33131 3 canals .................................................................................................... 642.19 785.99 33141 4 or more canals ....................................................................................... 797.28 941.32 2 Root canals, primary teeth 33401 1 canal ...................................................................................................... 123.10 157.87 33402 2 canals .................................................................................................... 169.22 209.18 33403 3 canals or more ....................................................................................... 226.69 280.29 3 Apexification/apical closure/induction of hard tissue repair (including biomechanical preparation and placement of dentogenic media) 33601 1 canal ...................................................................................................... 124.33 152.16 33602 2 canals .................................................................................................... 164.62 219.58 33603 3 canals .................................................................................................... 209.65 287.93 33604 4 canals or more ....................................................................................... 376.64 433.93 4 Re-insertion of dentogenic media per visit 33611 1 canal ........................................................................................................ 55.42 65.32 33612 2 canals ...................................................................................................... 55.42 65.32 33613 3 canals ...................................................................................................... 55.42 65.32 33614 4 canals or more ......................................................................................... 55.42 65.32 Periapacal Services 1 Apicoectomy/apical curettage Maxillary anterior 34111 1 root ........................................................................................................ 170.50 208.72 34112 2 roots ...................................................................................................... 243.61 284.03 Maxillary bicuspid 34121 1 root ........................................................................................................ 228.00 296.42 34122 2 roots ...................................................................................................... 303.00 353.90 34123 3 roots or more ......................................................................................... 379.00 411.24 Maxillary molar 34131 1 root ........................................................................................................ 242.26 296.42 34132 2 roots ...................................................................................................... 320.61 353.90 34133 3 roots ...................................................................................................... 382.63 431.81 34134 4 or more roots ......................................................................................... 430.83 459.78 Mandibular anterior 34141 1 root ........................................................................................................ 170.50 208.72 34142 2 or more roots ......................................................................................... 243.61 270.50 Mandibular bicuspid 34151 1 root ........................................................................................................ 229.00 296.42 34152 2 roots ...................................................................................................... 303.00 353.90 34153 3 or more roots ......................................................................................... 381.00 411.24 Mandibular molar 34161 1 root ........................................................................................................ 242.26 296.42 34162 2 roots ...................................................................................................... 320.61 353.90 34163 3 roots ...................................................................................................... 382.63 411.24 34164 4 or more roots ......................................................................................... 430.83 459.78 312 © NS Registry of Regulations.

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Part II - Regulations Vol. 37, No. 7 2 Retrofilling Maxillary anterior 34211 1 canal ........................................................................................................ 67.78 82.96 34212 2 or more canals ......................................................................................... 82.13 103.43 Maxillary bicuspid 34221 1 canal ........................................................................................................ 67.78 82.96 34222 2 canals ...................................................................................................... 82.13 103.43 34223 3 canals ...................................................................................................... 99.37 129.30 34224 4 or more canals ....................................................................................... 111.40 145.44 Maxillary molar 34231 1 canal ........................................................................................................ 69.73 82.96 34232 2 canals ...................................................................................................... 86.06 103.43 34233 3 canals ...................................................................................................... 99.37 135.76 34234 4 or more canals ....................................................................................... 111.40 145.44 Mandibular anterior 34241 1 canal ........................................................................................................ 67.78 82.96 34242 2 or more canals ......................................................................................... 82.13 103.43 Mandibular bicuspid 34251 1 canal ........................................................................................................ 67.78 82.96 34252 2 canals ...................................................................................................... 82.13 103.43 34253 3 canals ...................................................................................................... 99.37 129.30 34254 4 canals .................................................................................................... 111.40 145.44 Mandibular molar 34261 1 canal ........................................................................................................ 69.73 82.96 34262 2 canals ...................................................................................................... 86.06 103.43 34263 3 canals ...................................................................................................... 99.37 129.30 34264 4 or more canals ....................................................................................... 111.40 145.44 3 Enlargement, canal and/or pulp chamber (preparation of post space) 34601 In previously filled tooth when root canal treatment done by another practitioner ..........................................................................

PA PA 34602 In calcified canals ..........................................................................................

PA PA Endodontic, Procedures, Miscellaneous 1 Isolation of endodontic tooth/teeth for asepsis 39101 Banding of tooth/teeth and/or contouring of tissue surrounding teeth to maintain aseptic operating field (per tooth) .................................. 82.33 100.69 Open and drain (separate emergency procedures) 39201 Anteriors and bicuspids ............................................................................. 66.00 71.47 39202 Molars ........................................................................................................ 66.00 71.47 Opening through artificial crown (in addition to procedures) 39211 Anterior and bicuspids ............................................................................... 81.57 83.20 39212 Molars ........................................................................................................ 81.57 83.20 © NS Registry of Regulations.

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Part II - Regulations Vol. 37, No. 7 2 Bleaching, non vital Bleaching endodontically treated tooth/teeth 39311 1 unit of time ............................................................................................ 53.81 54.89 39312 2 units of time ............................................................................................ 92.62 94.47 39313 3 units of time .......................................................................................... 131.41 134.04 39319 Each additional unit of time over 1 (MSI: to a maximum of 3) ................ 38.79 39.57

Part 3: Oral and Maxillofacial Surgery—70000–79999 Certain procedures included in this Part are also contained in the list of MSI dental surgical procedures (Schedule C: Dental Surgical Program) covering all eligible residents of the Province. These services continue as benefits of MSI and, accordingly, when a dental surgical procedure is performed in hospital, the claim for that service must be submitted with the fee code set out in

Schedule C. Unless otherwise specified, a bilateral procedure is paid at an additional fee equivalent to 50% of that shown for the unilateral procedure. When performed under separate anaesthetics, at an interval, the full fee is paid for each procedure. When more than 2 quadrants are involved, the first 2 procedures will both be paid at 100% and subsequent procedures at 50% each. The following surgical services include necessary local anaesthetic, removal of excess gingival tissue, suturing and 1 post-operative treatment, when required.

