Ontario Dental Association · 2026 Suggested Fee Guide

Legitimate Coding
Optimization &
Underutilized Procedures

A staff training guide for Ontario general dental practices — covering coding upgrade opportunities, edge cases, and high-value procedures that are regularly left on the table.

General Practice Ontario 2026 Diagnosis · Prevention · Restoration Endo · Perio · Prosth · Surgery
"The intent of treatment determines the procedure code. The dentist is responsible for the accuracy of every claim that goes out under their UIN."
— ODA Suggested Fee Guide, Preamble, para. 9
Foundations

The Four Rules That Govern Every Code

🎯
Intent, not technology
A laser, CAD/CAM, or microscope does not change the code. The intent of treatment determines the code — not the equipment used.
⏱
Time = treatment time
Includes: history review, consent, anaesthesia, procedure, post-op instructions, charting. Excludes setup, breakdown, billing.
🩺
Best-match code required
When more than one code fits, use the best match. The ODA Guide is not a menu — each procedure has a correct code.
🪪
UIN = accountability
Attaching your UIN to a claim means you own its accuracy. Every code must be defensible from the chart note alone.
What this training is — and is not
  • Choosing the correct code when clinical work genuinely warrants a higher-value code
  • Documenting clinical findings so the chart supports the code billed
  • Offering clinically appropriate services that are routinely overlooked
  • Not: modifying the procedure to fit a higher code
  • Not: splitting one appointment into two claims
  • Not: using another dentist's UIN or billing for services not performed
When in doubt
Call ODA Practice Advisory Services — confidential, free for members.
1-866-739-8099 ext. 3301 · Mon–Fri 8:30 am–4:30 pm
Restoration 20000 series

Surface Counting — The Most Commonly Under-coded Service

The ODA Rule

Coding is based on the number of distinct surfaces involved in one restoration, with one material, at one appointment — not the number of discrete restorations placed.

Composite molar (23321–23325) 2026 fees

CodeSurfacesFee (approx.)
233211 surface~$257
233222 surfaces~$321
233233 surfaces~$386
233244 surfaces~$471
233255 surfaces (max)~$498
Fee difference: 1 vs 4 surface
+$214 per tooth
Same appointment, legitimately documented.

Upgrade triggers — document these

  • Buccal composite wraps past mesial line angle → code B+M = 2-surface (23322), not 1-surface (23321)
  • Buccal wraps both line angles → B+M+D = 3-surface (23323)
  • Occlusal with proximal box (caries reaches marginal ridge) → OM, OD, or MOD — not just O
  • Class IV anterior composite past incisal edge → incisal = a surface (e.g. MI, DI, MID)
  • Class V on molar extending to proximal root surface → BM or BD = 2-surface, not 1
Documentation required
Pre-op note: lesion extent (e.g. "MO carious, ICDAS 4, extends past buccal line angle")

Post-op note: surfaces listed explicitly (e.g. "placed bonded composite #16 MOB, 3 surfaces")

Intraoral photo of the prep is the single strongest defence against insurer downcoding.
Restoration 20000 series

Bonded vs Non-Bonded — Different Codes, Different Fees

CodeDescriptionFee
21301Amalgam core — non-bonded (with crown)~$419
21302Amalgam core — bonded (with crown)~$446
23601Tooth-coloured core — non-bonded (with crown)~$419
23602Tooth-coloured core — bonded (with crown)~$446
What "bonded" actually means
A genuine bonded protocol requires: acid etch + primer + adhesive + light cure of each increment. Simply using a composite material does not make it bonded — the bonding agent must be placed and cured before the composite.
Chart note trigger phrase
"Scotchbond Universal selective-etch, light-cured per manufacturer protocol, followed by incremental core buildup."

