Item 1 (Exams and Diagnosis) and Item 2 (Preventive and Periodontal)

Section I - Oral Health Examination and Diagnosis

1-(a) Extensive Clinical Examination

• The extensive clinical examination now has a minimum recall period of 12 months.
• Depending on each patient’s dental history and clinical assessment, the recall frequency can be set at 12, 18 or 24 months.
• It cannot be claimed again by the same dentist for the same patient within 11 complete calendar months. Item 1-(a) can be claimed within 11 complete calendar months by an Orthodontist or by a GDP, if submitted as part of an orthodontic claim.
• Dentists are not expected to extend the recall after the first new patient examination, as there will be no known history of patient behaviours. If, in your clinical opinion, the patient is a high risk for dental disease or other oral health issues, then earlier recall may be appropriate using the item 1-(b) Review Examination, at intervals determined by the clinical evaluation.
• Dentists are not expected to complete a full 6-point pocket chart at this examination. If, following a BPE recording of 3 or 4 and/or interdental bone loss, the practitioner determines that the patient requires further periodontal assessment, this would be completed and claimed under item 2(c) Periodontal Assessment and Treatment.
• If a patient presents with a complaint or emergency at examination appointment 1-(a) or 1-(b) that was not expected, item 1-(c) Unscheduled Care Assessment and Treatment can additionally be claimed but must be submitted on a separate claim. 1-(c) can only be claimed if there are no other items of treatment that can be claimed to deal with the unexpected complaint or emergency.
• Where the recall interval for a patient will no longer be 6 months, information should be clearly communicated to the patient outlining the factors that have determined this recall period in order to alleviate concern.

1-(b) Review Examination

• A review examination under item 1-(b) can be claimed when risk factors have been identified that require an additional appointment to allow for review between examinations, at a time outwith an open course of treatment.
• The clinical examples listed under item 1-(b) are not exhaustive. A claim must be clinically justified, and the justification recorded in the patients records.
• There is no time bar to item 1-(b), however, it cannot be claimed as part of an open treatment plan which includes a 1-(a) Extensive Clinical Examination. For example:
  • if at a 1-(a) Examination, a suspicious lesion is identified as well as a need for a filling, the dentist might need to see the patient to review the suspicious lesion sooner than the filling appointment.
  • In that case, the dentist could claim a 1b review exam whilst the course of treatment for the filling is still open, but they would do this as a separate claim.
• Item 1-(b) can be claimed with item 2-(a) Enhanced Preventive Advice and Treatment (including Childsmile). To claim item 2-(a), 2 complete calendar months must have passed since the last item 2-(a) was claimed.

1-(c) Unscheduled Care Assessment and Treatment

• This item is for use when a patient attends an unscheduled appointment as an emergency or has an acute condition and there is no other code in Determination I which can be claimed. The clinical examples listed under item 1-(c) are not exhaustive and it can be claimed for other clinically appropriate reasons, which should be recorded in the patients records for example:
  • managing lesions;
  • TMJ dysfunction;
  • temporary dressings;
  • recementing crowns;
  • any other scenario for which there is no other code that can be claimed.
• Item 1-(c) must be claimed on its own. It can be claimed in addition to another examination/treatment item if unscheduled treatment is also required when a patient attends the practice, but the 1-(c) must be submitted as a separate claim.
• If a patient is seen as an emergency and the full root canal course of treatment cannot be started at that appointment, but the dentist needs to drain the root canal, do a pulp extirpation, or incise an abscess, as a palliative for a patient in pain until they can be seen for a routine appointment to undertake the course of treatment, then a 1-(c) could be claimed for the unscheduled care appointment. Once the patient comes back to start the course of treatment then item 3-(f), (g), or (h) could be claimed (as appropriate) for the routine treatment. The 1-(c) should be submitted as a separate claim.
• Item 1-(c) cannot be claimed for the arrest of haemorrhage at the same appointment as item 5-(a) Extraction, 5-(b) Surgical Extraction or 5-(c) Advanced Surgical Dentistry. However, it can be claimed if a patient returns due to further bleeding for an unscheduled appointment later on the same day.

1-(d) Intraoral Radiograph

• This item is claimed for all intraoral radiographs, their assessment and reporting. The fee is per radiograph.
• Clinical discretion is required as per IR(ME)R guidance. There is no restriction on the number of radiographs, as long as there is clinical justification.

1-(e) Extraoral Radiograph

• This item is claimed for all extraoral radiographs, their assessment and reporting and the fee is per radiograph.
• Clinical discretion is required as per IR(ME)R guidance. There is no restriction on the number of radiographs, as long as there is clinical justification.

1-(f) Study Models (per set)

• This item can be claimed for a single set of study casts or digital study models.
• Photographs of study models are now routinely requested by Practitioner Services; therefore, duplicate study models cannot be claimed.
• Item 1-(f) cannot be claimed for a patient more than once in any 11 complete calendar months. Where in connection with Orthodontic treatment, item 1-(f) can be claimed up to twice per course of treatment.