A surgical site is considered to include a full quadrant, sextant or group of several teeth that can be practically and conveniently combined for a single surgical sitting, or in some cases a single tooth.

Removals (Extractions), Erupted Teeth 1 Removals, erupted teeth, uncomplicated MSI: Unless directly related to a developmental anomaly (supply details with claim) uncomplicated extractions are insured only in the case of 1) pain, infection, trauma 2) ankylosis and 3) supernumerary teeth. 71101 Single tooth, uncomplicated ...................................................................... 64.70 62.76 71109 Each additional tooth, same quadrant, same appointment ......................... 43.35 33.00 2 Removals, erupted teeth, complicated 71201 Odontectomy, (extraction), erupted tooth, surgical approach, requiring surgical flap and/or sectioning of tooth ................................... 139.67 169.98 71209 Each additional tooth, same quadrant ........................................................ 85.44 85.00 Removals (Extractions), Surgical 1 Removals, impactions, soft tissue coverage Removals, impaction, requiring incision of overlying soft tissue and removal of the tooth 72111 Single tooth .............................................................................................. 139.67 169.98 72119 Each additional tooth, same quadrant ........................................................ 86.06 85.00 2 Removals, impactions, involving tissue and/or bone coverage Removals, impaction, requiring incision of overlying soft tissue, elevation of a flap and either removal of bone and tooth or sectioning and removal of tooth (partial bone impaction) 314 © NS Registry of Regulations.

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Part II - Regulations Vol. 37, No. 7 72211 Single tooth .............................................................................................. 169.22 280.09 72219 Each additional tooth, same quadrant ...................................................... 103.65 140.05 Removals, impaction, requiring incision of overlying soft tissue, elevation of a flap, removal of bone and sectioning of tooth for removal 72221 Single tooth .............................................................................................. 231.98 311.48 72229 Each additional tooth, same quadrant ...................................................... 143.86 155.75 3 Removals (extractions), residual roots Removals, residual roots, erupted 72311 First tooth .................................................................................................. 51.29 62.76 72319 Each additional tooth, same quadrant ........................................................ 33.29 31.41 Removals, residual roots, soft tissue coverage 72321 First tooth ................................................................................................. 96.13 117.67 72329 Each additional tooth, same quadrant ........................................................ 60.31 58.85 Removals, residual roots, bone tissue coverage 72331 First tooth ................................................................................................ 199.93 244.66 72339 Each additional tooth, same quadrant ...................................................... 123.76 122.33 4 Post extraction bone preservation Simple ridge preservation, alloplastic material (+ E—not payable by MSI) 72411 First tooth ......................................................................................................

PA PA 5 Surgical exposure of teeth Surgical exposure, unerupted, uncomplicated, soft tissue coverage (includes operculectomy) 72511 Single tooth .............................................................................................. 176.84 225.74 72519 Each additional tooth, same quadrant ........................................................ 88.44 112.89 Surgical exposure, complex, hard tissue coverage 72521 Single tooth .............................................................................................. 176.84 225.74 72529 Each additional tooth, same quadrant ........................................................ 88.44 112.89 Surgical exposure, unerupted tooth, with orthodontic attachment 72531 Single tooth .............................................................................................. 194.82 238.58 72539 Each additional tooth, same quadrant ........................................................ 97.39 119.28 Surgical exposure, unerupted tooth, soft tissue coverage with positioning of attached gingivae 72541 Single tooth ....................................................................................................

PA PA Surgical exposure, unerupted tooth, hard tissue coverage with positioning of attached gingivae 72551 Single tooth .................................................................................................... PA PA 6 Surgical movement of teeth Transplantation of erupted tooth 72611 First tooth ...................................................................................................... PA PA Transplantation of unerupted tooth 72621 First tooth ...................................................................................................... PA PA © NS Registry of Regulations.

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Part II - Regulations Vol. 37, No. 7 Repositioning, surgical 72631 First tooth ......................................................................................................

PA PA Surgical Incisions Surgical incision and drainage and/or exploration, intra-oral soft tissue 75111 Intra-oral, surgical exploration, soft tissue ................................................ 71.74 96.80 75112 Intra-oral, abscess, soft tissue .................................................................... 71.74 96.80 75113 Intra-oral, abscess, in major anatomical area with drain ........................... 71.74 96.80 Surgical incision and drainage and/or exploration, intra-oral hard tissue 75121 Intra-oral, abscess, hard tissue, trephination and drainage ............................

PA PA Treatment of Fractures It is understood that the majority of fractures will be treated in hospital and covered under the MSI Dental Surgical Benefit. However, independent consideration is given for fractures treated in a dental office. Explanation should be included on the claim form.