Other bonded vs non-bonded distinctions

  • Posterior composites 23211–23225 are the bonded molar/bicuspid series; amalgam 21211–21225 posterior codes exist too — don't mix series
  • Retentive pins (21401–21405) are in addition to the restoration code — often forgotten entirely
  • Prefabricated posts (25731–25733) are in addition to the restoration code — same issue
Crown with post & core — checklist
✦ Crown code (27201/27211/27301)
✦ Post code (25731–25733 prefabricated) or (25711–25713 cast)
✦ Core code (21302 or 23602 bonded)
✦ +L for the crown lab
✦ +E for the post material

All five elements are billable. Most offices bill only the crown.
Oral & Maxillofacial Surgery 70000 series

Extractions — Simple vs Surgical Is a Documentation Decision

Code
Description
Lower fee
Higher fee
Upgrade trigger
71101

71201
Simple (forceps only) vs surgical extraction requiring flap elevation and/or tooth sectioning
~$228
~$340
Curved/dilacerated roots; tooth fractures during luxation; flap needed to protect adjacent structure
72211

72221

72231
Soft tissue impaction → partially bony → fully bony impaction
~$509
~$681–731
Pre-op PA shows degree of bony coverage; document angulation, depth, adjacent structures
72241
Coronectomy — deliberate vital root retention to prevent IAN injury (new 2022)
—
~$731
CBCT shows IAN contact; informed consent specific to coronectomy; post-op CBCT at 6 months
71101

72311
Retained root tip (not same procedure as original extraction)
—
~$129
Root retained from a prior appointment or prior dentist — different code series from 71101
Documentation must explicitly describe the surgical element. "Sectioned with 702 bur mesio-distally due to root divergence noted on pre-op PA." Without this, insurers downgrade to 71101 and the practice cannot dispute it.
Endodontics 30000 series

Root Canal — 6 Codes Per Canal Count, Most Used Only 1

The 6-code structure (per canal count)

SuffixConditionFee uplift
33111 / 33131 / 33141Uncomplicated (baseline)—
33112 / 33132 / 33142Difficult access (through crown, limited opening)+12%
33113 / 33133 / 33143Exceptional anatomy (dilaceration, dens-in-dente)+15%
33114 / 33134 / 33144Calcified canals (can't pass size 10 file)+15%
33115 / 33135 / 33145Retreatment — previously completed RCT+20%
33116 / 33136 / 33146Continuation of aborted treatment+20%
4-canal molar example
33141 uncomplicated: ~$1,461
33144 calcified canals: ~$1,635
Difference: +$174 per tooth

Upgrade triggers + companion codes often missed

  • Sclerosed MB2 that won't take a size 10 file → 33134 calcified. Document: file used, chelator, ultrasonic troughing, microscope.
  • Pulp chamber obliteration on PA → calcified canal code. Reference the specific radiograph.
  • RCT through existing PFM crown → difficult access (33112/33132/33142). Note: access through crown, alignment challenge, dam isolation.
  • Any retreatment of prior GP/endo → always 33115/33125/33135/33145, never the basic RCT code.
  • 34602 Enlargement of canal in calcified canals — separately billable when conventional instrumentation fails (~$187). Almost always missed.
  • 39211/39212 Access through existing crown — separately billable add-on (~$131).
  • 39101 Core buildup for isolation — when a box must be built to hold the rubber dam (~$131).
⚠️ Critical rule: pulpectomy + RCT same dentist < 3 months
If you open/drain (32311/32314) and complete the RCT within 3 months, you must reduce the RCT fee by ½ the pulpectomy fee. Missing this leads to audit exposure.
Prevention 10000 · Periodontics 40000

Scaling vs Root Planing — The Clinical Evidence Must Drive the Code

The two code series compared

CodeServiceFee/unit
11111Scaling — 1 unit (15 min)~$75
11112Scaling — 2 units (30 min)~$144
11114Scaling — 4 units (60 min)~$264
11116Scaling — 6 units (90 min)~$397
43421Root planing — 1 unit / sextant~$75
43422Root planing — 2 units / sextant~$144
Why are the fees the same per unit?
The ODA fee rates are identical for 11111 and 43421 — but root planing is a sextant code with a separate billable entry per sextant, while scaling is a single time-based code for the whole mouth. A full-mouth RP across 6 sextants generates 6 separate billing entries.
49101 is not a routine perio maintenance code
2025 clarification: 49101 is for post-surgical re-evaluation >1 month after surgery, or if performed by a different practitioner. Routine maintenance after SRP uses 01502.

