Core OHIP dental service code inventory for billing clerks

Core OHIP dental service code inventory for billing clerks

Symptoms

Use this article when a clerk is asking:

  • What code family am I looking at?

  • Is this a routine code, premium code, virtual code, or prior approval code?

  • Which codes should our team memorize first?

Cause

Most new dental clerks struggle because they try to memorize all codes at once. That usually leads to coding errors. It is safer to learn the code families in the order they appear in real billing work.

Resolution

Tier 1 — memorize these first

Consultation and visit family

  • T650 — hospital consultation

  • T651 — follow-up assessment within 12 months, same diagnosis

  • T652 — visit to admitted bed patient

  • T653 — examination under general anesthesia

  • T654 — diagnostic imaging add-on to T653 where applicable

Virtual family

  • T655 — virtual consultation

  • T656 — virtual follow-up assessment

Special handling family

  • T800 — independent consideration / unlisted dental surgical claim

Premium family

  • T809 — 30% non-elective surgical premium

  • T810 — 50% non-elective surgical premium

  • T814 — 30% virtual consultation/visit premium for evening/weekend/holiday

  • T815 — 30% virtual consultation/visit premium for intensive care setting

  • T816 — 50% virtual consultation/visit premium for midnight to 7:00 a.m.

Tier 2 — prior approval / Part III family

These are the code ranges clerks should recognize immediately as prior-authorization-sensitive:

  • T901–T912

  • T925–T928

  • T936

  • T950

Tier 3 — how to use the inventory

When building an internal office cheat sheet, do not list only the code and fee. For each code or code family, include:

  • code,

  • plain-language description,

  • setting requirement,

  • required documentation,

  • manual review / prior approval flag,

  • and common rejection reason.

That format works better for both staff training and Zoho Answer Bot search.

Examples

Example 1 — routine consult family
Question from staff: “Which family does T651 belong to?”
Answer: consultation/follow-up family.

Example 2 — special handling family
Question from staff: “What should I think when I see T800?”
Answer: not routine; think independent consideration.

Example 3 — prior approval family
Question from staff: “What should I think when I see T905?”
Answer: Part III / prior-authorization-sensitive workflow.

Example 4 — premium family
Question from staff: “What should I think when I see T815?”
Answer: virtual/in-person premium logic tied to ICU/intensive care conditions.