Fracture, alveolar, debridement, teeth removed Reduction, alveolar, closed, with teeth (fixation extra) Reduction, alveolar, open, with teeth (fixation extra) Replantation, avulsed tooth/teeth (including splinting) 76941 Replantation, first tooth ........................................................................... 207.31 215.35 76949 Each additional tooth ............................................................................... 105.54 107.71 Repositioning of traumatically displaced teeth 76951 1 unit of time ............................................................................................. 49.63 47.23 76952 2 units of time ............................................................................................ 99.26 94.46 76959 Each additional unit of time over 2 ........................................................... 49.63 47.23 Hemorrhage, Control of 79403 Hemorrhage control, using compression and hemostatic agent ................ 49.98 61.24 79404 Hemorrhage control, using hemo static substance and sutures (including removal of bony tissue, if necessary) ....................................... 49.98 61.24 Post-Surgical Care (Required by complications and unusual circumstances, refer to comment at beginning of

Part 3.) 79605 Post-surgical care, alveolitis, treatment of (without anaesthesia) .............. 42.32 51.93 79606 Post-surgical care, alveolitis, treatment of (with anaesthesia) ................... 42.32 51.93 Implantology (Includes placement of implant, post-surgical care, uncovering and placement of attachment but not prosthesis.) 1 Implants, endosseous, integrated cylindrical 79951 First stage surgical placement, maxilla per implant 316 © NS Registry of Regulations. Web version.

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Part II - Regulations Vol. 37, No. 7 (+ E—not payable by MSI) ........................................................................... PA PA 79952 First stage surgical placement, mandible per implant (+ E—not payable by MSI) ........................................................................... PA PA 79953 Second stage exposure and temporization, maxilla per implant (+ E—not payable by MSI) ...........................................................................

PA PA 79954 Second stage exposure and temporization, mandible per implant (+ E—not payable by MSI) ........................................................................... PA PA 2 Implants, removal of 79991 First implant (uncomplicated) ....................................................................... PA PA 79992 First implant (complicated) ........................................................................... PA PA

Part 4: Orthodontics—80000–89999 Orthodontic Services, Observations and Adjustments Recementation of fixed appliances—MSI—not including brackets 80651 1 unit of time ............................................................................................. 44.92 54.74 Appliances, Active, for Tooth Guidance or Minor Tooth Movement 1 Appliances, removable Appliances, removable, space regaining 81113 Appliance, maxillary, bilateral + L .......................................................... 492.86 643.60 81114 Appliance, mandibular, bilateral + L ....................................................... 492.86 643.60 Appliances, removable, cross-bite correction 81121 Appliance, maxillary, simple + L ..................................................................

PA 1180.34 81122 Appliance, mandibular, simple + L ............................................................... PA 1180.34 Appliances, removable, dental arch expansion 81131 Appliance, maxillary, simple + L .................................................................. PA PA 81132 Appliance, mandibular, simple + L ............................................................... PA PA Appliances, removal, closure of diastemas 81141 Appliance, maxillary, simple + L ..................................................................

PA PA 81142 Appliance, mandibular, simple + L ............................................................... PA PA Appliances, removable, alignment of anterior teeth 81151 Appliance, maxillary, simple + L .................................................................. PA PA 81152 Appliance, mandibular, simple + L ...............................................................

PA PA 2 Appliances, fixed or cemented Appliance, fixed, space regaining (e.g., lingual or labial arch with molar bands, tubes, locks) 81211 Appliance, maxillary + L ............................................................................... PA 643.60 81212 Appliance, mandibular + L ............................................................................ PA 643.60 Appliance, fixed, space regaining, unilateral 81221 Appliance, maxillary + L ...............................................................................

PA 449.14 81222 Appliance, mandibular + L ............................................................................ PA 449.14 © NS Registry of Regulations. Web version. 317

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Part II - Regulations Vol. 37, No. 7 Appliance, fixed, cross-bite correction—anterior (MSI: as Phase I treatment) 81231 Appliance, maxillary + L ............................................................................... PA 1180.34 81232 Appliance, mandibular + L ............................................................................ PA 1180.34 Appliance, fixed, cross-bite correction—posterior (MSI: as Phase I treatment) 81241 Appliance, maxillary + L ...............................................................................

PA 1180.34 81242 Appliance, mandibular + L ............................................................................ PA 1180.34 81243 Appliance, two-molar band, hooked and elastics + L ................................... PA 1180.34 Appliance, fixed, dental arch expansion 81251 Appliance, maxillary + L ............................................................................... PA PA 81253 Appliance, maxillary, rapid expansion + L ...................................................

PA PA Appliance, fixed, closure of diastemas 81261 Appliance, maxillary, simple + L .................................................................. PA PA 81262 Appliance, mandibular, simple + L ............................................................... PA PA Appliance, fixed, alignment of incisor teeth 81271 Appliance, maxillary, simple + L .................................................................. PA PA 81272 Appliance, mandibular, simple + L ...............................................................

PA PA Appliances, fixed, mechanical eruption tooth/teeth 81291 Appliance, maxillary + L ............................................................................... PA PA 81292 Appliance, mandibular + L ............................................................................ PA PA 3 Appliances, retention, orthodontic retaining appliances Appliances, removable, retention 83101 Appliance, maxillary + L (MSI: $60.00 lab maximum) ................................ PA 312.61 83102 Appliance, mandibular + L (MSI: $60.00 lab maximum) .............................

PA 312.61 83103 Appliance, tooth positioner + L (MSI: $60.00 lab maximum) ...................... PA 312.61 Appliances, fixed/cemented, retention 83201 Appliance, maxillary + L (MSI: $60.00 lab maximum) ................................ PA 312.61 83202 Appliance, mandibular + L (MSI: $60.00 lab maximum) ............................. PA 312.61 Comprehensive Orthodontic Treatment 1 Fixed appliance (includes formal full banded treatment and retention) Permanent dentition 84101 Class I malocclusion (MSI: non-surgical case) .............................................

PA 5140.45 84101 Class I malocclusion (MSI: surgical case) ..................................................... PA 5648.26 84201 Class II malocclusion (MSI: non-surgical case) ............................................ PA 6005.26 84201 Class II malocclusion (MSI: surgical case) ................................................... PA 6362.28 84301 Class III malocclusion (MSI: non-surgical case) ........................................... PA 7379.26 84301 Class III malocclusion (MSI: surgical case) ..................................................