When root planing is the correct code

  • Pocket depths ≥4 mm with bleeding on probing in defined sextants
  • Radiographic bone loss on current bitewings or PAs
  • A documented periodontal diagnosis (Stage I–IV / Grade A–C)
  • Subgingival calculus identified and documented
Documentation checklist for root planing
✦ Six-point perio chart with date (pocket depth, BoP, CAL, recession, mobility, furcation)
✦ Radiograph showing bone loss in each sextant billed
✦ Written perio diagnosis signed by dentist
✦ Sextant numbers on the claim
✦ 49101 re-evaluation booked 4–8 weeks out
41301/41302 Desensitization — almost never billed
Post-SRP cervical sensitivity treated with Gluma, varnish, oxalates, etc. Codes: 41301 (1 unit) / 41302 (2 units). ~$66/$133. Document: agent used, teeth/sextants treated.
Prevention 10000 series

Occlusal Appliances — The Highest-Volume Missed Revenue in Most Practices

14611 / 14612
Night guard / bruxism appliance
Per-arch. ~$401 +L. Hard or soft — both code to 14611/14612.

⚠️ 14502 is for athletic mouthguards only. Using 14502 instead of 14611 underbills by ~$215.
14711 / 14712
TMJ diagnostic / therapeutic appliance
Per-arch. ~$440 +L. For anterior repositioning, flat-plane, deprogrammer. Document: TMJ click/crepitus, pain, opening limitation, muscle tenderness.
14811 / 14812
Myofascial Pain Dysfunction Syndrome appliance
~$619 +L. For MPDS/TMJD with confirmed myofascial diagnosis. Highest-fee appliance category. Requires documented MPDS diagnosis.
14901
Sleep apnea / MAD appliance
I.C. (independent consideration). Requires polysomnogram (PSG) interpreted by a physician. Without PSG, code as 14611. Document: PSG report on file, AHI, physician referral letter.

Adjustment & repair codes

14621 / 14622
Adjustment of appliance
Time-based + L. Billable separately after delivery visit.
14631
Direct reline of appliance
Chairside reline when appliance no longer fits. +L if sent to lab.
The workflow opportunity
At every exam, document wear facets. Every patient with wear facets and reported grinding is a night guard candidate. Most practices see 30–40% of active patients fitting this profile.
Underutilized codes · Prevention / Adjunctive

High-Value Codes That Already Exist in the Guide — Rarely Offered

13601–13609 +E
SDF & Remineralization Agent Application
Silver diamine fluoride, CPP-ACFP, MI Paste Plus applied to hard tissue lesions. ~$78/unit + material expense. Indications: caries arrest in pediatric, geriatric, special needs, or high-risk patients.
Resin Infiltration (+E)
Icon / Resin Infiltration
For non-cavitated incipient lesions: use 13601 +E (the Icon kit is the +E expense). For post-ortho white spots on anterior teeth: consider 23111 (1-surface composite) if restorative intent. Document: ICDAS score, lesion location, clinical photos before/after.
13401 vs 13411
Sealants vs Preventive Restorative Resin
If the bur entered enamel or dentin (no matter how minimally), code 13411/13419 — PRR is ~$80 and is a higher fee than a sealant (13401). The distinction: any mechanical preparation → PRR.
04221
Non-ionizing caries scanning
Laser fluorescence devices (DIAGNOcam, SoproLife, Logicon). Time-based. Almost never billed. Document device used, teeth scanned, findings.
13101–13109
Nutritional Counselling
~$58/unit. Includes recording and analysis of up to 7-day dietary intake + consultation. Indicated for high-caries-risk, eating disorders, pediatric rampant caries, frequent snackers, dry-mouth patients. Almost zero Ontario GPs bill this routinely.
13211–13219
Individual Oral Hygiene Instruction
~$58/unit. Legitimately billable for new perio patients, new ortho appliance, peri-implant maintenance, uncontrolled diabetics. Document: OHI content, devices demonstrated, patient's baseline status.
08011–08019
Remote Assessment (Virtual Triage)
~$87/unit. New in 2022. Phone or video assessment of a chief complaint. After-hours triage calls, post-op concerns, rural patients. Some private plans now reimburse. Document: time spent, chief complaint, advice given, follow-up plan.
04811–04819
Diagnostic Photographs
~$11/photo. Pre-op intraoral photos for perio, fractured cusps, wear, pre-Invisalign records are billable if diagnostic in intent — not just for marketing. Document: clinical indication for each photo.
Periodontics 40000 series

