Dental Insurance Benefits Part 4
ODA Suggested Fee Guide
The Ontario Dental Association publishes The ODA Suggested Fee Guide for General Practitioners©. The Guide is based on the provision of dental services which are performed under normal conditions. It is intended to serve only as a reference for the general practitioner to enable development of a structure of fees which is fair and reasonable to the patient and to the practitioner. The Guide is not obligatory and each practitioner is expected to determine independently the fees which will be charged for the services performed, which means that fees will vary both above and below the Guide. The Guide is issued merely for professional information purposes, without any intention or expectation whatsoever that a practitioner will adopt the suggested fees.
The Guide is not available on the ODA website. However, copies have been placed in the reference section of many public libraries so that members of the public can access this document.
The Guide is approximately 80 pages in length, contains roughly 1,300 dental services and it is written using correct dental terminology so you will not find words such as cleaning, check-up, filling, cap, bridge and so on. Each dental service is identified by a five-digit number called a procedure code. The descriptions attached to the procedure code describe the dental service but not the reason the service was performed. For example, the Guide contains several procedure codes that describe veneers — however, none of the descriptions identify the reason the veneer is being placed (i.e., for cosmetic reasons or to restore a tooth that is missing or has lost tooth structure). Furthermore, you will not find dental plan contract language such as basic, major, cosmetic nor will you find frequency limitations such as “once every six months”. This type of language is specific to a dental plan contract and it is used to describe the situations under which subscribers will be reimbursed for specific dental services. The Guide is a listing of dental services that general practitioners may perform.
If you have the procedure codes for the treatment that was prescribed or performed by your dentist, you may contact the ODA’s Practice Advisory Services staff who can provide you with information about the suggested fees.