PA 8703.51 84401 Malocclusions not requiri ng complete banding ............................................. PA PA 2 Removable appliance (includes removable appliance therapy and retention; e.g., functional appliances for mixed and primary dentition) Permanent dentition 87101 Class I malocclusion + L ............................................................................... PA PA 318 © NS Registry of Regulations. Web version.

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Part II - Regulations Vol. 37, No. 7 87201 Class II malocclusion + L .............................................................................. PA PA 87301 Class III malocclusion + L ............................................................................. PA PA Mixed dentition 88101 Class I malocclusion + L ............................................................................... PA PA 88201 Class II malocclusion + L .............................................................................. PA PA 88301 Class III malocclusion + L ............................................................................. PA PA

Part 5: Periodontics—40000–49999 Desensitization This may involve application and burnishing of medicinal aids on the root or the use of a variety of therapeutic procedures.

More than 1 appointment may be necessary. (MSI: details as to rationale must accompany claim.) 41301 1 unit of time ............................................................................................. 31.52 32.15 41302 2 units of time ............................................................................................ 63.03 64.29 41309 Each additional unit of time over 2 ........................................................... 31.52 32.15 Periodontal Services, Surgical Includes local anesthetic, suturing and placing and removing initial surgical dressing.

A surgical site is an area that lends itself to 1 or more procedures.

It is considered to include a full quadrant, sextant or a group of teeth that can be practically and conveniently combined for a single surgical sitting, or in some cases a single tooth. 1 Periodontal surgery, gingival curettage Surgical curettage, including definitive root planing 42111 Per sextant ............................................................................................... 111.47 136.63 2 Periodontal surgery, gingivoplasty 42201 Per sextant .....................................................................................................

PA 195.37 3 Periodontal surgery, gingivectomy (the procedure by which gingival deformities are reshaped and reduced to create normal and functional form, when the pocket is uncomplicated by extension into the underlying bone) Gingivectomy, uncomplicated 42311 Per sextant ..................................................................................................... PA 140.21 Gingivectomy, with curettage 42321 Per sextant .....................................................................................................

PA 154.24 Gingival fiber incision (supra crestal fibrotomy) 42331 Per tooth ........................................................................................................ PA 26.08 42339 Each additional tooth ..................................................................................... PA 26.08 Soft tissue recontouring for crown lengthening 42341 Limited recontouring of tissue, per tooth ...................................................... PA 72.91 © NS Registry of Regulations. Web version. 319

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Part II - Regulations Vol. 37, No. 7 4 Periodontal surgery, flap approach Flap approach, with osteoplasty/ostectomy 42411 Per sextant ..................................................................................................... PA 286.43 Flap approach, with curettage of osseous defect 42421 Per sextant ..................................................................................................... PA 286.43 Flap approach, with curettage of osseous defect and osteoplasty 42431 Per sextant .....................................................................................................

PA 320.74 Flap approach, exploratory (for diagnosis) 42441 Per site ........................................................................................................... PA 70.57 Flap approach, with osteoplasty/ostoectomy for crown lengthening 42451 Per site ...........................................................................................................

PA 286.4 3 5 Periodontal surgery, grafts Grafts, soft tissue, pedicle (including apically or coronally positioned, lateral sliding and rotated flaps) 42511 Per site ........................................................................................................... PA 318.3 1 42512 Periosteal stimulation in addition to 42511 ................................................... PA 350.14 Grafts, soft tissue, pedicle (coronally positioned) 42521 Per site ...........................................................................................................

PA 318.3 1 42522 Periosteal stimulation in addition to 42521 ................................................... PA 350.14 Grafts, free soft tissue 42531 Per site ........................................................................................................... PA 318.3 1 Grafts, soft tissue, pedicle, with free graft placed in pedicle donor site 42541 Per site ...........................................................................................................

PA 318.3 1 Grafts, free connective tissue (for root coverage) 42551 Per site ........................................................................................................... PA 318.3 1 Grafts, free connective tissue (for ridge augmentation) 42561 Per site ........................................................................................................... PA 318.3 1 Grafts, connective tissue, pedicle with free graft for root coverage 42571 Per site ...........................................................................................................

PA 318.3 1 Grafts, gingival onlay, for ridge augmentation 42581 Per site ........................................................................................................... PA 318.3 1 6 Periodontal surgery, grafts, osseous tissue Grafts, osseous, autograft (including flap entry and closure) 42611 Per site ........................................................................................................... PA 274.8 4 Grafts, osseous, allograft (including flap entry and closure) 42621 Per site (+ E—not payable by MSI) ..............................................................

PA PA 320 © NS Registry of Regulations. Web version.

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Part II - Regulations Vol. 37, No. 7 7 Periodontal surgery, miscellaneous procedures Guided tissue regeneration (including re-entry) 42711 Per site (+ E—not payable by MSI) .............................................................. PA PA 8 Periodontal surgery, miscellaneous procedures Proximal wedge procedure (as a separate procedure) 42811 With flap curettage, per site ........................................................................... PA PA 42819 With flap curettage and ostectomy/ostoplasty, per site .................................

PA PA Post surgical periodontal treatment visit per dressing change 42821 1 unit of time ................................................................................................. PA PA 42822 2 units of time ................................................................................................ PA PA 42823 3 units of time ................................................................................................ PA PA 42829 Each additional unit of time over 3 ...............................................................