Periodontal Surgery — Crown Lengthening, Grafts & GTR

Crown lengthening (new 2022)

CodeDescriptionFee
42311Gingivectomy / gingivoplasty — soft tissue only~$577
42451Flap + osteoplasty/ostectomy for crown lengthening — per site~$779–971
When is 42451 the correct code?
Any time bone is removed to establish biologic width before a crown impression. If you only cut soft tissue (gingivectomy), use 42311. If you open a flap and remove bone — even a small amount — 42451 is required. Document: pre-op PA, intra-op photos, biologic width measurement, 6–8 week healing interval.
Soft tissue grafts (per site)
42511 Pedicle graft: ~$904
42521 Free gingival graft: ~$904
42561 Autograft — free connective tissue (includes harvest): ~$1,489
42562 Allograft: ~$934
42552 Allograft for root coverage: ~$934

Autograft (42561) costs 59% more than allograft (42562) for the same recipient site — and is the more evidence-based option for root coverage.

Guided tissue regeneration & bone grafts

CodeDescriptionFee
42701GTR — non-resorbable membrane / site~$898
42702GTR — resorbable membrane / site~$898
42703GTR membrane removal (re-entry, non-resorbable)~$238
42721 +EBiologics / PRF / materials (no flap included)~$559
42621 +EOsseous allograft, with flap entry and closure~$1,559
⚠️ 42621 vs 42721 — most common confusion
42621 includes surgical entry + closure. Use when you are performing the full grafting procedure including raising a flap.

42721 is the material-only code (PRF, growth factor, membrane) used in addition to another surgical entry code when the materials are placed during a separately coded procedure.
  • Socket preservation at time of extraction: bill the extraction code + 42721 +E (material only, since the socket is already open)
  • Sinus lift lateral window: 42621 (graft with flap) + 42721 (membrane/PRF, in addition) + +E for each material
  • Bone graft membrane removal at second stage: 42703
Surgery 70000 · Restoration 20000 · Adjunctive

Implant-Related Codes — Half the Billing Is Usually Missed

Pre-surgical

02951/02952 +L +E
Radiographic guide
Diagnostic stent/guide for imaging. ~$202 +L +E.
03001/03002 +L +E
Surgical template
Actual guided surgery template from wax-up. ~$202 +L +E.
07011–07013
CBCT acquisition
Small FOV: ~$202. Large FOV 1 arch: ~$401. 2 arches: ~$551.

07031 interpretation is separately billable (~$93/unit). Most offices forget it.

Surgical phase

79931–79933 +E
Implant placement — per implant
Cover screw: ~$1,468. Healing abutment: ~$1,468. Final transmucosal element: ~$1,947. +E for the implant fixture.
79221 +E
Second stage / uncovering
~$266. Frequently absorbed into the placement fee — it is a distinct, separately billable appointment.
29341–29349 +E
Removal/replacement of healing abutment
~$98/unit. To refine emergence profile before impression. Almost always missed.

Restorative phase

26101–26103 +L +E
Mesostructure / abutment
Indirect angulated, custom lab, or direct chairside. +L for lab, +E for the abutment component.
27205 / 27215 / 27305
Implant-supported crown
+$55 vs tooth-supported crown. Ceramic: ~$1,222. Metal-ceramic: ~$1,222. Cast metal: ~$1,222. +E for screws/components.
29351–29354
Removal of fractured retaining screw
Separate billable procedure when a screw fractures inside the implant. ~$98/unit. Often given away free.
Diagnosis 00000 series · Edge Cases

Diagnosis Codes — Grey Areas That Frequently Cost Revenue

Examination codes — common errors

  • 01101 vs 01102 vs 01103 — Complete exam codes differ by dentition stage, not patient age. A 7-year-old in mixed dentition is 01102, not 01103. Insurers downgrade based on age of patient vs dentition.
  • 01201 (new limited exam, new patient) includes PSR but not full probe score. Useful for emergency new patients. Note: it can create frequency issues if a 01103 complete exam is billed too close after.
  • 01204/01205 Specific/Emergency exam — range of ½ to 2 units ($56–$162). Using only the top of the range "without consideration of time" is explicitly described in the Guide as contrary to ODA policy.