Section II – Preventive Care and Periodontal Treatment

2-(a) Enhanced Preventive Advice and Treatment (including Childsmile)

• Item 2-(a) can be claimed after 2 complete calendar months from a previous claim under item 2-(a), if clinically required, by the same dentist.
• Item 2-(a) should be claimed when treating patients with a BPE of 1 or 2 or as part of periodontal maintenance therapy. This aligns with Step 4 of the BSP guidance.
• Item 2-(a) should be claimed for the delivery of Childsmile. This can also be delivered by a Therapist, Hygienist or Childsmile nurse on the instruction of a dentist.
• Item 2-(a) cannot be claimed with items 2-(c) or 2-(d) in the same course of treatment.
• A scale and polish, now termed Professional Mechanical Plaque Removal (PMPR), can be claimed under item 2-(a), alongside preventive advice.
• Fluoride varnish can be applied to any dentate or partially dentate patient, including adults, if a patient is at high risk of caries. Fluoride varnish should, with parental/guardian consent, also be applied to children as part of Childsmile up to the age of 12 years old.
• Interdental cleaning advice should be provided to any patient based on clinical findings.

In some specific clinical circumstances, it may not be possible to record a basic periodontal examination by probing. If BPE examination has not been recorded by probing due to a specific clinical issue, then code X should be entered as the appropriate periodontal matrix code.

2-(b) Fissure Sealants

• Fissure sealants can be applied by dentists, hygienists and therapists.
• Fissure sealants can be applied to and claimed for:
• unfilled permanent molars within 2 years of eruption
• hypoplastic premolars within 2 years of eruption
• unfilled retained deciduous molar teeth
• If a fissure sealant de-bonds within 23 months of its application, it should be maintained/replaced as part of the original claim.
• For patients with special care needs (adults included) or those with high caries risk, item 2-(b) can be claimed for:
• initial applications after 2 years of eruption and;
• additional applications can be claimed after 23 complete calendar months from the last application on the same tooth.

2-(c) Periodontal Assessment and Treatment for patients with a BPE of 3 or 4 and/or interdental bone loss (standard)

• This item is to be used for initial periodontal assessment and subsequent treatment and advice.
• Professional Mechanical Plaque Removal (PMPR) with supra- and subgingival scaling can be completed at the start of treatment, to allow for assessment. This aligns with Step 2 of the BSP guidance. This can be completed by a hygienist or therapist and claimed via the prescribing dentist.
• A treatment plan should be given to the patient, explaining their role and responsibility in their own treatment.
• Where more than 1 treatment appointment is required, additional appointments (up to 3) can be claimed under item under 2-(e) in a course of treatment.
• Item 2-(c) can be repeated and claimed after no less than 2 complete calendar months from the previous course of treatment claimed under item 2(c) or 2(d) as long as a review examination 1-(b) with a 6-point pocket chart has been completed.
• If a patient has responded well to treatment and is stable then they should proceed to maintenance therapy, step 4 of the BSP guidance claiming item 2-(a) as appropriate. This treatment can be completed by a hygienist or therapist and claimed via the prescribing dentist.
• Should the patient have responded well to treatment and advice, but there are residual non-responding sites, then item 2-(d) Periodontal Assessment and Treatment (enhanced) for patients with a BPE of 3 or 4 and /or interdental bone loss could be provided and claimed. See Step 3 of the BSP guidance.
• If a patient has not responded well to treatment or advice, then item 2-(c) can be repeated as required. This can be carried out every 2 complete calendar months (following a 1-(b) review each time) if, in your clinical opinion, you consider a patient is engaged or is attempting to engage and has mitigating factors beyond their control. Periodontal review
• Item 1-(b) can be claimed for a Periodontal Review, 2 complete calendar months after a claim for periodontal treatment has been completed, prior to proceeding with another course/claim of treatment under 2-(c) and 2-(d). This can be completed by a hygienist or therapist.
• If in your clinical opinion, you consider a patient is not taking responsibility or engaging with their treatment, then the dentist may decide to cease treatment. This decision should be recorded in the patients records with clear justification.
• If a patient returns and wishes to re-engage with the necessary periodontal treatment, then the process can be re-started.

2-(d) Periodontal Assessment and Treatment for patients with a BPE of 3 or 4 and/or interdental bone loss (enhanced)

• This item can be claimed for the treatment of patients who have completed item 2-(c) and have non-responding sites. This aligns with Step 3 of the BSP guidance.
• If a patient has not responded well to treatment or advice, then item 2-(c) or 2-(d) can be repeated as required. This can be carried out every 2 complete calendar months (following an item 1-(b) review each time) if, in your clinical opinion, you consider a patient is engaged or is attempting to engage and has mitigating factors beyond their control.
• If a patient has responded well to treatment and is stable then they should proceed to maintenance therapy, step 4 of the BSP guidance which can be claimed under item 2-(a).

2-(e) Additional Periodontal Supplement

• This can be claimed alongside item 2-(c) or 2-(d) where multiple appointments are required to treat more than one sextant.
• It can be claimed a maximum of 3 times per course of periodontal treatment under items 2-(c) or (d).