PA PA Periodontal abscess or pericoronitis, may include one or more of the following procedures: lancing, scaling, curettage, surgery or medication 42831 1 unit of time ................................................................................................. PA PA 42832 2 units of time ................................................................................................ PA PA 42833 3 units of time ................................................................................................

PA PA 42834 4 units of time ................................................................................................ PA PA 42839 Each additional unit of time over 4 ...............................................................

PA PA Periodontal Procedures, Adjunctive When per joint is designated, the corresponding tooth code is represented by the mesial of the tooth involved, except at the midline, where the tooth to the right of the joint is utilized. 1 Periodontal splinting or ligation, provisional, intra-coronal “A” splint (acrylic, composite or amalgam, plus knurled wire) 43111 Per joint .........................................................................................................

PA 46.12 2 Periodontal splinting or ligation, provisional, extra-coronal Acid etch joint restorations (per joint) 43211 Per joint ......................................................................................................... PA 60.44 Acid etch, interproximal enamel splint 43221 Per joint ......................................................................................................... PA 60.44 Wire ligation 43231 Per joint .........................................................................................................

PA 60.44 Wire ligation, acrylic covered 43241 Per joint ......................................................................................................... PA 60.44 Dental floss ligation 43251 Per joint ......................................................................................................... PA 60.44 Orthodontic band splint 43261 Per band .........................................................................................................

PA 60.44 Cast/soldered splint acid etch/resin bonded 43271 Per abutment + L ........................................................................................... PA 60.44 © NS Registry of Regulations. Web version. 321

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Part II - Regulations Vol. 37, No. 7 Removal of fixed periodontal splints 43281 1 unit of time ................................................................................................. PA PA 43289 Each additional unit of time .......................................................................... PA PA Occlusion Occlusal adjustment/equilibration: (

a) may require several sessions; (

b) may be used in conjunction with basic restorative treatment only when occlusal adjustment/equilibration is not required as a result of that restoration; (

c) is not to be used in conjunction w ith the delivery and post-insertion care of fixed or removable prosthesis (5000 and 6000 code series) by the same dentist for a period of 3 months. 16511 1 unit of time ............................................................................................. 49.44 60.44 16512 2 units of time ............................................................................................ 98.90 120.89 16513 3 units of time .......................................................................................... 148.35 181.33 16514 4 units of time .......................................................................................... 197.81 241.82 16517 1/2 unit of time .......................................................................................... 24.73 30.23 16519 Each additional unit of time over 4 ........................................................... 49.44 60.44 Root Planing, Periodontal 43421 1 unit of time ............................................................................................. 49.44 60.44 43422 2 units of time ............................................................................................ 98.90 120.89 43423 3 units of time .......................................................................................... 148.35 181.33 43424 4 units of time .......................................................................................... 197.81 241.82 43425 5 units of time .......................................................................................... 247.27 302.25 43426 6 units of time .......................................................................................... 296.71 362.67 43427 1/2 unit of time .......................................................................................... 24.73 30.23 43429 Each additional unit of time ...................................................................... 49.44 60.44 Chemotherapeutic and/or Antimicrobial Agents 1 Chemotherapeutic and/or antimicrobial agents, topical application 43511 1 unit of time .................................................................................................

PA PA 43519 Each additional unit of time .......................................................................... PA PA 2 Chemotherapeutic and/or antimicrobial agents, intra-sulcular 43521 1 unit of time ................................................................................................. PA PA 43529 Each additional unit of time .......................................................................... PA PA Appliances 1 Appliances, periodontal (See separate codes for TMJ (43700) and TMJ appliances (78700).

Appliances, periodontal (including bruxism appliance): includes impression, insertion and adjustment 14611 Maxillary appliance + L ................................................................................ PA PA 14612 Mandibular appliance + L ............................................................................. PA PA 322 © NS Registry of Regulations. Web version.

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Part II - Regulations Vol. 37, No. 7 Appliances, maintenance, adjustments, repair (including bruxism appliances) 14621 1 unit of time + L ........................................................................................... PA PA 14622 2 units of time + L ......................................................................................... PA PA 14623 3 units of time + L ......................................................................................... PA PA 14629 Each additional unit of time over 3 ...............................................................

PA PA Appliances, reline (including bruxism appliances) 14631 Reline, direct .................................................................................................. PA PA 14632 Reline, processed + L .................................................................................... PA PA 2 Appliances, temporomandibular joint Appliance, TMJ, diagnostic 14711 Maxillary appliance + L ................................................................................ PA PA 14712 Mandibular appliance + L .............................................................................

PA PA Appliance, TMJ intra-oral repositioning 14721 Maxillary appliance + L .......................................................................... 266.33 325.68 14722 Mandibular appliance + L ....................................................................... 266.33 325.68 Appliance, TMJ, periodic maintenance, adjustments, repairs 14731 1 unit of time + L ....................................................................................... 44.89 54.98 14732 2 units of time + L ..................................................................................... 89.78 109.95 14733 3 units of time + L ................................................................................... 134.65 164.91 14739 Each additional unit of time over 3 ........................................................... 44.89 54.98 Appliance, TMJ, relines 14741 Reline, direct ..................................................................................................

PA PA 14742 Reline, processed + L .................................................................................... PA PA 3 Appliances, myofa[s]cial pain syndrome (conditions that originate outside the temporomandibular joint), including models, gnathological determinants, adjustments and 3 post-insertion adjustments 14801 Maxillary appliance + L ................................................................................ PA PA 14802 Mandibular appliance + L .............................................................................

PA PA Appliance, myofa[s]cial pain syndrome, periodic maintenance, adjustment and repairs 14811 1 unit of time + L ........................................................................................... PA PA 14812 2 units of time + L ......................................................................................... PA PA 14813 3 units of time + L ......................................................................................... PA PA 14819 Each additional unit of time over 3 ...............................................................