Radiograph interpretation codes (2022+)

CodeDescriptionFee
02811–02819Interpretation of radiographs from another source~$93/unit
07031–07039CBCT interpretation (per 15-min unit)~$93/unit
07021–07029CBCT image processing~$93/unit

Frequently forgotten diagnosis codes

05101–05109
Treatment planning (complex cases)
For full-mouth rehabilitation, implant work-ups, complex ortho. Time spent beyond what is implicit in the exam fee is separately billable. Document time.
04401
Cytological smear / brush biopsy
+L +E. Brush biopsy (OralCDx, Oral ID) of suspicious mucosal lesion. Almost never billed in GP practices despite routine performance. Document: lesion description, location, clinical photos.
04311 / 04312
Soft tissue biopsy (by aspiration / by incision)
+L. Separately billable when a lesion is biopsied and sent to oral pathology lab. 99113 (pathology expense) is the +L pass-through for the lab fee.
08011–08019
Remote assessment — after-hours triage
~$87/unit. Telephone or video triage of a chief complaint. Some private plans reimburse. Document: call duration, CC, advice given, outcome.
Adjunctive General Services 90000 series

Adjunctive Services — Report Writing, Bleaching, Consultations

Reports & forms

93301–93303
Form completion
Insurance forms, disability forms, workplace accident forms. ~$58–$174 depending on complexity. Bill it every time — it costs time.
93121–93123
Written report to third party
Medico-legal reports, specialist referral letters, insurance narratives. ~$87/unit. Underused despite being time-consuming.
93111–93119
Consultation with member of profession
Phone/letter consult with specialist, MD, or another dentist about a shared patient. ~$87/unit. Rarely billed despite regular occurrence.

Whitening / bleaching

97111–97119
In-office vital bleaching
Per 15-min unit. ~$155/unit. A typical 60-min in-office Zoom/Opalescence session = 4 units = ~$620 + materials. +E for bleaching agent.
97123
At-home tray bleaching
Maxillary + mandibular combined. ~$406 +L. The +L covers the lab cost for custom trays.
39311–39319
Non-vital bleaching (internal)
Endodontics series. Time-based internal bleaching post-RCT for a discoloured anterior. Highly underused. Each walking bleach appointment billable separately.

Pass-through expenses

99111
Commercial lab expense (+L)
Pass-through for any commercial lab fee. Must be disclosed to patient. Bill actual cost.
99121 +E
Materials / drug expense
(Renumbered from 99555 in 2025.) Covers implant components, bone substitutes, PRF kits, Icon, SDF, and other material pass-throughs. Bill at actual cost.
99777 +PS
Professional service from outside provider
New 2022. Covers fees from outside professionals passed through to the patient (e.g. lab interpretation fees, specialist consultation billed through your practice). Bill actual cost.
Prevention 10000 series · Pediatric

Space Maintainers — Consistently Underbilled in Every Pediatric Practice

CodeDescriptionFee
15101Band-type, fixed, unilateral~$201
15103Soldered lingual arch, bilateral~$401
15201Stainless steel crown type, fixed~$401
15401Removable acrylic with clasps~$252
15501Bonded pontic type~$252
15601Maintenance / recementation after 30 days~$92
15603 +LRepair (incl. recementation)~$138
When a space maintainer is indicated
Early loss of primary molar before age 9, when the permanent premolar has less than ¾ root formation. Failing to maintain space typically results in orthodontic correction years later — a much larger cost to the patient. The space maintainer at ~$201–$401 is the ethical and cost-effective choice.
Why most practices leave this revenue uncaptured
Most GPs refer the extraction but forget to offer or bill the space maintainer. When the GP does the extraction, the space maintainer conversation should happen at the same appointment. The band-and-loop or Nance appliance can be delivered 2 weeks later.

If referred out, the receiving dentist may or may not place a SM — follow up and offer to manage it in-house.
14101/14102 vs 88101–88109
Habit appliance vs orthodontic appliance
14101/14102 (removable habit appliance, ~$323) = intent is habit cessation (thumb, tongue thrust).

