Which OHIP dental service codes should billing clerks know?

Which OHIP dental service codes should billing clerks know?

Short answer
The hospital dental OHIP schedule is much broader than most clerks expect. For day-to-day work, clerks should know the access/assessment codes, the premium codes, the virtual-care codes, and the Part III prior approval extraction codes first. Then they should learn the broader surgical families by category rather than memorizing every code in isolation. The official schedule remains the source of truth for code existence and wording, while the current fee master should be used for current payment amounts.

A. High-priority code family for most clerks

Consultations, visits, and virtual care

  • T650-T654 - hospital consultation and related visit/examination codes.

  • T655-T656 - virtual consultation and virtual follow-up assessment.

  • T814-T816 - virtual care premiums.

  • T811-T813 - in-person consultation/visit premiums.

Emergency and support

  • T630-T632 - emergency/post-surgical care codes.

  • T643-T644 - surgical assisting.

  • T800 - unlisted procedure / independent consideration.

  • T809-T810 - non-elective surgical timing premiums.

B. Prior approval and hospital oral surgery codes clerks should recognize immediately

These are the codes most likely to trigger preapproval thinking in clerk workflow:

  • T901-T912 - odontectomy / impacted tooth and related surgical exposure/removal family. This includes erupted, complicated, soft tissue, partial bony impaction, complete bony impaction, unusual position, residual root, and surgical exposure variants.

  • T925-T928 - frenectomy/frenoplasty Part III family.

  • T936 - alveoloplasty independent of tooth extraction.

C. Working inventory by category

This inventory is designed for searchability in Zoho Answer Bot. It is grouped the way clerks usually think about incoming claims, not just the way surgeons think about surgery.

Assessment and access

  • T650-T656: hospital consults, follow-ups, admitted bed visits, examination under general anesthesia, diagnostic imaging add-on, and virtual consult/follow-up family.

Emergency / post-op / assisting / unlisted / premiums

  • T630-T632: bleeding control and post-surgical care.

  • T643-T644: assistant billing.

  • T800: unlisted procedure / independent consideration.

  • T809-T816: surgical timing premiums plus consultation/visit/virtual-care premium families.

Soft tissue and periodontal-type surgical families

  • T330-T339, T341-T354: gingivoplasty and vestibuloplasty family.

  • T580-T583: frenectomy/glossectomy/myotomy family outside Part III grouping.

  • T925-T928, T936: Part III frenectomy/alveoloplasty family.

Biopsy, aspiration, pathology-type support

  • T660, T662-T663, T665, T667-T669: biopsy and cytology / aspiration family.

Incision, drainage, exploration, and sequestrectomy

  • T387-T389, T393, T395-T396, T401-T406: surgical exploration, incision, drainage, and sequestrectomy family.

Cysts, tumours, and resection

  • T368-T378, T390-T392, T394: cysts and tumours family.

  • T407-T409, T427-T429, T445: maxillectomy/mandibulectomy family.

Reconstruction, fixation, fracture, and orthognathic families

  • T101-T114, T117-T118, T210-T211, T359-T364, T382-T386: reconstruction family.

  • T121-T126, T410, T412-T416, T419-T420, T422-T423, T435-T439, T589: fixation family.

  • T424-T426, T430-T433, T440-T443, T450-T452, T460-T465, T468, T470-T471, T480-T481, T488-T489, T491, T493-T496: fracture family.

  • T022-T031, T040-T043, T200-T202, T212-T214, T532, T534, T536, T538, T540-T548, T550-T551, T553-T556, T558-T562, T565, T567, T579, T740-T744, T747-T748, T750-T751: orthognathic surgery family.

TMJ, neuro, salivary, sinus, airway

  • T219-T220, T225, T231-T239, T527-T528, T531, T533, T535, T537, T590-T596, T598-T599: temporomandibular joint family.

  • T605, T607-T614, T618-T619, T633-T639, T645-T647: neurological disturbances family.

  • T230, T454-T458, T601-T603, T606, T760-T761: salivary gland family.

  • T620, T622-T625, T628-T629, T664, T666: maxillary sinus family.

  • T310-T312: tracheotomy family.

Endodontic surgery

  • T701-T712: root resection and apical curettage family.

Part III extraction and exposure family

  • T901-T912: odontectomy and surgical exposure family. This is one of the most important families for clerks because it overlaps heavily with prior approval logic, same-day consult problems, and hospital necessity questions.

D. Best practice for code lookup in daily work

Do not build your office cheat sheet around fee amounts only. Build it around:

  1. code,

  2. plain-language description,

  3. setting requirement,

  4. special documentation rule,

  5. manual review or prior approval trigger, and

  6. common denial reason.

That structure matches the way claims are actually rejected and is more useful for Answer Bot than a flat fee list. It also avoids stale fee errors when Ontario publishes fee increases or fee schedule master changes.

Citations

  • Ontario OHIP dental schedule page.

  • Schedule of Benefits - Dental Services under the Health Insurance Act.

  • Ontario dental fee increase and fee schedule master update bulletins.

  • Ontario technical specifications listing specialized submissions and prior-authorization dental codes.