Skip to content The following table lists eligible denture procedures available to recipients of Ontario Works OW and Ontario Disability Support Program ODSP. Please note lab fees, exams, cleaning and other services necessary for the placement, repair addition or reline of the denture are included in the fees. Procedure Service GP Fee Specialist Fee Dentures Replacement of dentures is limited to once in a five-year period. Complete/partial over dentures are not a covered benefit. Complete upper $ $ Complete lower $ $ Partial upper $ $ Partial lower $ $ Repairs – Complete Denture Limited to a maximum of $ per denture per 12 consecutive months. Maxillary +L Up to $ Up to $ Mandibular +L Up to $ Up to $ Additions/ Repairs – Partial Denture Replacement of existing dentures will not be considered within six months from date of repair/addition No impression required upper $ $ No impression required lower $ $ Impression required upper Up to $ Up to $ Impression required lower Up to $ Up to $ Reline Relines are limited to once every 36 months. Relines within three months of insertion are not covered. Replacement of existing dentures will not be considered within six months from date of reline. Complete upper $ $ Complete lower $ $ Partial upper $ $ Partial lower $ $ Eligible Emergency Dental Procedures The following table lists eligible emergency dental procedures available to recipients of Ontario Works OW. Please note Lab fees are included in the fees listed in the schedule of covered emergency dental procedures. A differential rate will be paid to a licensed specialist for services performed within their specialty and when the patient was referred to the specialist by a general dentist. Procedure Code Service GP Fee Specialist Fee Preventive 13601 Topical application to hard tissue lesions of antimicrobial or remineralization agent. One unit only. $ $ Diagnostic Coverage is limited to one time unit 15 minute interval only. 01204 Specific examination $19 $ 01205 Emergency examination $19 $ Radiographs Only six Intraoral radiographs will be considered in 12 consecutive months. Periapical 02111 Single periapical $ $ 02112 Two periapical $ $ 02113 Three periapical $ $ Bitewing 02141 Single bitewing $ $ 02142 Two bitewings $ $ 02143 Three bitewings $ $ Panoramic 02601 Single film $ $ Tests The lab codes are eligible only in conjunction with codes 04311, 04312, 04321, 04322. Lab costs are included in the fees listed in the Schedule of Covered Emergency Dental Procedures for all other procedures. Histological, soft tissue 04311 Biopsy, soft oral tissue by puncture +L* $ $ 04312 Biopsy, soft oral tissue by incision +L* $ $ Histological, hard tissue 04321 Biopsy, hard oral tissue by puncture +L* $ $ 04322 Biopsy, hard oral tissue by incision +L $ $ Lab Codes *99222 Commercial lab fee up to a maximum of fee listed $ $ *99333 In office lab fee up to a maximum of fee listed $ $ Restorative Coverage for the codes is provided only when treatment is rendered within 30 days of accident. Coverage is not provided for surfaces re-treated within two years. Trauma, Control, Smoothing Teeth 20131 First tooth $ $ 20139 Each additional tooth, same quadrant $ $ Caries, Trauma, Pain Control 20111 First Tooth $ $ 20119 Each additional tooth, same quadrant $ $ Amalgam Non-Bonded, Permanent Bicuspids and Anteriors 21211 One surface $ $ 21212 Two surfaces $ $ 21213 Three surfaces $ $ 21214 Four surfaces $ $ 21215 Five surfaces or maximum surfaces per tooth $ $ Non-bonded Permanent Molars 21221 One surface $ $ 21222 Two surfaces $ $ 21223 Three surfaces $ $ 21224 Four surfaces $ $ 21225 Five surfaces or maximum surfaces per tooth $ $ Bonded, Permanent Bicuspids and Anteriors 21231 One surface $ $ 21232 Two surfaces $ $ 21233 Three surfaces $ $ 21234 Four surfaces $ $ 21235 Five surfaces or maximum surfaces per tooth $ $ Bonded, Permanent Molars 21241 One surface $ $ 21242 Two surfaces $ $ 21243 Three surfaces $ $ 21244 Four surfaces $ $ 21245 Five surfaces or maximum surfaces per tooth $ $ Etch/Bond Technique Coverage is provided for Permanent Anteriors and Bicuspids only. Permanent Anteriors 23111 One surface $ $ 23112 Two surfaces $ $ 23113 Three surfaces $ $ 23114 Four surfaces $ $ 23115 Five surfaces $ $ Tooth-Coloured, Permanent Bicuspids 23311 One surface $ $ 23312 Two surfaces $ $ 23313 Three surfaces $ $ 23314 Four surfaces $ $ 23315 Five surfaces $ $ Pulpectomy Coverage is not provided for molar teeth including single or multiple canals. Permanent Anteriors and Bicuspids 32311 One canal $ $ 32312 Two canals $ $ Endontics Root Canal Therapy 33111 One canal tooth 13, 12, 11, 21, 22, 23, 33, 32, 31, 41, 42, 43 $ $ 33121 Two canals tooth 13, 12, 11, 21, 22, 23, 33, 32, 31, 41, 42, 43 $ $ Extractions Erupted Teeth Uncomplicated 71101 Single tooth $ $ 71109 Additional tooth, same quadrant $19 $ Complicated, Surgical Approach 71201 Single tooth $ $ 71209 Additional tooth, same quadrant $ $ Removal of Residual Roots – Erupted 72311 First tooth in arch $ $ 72319 Each additional tooth, same quadrant $ $ Impactions Soft Tissue Coverage 72111 Single tooth $ $ 72119 Additional tooth, same quadrant $ $ Bone Coverage either removal of bone and tooth or sectioning and removal of tooth 72211 Single tooth $ $ 72219 Additional tooth, same quadrant $ $ Bone Covered Required removal of bone and sectioning of tooth for removal 72221 Sectioning single tooth $ $ 72229 Sectioning additional tooth, same quadrant $ $ Residual Roots Soft Tissue Coverage 72321 First tooth $ $ 72329 Additional tooth, same quadrant $ $ Residual Roots Bone Tissue Coverage 72331 First tooth $ $ 72339 Additional tooth, same quadrant $ $ Intra-Oral Incision Incision and Drainage 75111 Intra-oral incision and drainage $ $ Conscious Sedation Nitrous Oxide and Oxygen 92411 One units of time $ $ 92412 Two unit of time $ $ 92413 Three units of time $ $ 92414 Four units of time $ $66 92415 Five units of time $ $ 92416 Six units of time $ $ 92417 Seven units of time $ $ 92418 Eight units of time $ $