PA PA Periodontal Services, Miscellaneous 1 Periodontal re-evaluation 49101 1 unit of time ................................................................................................. PA PA 49102 2 units of time ................................................................................................ PA PA 49109 Each additional unit of time over 2 ............................................................... PA PA 2 Periodontal irrigation, subgingival 49211 1 unit of time .................................................................................................

PA PA 49219 Each additional unit of time .......................................................................... PA PA © NS Registry of Regulations. Web version. 323

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Part II - Regulations Vol. 37, No. 7 3 Provisional non-coded services Root separation .............................................................................................. PA PA Forced eruption—1 tooth .............................................................................. PA PA Forced eruption—more than 1 tooth ............................................................. PA PA Rapid extrusion—1 tooth .............................................................................. PA PA Rapid extrusion—more than 1 tooth ............................................................. PA PA

Part 6: Preventive—10000–19999 Any procedure carried out by an auxiliary is paid at the General Practitioner level. To qualify for a specialist’s fee, the procedure must be carried out personally by the specialist on a properly referred patient. The fees for preventive services assume a 1-to-1 relationship between patient and dentist.

If service is provided to a group at the same time, only one fee is payable. 1 Polishing—see “Caries prevention service” below 2 Scaling 11111 1 unit of time ............................................................................................. 30.29 30.90 11112 2 units of time ............................................................................................ 60.56 61.77 11113 3 units of time ............................................................................................ 90.82 92.64 11114 4 units of time .......................................................................................... 121.10 123.52 11115 5 units of time .......................................................................................... 151.46 154.49 11116 6 units of time .......................................................................................... 181.43 185.06 11117 1/2 unit of time .......................................................................................... 15.14 15.44 11119 Each additional unit of time ...................................................................... 30.29 30.90 3 Fluoride treatments 12101 Fluoride treatment, topical application ...................................................... 15.00 16.14 Preventive Services, Other 1 Nutritional dietary counselling (including recording and analysis of 7- day dietary intake and consultation) (MSI: maximum payable per lifetime is 1 series of 4 appointments.) 13101 1 unit of time ............................................................................................. 25.00 30.90 2 Caries prevention service—MSI (previously MSI fee code 220) (Oral hygiene instruction/plaque control, including brushing and/or flossing and/or embrasure cleaning, including for MSI programs rubber cup polishing and minor scaling procedures.) (MSI: allowed once every 335 days.) 13211 1 unit of time ............................................................................................. 30.29 30.90 3 Sealants, pit and fissure (acid etch preparation included.

MSI: limited to 6-year molars that meet guidelines—1 application per tooth.) 13401 Each tooth .................................................................................................. 20.00 28.15 4 Disking of teeth, interproximal (MSI: maximum 3 units per lifetime) 16201 1 unit of time ............................................................................................. 37.58 37.58 16202 2 units of time ............................................................................................ 75.16 75.16 16203 3 units of time .......................................................................................... 112.74 112.74 324 © NS Registry of Regulations.

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Part II - Regulations Vol. 37, No. 7 5 Recontouring of teeth for functional reasons (not associated with delivery of a single or multiple prosthesis) 16301 1 unit of time ................................................................................................. PA PA 16309 Each additional unit of time ..........................................................................

PA PA Space Maintainers Includes design, separation, fabrication, insertion and, if applicable, initial cementation and removal. 1 Space maintainers, band type 15101 Space maintainer, band type, fixed, unilateral + L .................................. 124.33 169.60 15103 Space maintainer, band type, fixed, bilateral (soldered lingual arch) + L ...................................................................................... 149.00 258.04 15105 Space maintainer, band type, fixed, bilateral tubes and locking wires + L ..................................................................................... 181.00 282.20 2 Space maintainers, stainless steel crown type 15201 Space maintainer, stainless steel crown type, fixed + L .......................... 160.00 196.43 3 Space maintainers, maintenance of 15601 Maintenance, space maintainer appliance, including adjustment and/or recementation after 30 days post-insertion ..................................... 53.00 59.28

Part 7: Prosthetics—Removable—50000–59999 Dentures, complete (including impressions, initial and final jaw relation records, try-in evaluation and check records, insertion and adjustments, including 3 months post-insertion care) 1 Dentures, complete, equilibrated (involves remounted equilibration on a semi-adjustable articulator) 51201 Maxillary + L ................................................................................................. PA 1243.52 51202 Mandibular + L ..............................................................................................

PA 1296.19 51204 Liners, resilient in addition to above + L ...................................................... PA 61.35 2 Dentures, surgical, standard (immediate) (includes tissue conditioner, but does not include hard reline.

Does include 3 months post-insertion care.) 51301 Maxillary + L ........................................................................................... 562.70 PA 51302 Mandibular + L ........................................................................................ 562.70 PA 3 Dentures, complete, transitional (temporary) 51601 Maxillary + L ................................................................................................. PA 853.57 51602 Mandibular + L ..............................................................................................

PA 853.57 4 Dentures, complete, overdenture 51701 Maxillary + L ................................................................................................. PA PA 51702 Mandibular + L .............................................................................................. PA PA 5 Dentures, complete, overdentures (immediate) 51801 Maxillary + L ................................................................................................. PA PA 51802 Mandibular + L .............................................................................................. PA PA © NS Registry of Regulations.

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Part II - Regulations Vol. 37, No. 7 6 Dentures, complete, attached to implants Dentures, removable, tissue bone, with independent attachments secured to implants 51921 Maxillary + L ................................................................................................. PA PA 51922 Mandibular + L ..............................................................................................