88101–88109 (ortho removable) = intent is tooth movement.

Wrong series = wrong claim. Intent drives the code.
15601 — 30-day rule
Recementation or maintenance within the first 30 days of delivery is included in the original fee. After 30 days, 15601 (~$92) is a separately billable appointment. Most practices never bill this follow-up code.
Compliance

The 6-Question Chart Note That Defends Every Code

Every chart note for a coded procedure should answer these six questions before the claim goes out.

1
What was the clinical finding?
Pocket depths, lesion ICDAS score, fracture pattern, calcification on PA, root divergence, bony impaction depth.
2
What was the intent of treatment?
Therapeutic SRP, biologic width restoration, calcified canal negotiation, bonded core placement, coronectomy for IAN protection.
3
What was actually performed?
Specific surfaces, materials used, flap elevated, bone removed, sectioning performed, adhesive system used, time spent per activity.
4
What did the patient consent to?
Informed consent including alternatives and risks, specific to the actual procedure performed (not a generic "dental consent").
5
What images/measurements support the code?
PA, bitewing, CBCT, intraoral photo, perio chart with date, pocket depths, furcation class, mobility grade — linked explicitly to the tooth treated.
6
What is the post-op plan?
Follow-up appointments, re-evaluation date (e.g. 49101 at 6 weeks for perio), medications, post-op instructions given.
Implementation

Five Workflow Changes That Capture Revenue Starting Monday

💻
1. Code prompts in the software
When a dentist enters an extraction code, the software should prompt: "Was a flap elevated? Was the tooth sectioned? If yes → 71201." Same for composites: "Document surfaces explicitly in the post-op note."
📋
2. End-of-day restoration audit
Treatment coordinator reviews every restoration coded that day against the chart entry. Are the surfaces documented? Was bonding noted for bonded codes? Takes 5 minutes.
🪥
3. Hygiene morning huddle
Before each recall, hygienist flags patients with: pockets ≥4 mm (→ root planing?), cervical sensitivity (→ 41301 desensitization?), white spots (→ 13601 SDF or resin infiltration?), wear facets (→ 14611 night guard conversation?).
🔍
4. Quarterly chart audit
Pull 10 random charts. Check: code billed vs chart documentation. Track the top 3 documentation gaps. Use them as training topics for the next team meeting. Rotate the auditor role among treatment coordinators.
📅
5. Annual fee guide review (every January)
New codes, deactivated codes, and amended descriptions change every year. The 2026 guide had 30+ changes including new surgery, endo, and sedation codes. Assign one team member to read the changes memo and brief the team.
ODA Practice Advisory — free for members
1-866-739-8099 ext. 3301
Confidential coding questions, Mon–Fri 8:30 am–4:30 pm. Use this before submitting an unusual claim — they will tell you which code applies and what documentation is needed. No charge, no judgment.
Summary

Key Takeaways — What Every Team Member Should Know

📐
Count surfaces accurately
  • Buccal past line angle = 2 surfaces
  • Occlusal with proximal box = 2+ surfaces
  • Class IV past incisal edge = incisal counts
  • Always document surfaces in the post-op note
  • Intraoral photo of prep = best defence
⚡
Document the surgical element
  • Flap elevated OR tooth sectioned = 71201 (not 71101)
  • Bone removal for crown lengthening = 42451 (not 42311)
  • Calcified canal that resists #10 file = 33134/33144
  • Retreatment of prior RCT = 33115–33146, never 33111
  • Access through existing crown = 39211/39212 add-on
💰
Offer the underused services
  • Night guards (14611) for every bruxer
  • SDF (13601) for high-risk patients
  • CBCT interpretation (07031) after every CBCT
  • Space maintainers for early primary loss
  • Desensitization (41301) post-SRP / post-crown prep
  • Remote assessment (08011) for after-hours triage
Legitimate billing optimization is not about finding loopholes — it is about accurately reflecting the complexity of what was done, documenting it so the chart stands on its own, and offering patients evidence-based services that improve their oral health. The revenue follows from doing both those things well.
ODA Advisory Services · 1-866-739-8099 ext. 3301 · mmoreto@oda.ca