PA PA Dentures, Partial, Acrylic 1 Dentures, partial, acrylic base (transitional) (with or without clasps) 52101 Maxillary + L ........................................................................................... 174.55 PA 52102 Mandibular + L ........................................................................................ 174.55 PA 2 Dentures, partial, acrylic base (immediate) 52111 Maxillary + L .................................................................................................

PA PA 52112 Mandibular + L ..............................................................................................

PA PA 3 Dentures, partial, acrylic, with meta l wrought/cast clasps and/or rests 52301 Maxillary + L ........................................................................................... 342.90 430.37 52302 Mandibular + L ........................................................................................ 342.90 430.37 4 Dentures, partial, acrylic, with meta l wrought/cast clasps and/or rests (immediate) 52311 Maxillary + L ........................................................................................... 342.90 430.37 52312 Mandibular + L ........................................................................................ 342.90 430.37 5 Dentures, partial, overdenture, a crylic, with cast/wrought clasps and/or rests 52501 Maxillary + L .................................................................................................

PA PA 52502 Mandibular + L .............................................................................................. PA PA 6 Dentures, partial, overdenture, a crylic, with cast/wrought clasps and/or rests (immediate) 52511 Maxillary + L ................................................................................................. PA PA 52512 Mandibular + L ..............................................................................................

PA PA Dentures, Partial, Cast with Acrylic Base 1 Dentures, partial, free end, cast frame/connector, clasps and rests 53101 Maxillary + L ................................................................................................. PA PA 53102 Mandibular + L .............................................................................................. PA PA 53104 Altered cast impression techni que in conjunction with 53101, 53102, 53103 + L ..........................................................................................

PA PA 2 Dentures, partial, tooth borne, cast frame/connector, clasps and rests 53201 Maxillary + L ........................................................................................... 489.49 PA 53202 Mandibular + L ........................................................................................ 489.49 PA 3 Dentures, partial, cast, precision attachments 53401 Maxillary + L ........................................................................................... 694.55 PA 53402 Mandibular + L ........................................................................................ 694.55 PA 326 © NS Registry of Regulations.

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Part II - Regulations Vol. 37, No. 7 4 Dentures, partial, cast, semi-precision attachments 53501 Maxillary + L ................................................................................................. PA PA 53502 Mandibular + L .............................................................................................. PA PA 5 Dentures, partial, cast, overdenture, removable 53701 Maxillary + L .................................................................................................

PA PA 53702 Mandibular + L .............................................................................................. PA PA 53704 Altered cast impression technique done in conjunction with 53701, 53702 and 53703 + L .....................................................................................

PA PA Dentures, Adjustments (after 3 months post-insertion or by other than the dentist providing prosthesis) 1 Denture adjustments, partial or complete denture, minor 54201 1 unit of time + L ....................................................................................... 44.92 54.79 2 Denture adjustments, partial or complete denture, remount and occlusal equilibration 54301 Maxillary + L .................................................................................................

PA 302.92 54302 Mandibular + L ..............................................................................................

PA 302.92 Dentures, Repairs/Additions 1 Denture, repair, complete denture, no impression required 55101 Maxillary + L ............................................................................................. 40.48 49.81 55102 Mandibular + L .......................................................................................... 40.48 49.81 2 Denture, repair, complete denture, impression required 55201 Maxillary + L ............................................................................................. 81.71 99.88 55202 Mandibular + L .......................................................................................... 81.71 99.88 3 Denture, repairs/additions, partial denture, no impression required 55301 Maxillary + L ............................................................................................. 40.48 54.98 55302 Mandibular + L .......................................................................................... 40.48 54.98 4 Denture, repairs/additions, partial denture, impression required 55401 Maxillary + L ............................................................................................. 81.71 99.88 55402 Mandibular + L .......................................................................................... 81.71 99.88 5 Dentures, implant retained prosthesis, prophylaxis and polishing 55501 1 unit of time + L ...........................................................................................

PA PA 55509 Each additional unit of time .......................................................................... PA PA Dentures, Duplication, Relining, Rebasing, and Remaking 1 Dentures, duplication Denture, duplication, complete denture 56111 Maxillary + L ................................................................................................. PA PA 56112 Mandibular + L ..............................................................................................

PA PA 2 Dentures, relining Denture, reline, direct, complete denture 56211 Maxillary ................................................................................................. 144.41 147.30 © NS Registry of Regulations. Web version. 327

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Part II - Regulations Vol. 37, No. 7 56212 Mandibular .............................................................................................. 144.41 147.30 Denture, reline, direct, partial denture 56221 Maxillary ................................................................................................. 138.51 141.28 56222 Mandibular .............................................................................................. 138.51 141.28 Denture, reline, processed, complete denture 56231 Maxillary + L ........................................................................................... 179.69 183.28 56232 Mandibular + L ........................................................................................ 179.69 183.28 Denture, reline, processed, partial denture 56241 Maxillary + L ........................................................................................... 105.87 107.99 56242 Mandibular + L ........................................................................................ 105.87 107.99 Denture, reline, processed, functional impression requiring 3 appointments, partial denture 56261 Maxillary + L ........................................................................................... 179.69 183.28 56262 Mandibular + L ........................................................................................ 179.69 183.28 3 Dentures, remake Denture, remake, using existing framework, partial denture 56411 Maxillary + L .................................................................................................

PA PA 56412 Mandibular + L ..............................................................................................

PA PA Dentures, Tissue Conditioning 1 Denture, tissue conditioning, per appointment, complete denture 56511 Maxillary + L ............................................................................................. 87.94 89.70 56512 Mandibular + L .......................................................................................... 87.94 89.70 2 Denture, tissue conditioning, per appointment, partial denture 56521 Maxillary + L ........................................................................................... 101.74 103.77 56522 Mandibular + L ........................................................................................ 101.74 103.77 Dentures, Miscellaneous Services 56601 Resilient liner, in relined or rebased denture (in addition to reline or rebase of denture) + L ........................................................................... 87.94 89.70 56602 Resetting of teeth (not including reline or rebase of denture) + L .................

PA PA

Part 8: Prosthodontics—Fixed—60000–69999 Fixed bridges (each abutment, each retainer and each pontic constitutes a separate unit in a bridge, with a separate code number). 1 Pontics, bridge Pontics, cast 62101 Pontics, cast metal + L ................................................................................... PA 243.67 62102 Pontics, cast metal core with separate porcelain jacket pontic + L ............... PA 243.67 Pontics, porcelain/polymer glass 62501 Pontics, porcelain fused to metal + L ............................................................

PA 273.63 62502 Pontics, porcelain, aluminous + L ................................................................. PA 273.63 328 © NS Registry of Regulations. Web version.

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Part II - Regulations Vol. 37, No. 7 Pontics, acrylic/plastic/composite 62702 Pontics, acrylic/plastic/composite, processed indirect (transitional) + L ............................................................................................ PA PA 62703 Pontics, acrylic/plastic/com posite, transitional direct ................................... PA PA 2 Recontouring of retainers/pontics, per tooth (of existing bridgework) 63001 1 unit of time .................................................................................................

PA PA 63009 Each additional unit of time .......................................................................... PA PA 3 Master cast, facebow mounting 64101 Master cast, facebow mounting + L ..............................................................

PA PA 4 Repairs, removal Removal, fixed bridge 66211 1 unit of time ............................................................................................. 52.59 64.36 66212 2 units of time + L ................................................................................... 105.17 128.69 66213 3 units of time + L ................................................................................... 157.75 193.02 66219 Each additional unit of time ..................................................................... 52.59 64.36 5 Repairs, recementation (+ L if laboratory charges are incurred during repair of bridge) 66301 1 unit of time + L ....................................................................................... 60.47 73.81 6 Repairs, fixed bridge Repairs, porcelain/ceramic/plastic/composite, direct 66711 First tooth ......................................................................................................

PA PA 66719 Each additional tooth ..................................................................................... PA PA Repairs, solder indexing to repair broken solder joint 66721 1 unit of time + L ........................................................................................... PA PA 66729 Each additional unit of time ..........................................................................

PA PA Fixed Bridge Retainers 1 Retainers, plastic/acrylic 67111 Retainer, plastic/acrylic, processed + L ..................................................... 54.06 68.27 67112 Retainer, plastic processed to metal + L .................................................... 54.06 68.27 Retainers, plastic/acrylic, direct (transitional during healing, done at chairside) 67121 First tooth ...................................................................................................... PA PA 67129 Each additional tooth .....................................................................................

PA PA Retainers, plastic/acrylic, indirect, processed (transitional during healing) 67131 First tooth + L ................................................................................................ PA PA 67139 Each additional tooth + L .............................................................................. PA PA Retainers, plastic/acrylic, indirect, processed, attached to implants 67141 First implant + L ............................................................................................

PA PA 67149 Each additional implant + L .......................................................................... PA PA 2 Retainers, porcelain/ceramic/polymer glass 67201 Retainer, porcelain/ ceramic + L .................................................................... PA PA © NS Registry of Regulations. Web version. 329

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Part II - Regulations Vol. 37, No. 7 Retainers, porcelain fused to metal 67211 Retainers, porcelain/ceramic fused to metal + L ........................................... PA 594.89 67212 Stress breaker and/or precision attachments, in addition to above + L ..................................................................................... PA 169.83 Retainers, porcelain/ceramic fused to metal, attached to implant 67221 First implant + L ............................................................................................

PA PA 67229 Each additional implant + L .......................................................................... PA PA 3 Retainers, metal, cast Retainers, metal full cast 67301 Retainers, metal full cast + L ......................................................................... PA 594.89 67302 Stress breaker and/or precision attachments, in addition to above + L ..................................................................................... PA 169.83 Retainers, metal 3/4 cast 67311 Retainers, metal 3/4 cast + L .........................................................................

PA 594.89 67312 Stress breakers and/or precision attachments, in addition to above + L ..................................................................................... PA 169.83 Retainers, metal inlay (used with broken stress technique) 67321 Retainer, metal inlay, 2 surfaces + L ............................................................. PA 452.49 67322 Retainer, metal inlay, 3 or more surfaces + L ................................................

PA 567.67 Retainers, metal, onlay (internal retention type) 67331 Retainer, metal, onlay + L ............................................................................. PA 567.67 Retainers, metal, onlay (external retention type) 67341 Retainer, metal, onlay, acid etch and/or perforated, bonded to abutment tooth, (pontic extra) + L ............................................................. PA PA Retainers, metal, prefabricated or custom cast, attached to transmucosal component (25761) used with 67503 67351 Retainer + L and/or (+ E—not payable by MSI) ...........................................

PA PA 67359 Each additional retainer + L and/or (+ E—not payable by MSI) .................. PA PA Fixed Prosthodontics, Abutments/Retainers, Miscellaneous Services 67501 Abutment preparation under ex isting partial denture clasp, in addition to retainer codes + L .................................................................... PA PA 67502 Telescoping crown unit + L ........................................................................... PA 789.84 67503 Implant, each retentive bar attached by screws to implant (67351) to retain removable prosthesis (see 51920 for prosthesis) .............