Common use of Service Delivery Information Clause in Contracts

Service Delivery Information. The Provider will report all treatments provided to patients to the Payment Agent. This data, along with the treatment claims, will be submitted after the patient’s treatment has been Completed. All reporting will be as per the Operational Guidelines. The eligibility criteria that patients must meet before they can receive the Services listed below are specified in the service specifications contained in Part E of this Agreement. The pricing terms applicable to the Services are set out in this Part F. The standard services described in clause E5.1 of this Agreement will be purchased as a package. You will receive one payment per patient per year for these standard Services after the date you have either: a. achieved Completion for that patient; or b. you have reported to us non-Completion relating to that patient, provided that: i. the patient attended their annual check-up. ii. the patient failed to present for further treatment, scheduled in accordance with the action plan of services to be carried out for that patient following that patient’s annual check-up. iii. you have used your best endeavours to get the patient to present for their further scheduled treatment, including at least two documented recalls for treatment; and iv. you have reported such non-Completion to us. v. You agree to only claim payment from us for services provided within your local Te Whatu Ora district for the Service Area outlined in Part G. The price paid to you for each patient will be according to the school EQI applicable. The relevant price is set out in the table below (as amended from time to time under clause A39). 569 to 491 Band 1 COM1 $233.33 490 to 448 Band 2 COM2 $179.76 447 to 365 Band 3 COM3 $147.15 If a patient is attending a high school that is not assigned an EQI number by the Ministry of Education, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 3. If a patient is not enrolled at a high school, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 2. You agree to only claim payment from us for Services provided within the geographical areas for which we are responsible as specified in Part G whether or not a patient is resident within our geographical area. If you provide Services from a facility located outside the agreed geographical areas, then you agree not to claim for payment for those Services under this Agreement. You must have in place a separate contract for the additional facility with Te Whatu Ora. If you do not have a contract for the additional facility you will be responsible for arranging such contract and payment with Te Whatu Ora. F2.1 Schedule of prices for Additional Oral Health Services for Adolescents not Requiring Prior Approval Items Code Price (GST excl.) 2023/24 Item Code Price (GST excl.) 2023/24 F3 Schedule of prices for Oral Health Services for Adolescents Requiring High Caries Treatment Planning a. the enrolling adolescent is in Year 9 and has left the school dental service with extensive unmet treatment need. The Principal Dental Officer of the relevant school dental service should be made aware, if not already so, of such individuals leaving the service; or b. the adolescent has not attended the school dental service or any other health provider for an extended period of time, resulting in a large amount of unmet treatment need; OR c. the adolescent has recently entered New Zealand from overseas and, being an Eligible Person, presents to the oral health service provider with a large amount of unmet treatment need; or d. the adolescent’s caries risk has changed dramatically. The criteria for access to High Caries Treatment Planning funding is - where the adolescent can be shown to be in need of one surface fillings in four or more posterior teeth (molars and pre- molars) in addition to any other treatment needed. Once High Caries Treatment Planning has been approved the fees for the capitated items within the consultation package are able to be separately charged for as a fee for service as in clause F3.2 below.

Service Delivery Information. The Provider will report all treatments provided to patients to the Payment Agent. This data, along with the treatment claims, will be submitted after the patient’s treatment has been Completed. All reporting will be as per the Operational Guidelines. PART F: SERVICE PRICING FOR ORAL HEALTH SERVICES FOR ADOLESCENTS AND SPECIAL DENTAL SERVICES FOR CHILDREN AND ADOLESCENTS F1 Eligibility for and Pricing of Services The eligibility criteria that patients must meet before they can receive the Services listed below are specified in the service specifications contained in Part E of this Agreement. The pricing terms applicable to the Services are set out in this Part F. F2 Pricing for Standard Oral Health Services for Adolescents The standard services described in clause E5.1 of this Agreement will be purchased as a package. You will receive one payment per patient per year for these standard Services after the date you have either: a. achieved Completion for that patient; or b. you have reported to us non-Completion relating to that patient, provided that: i. : the patient attended their annual check-up. ii. the patient failed to present for further treatment, scheduled in accordance with the action plan of services to be carried out for that patient following that patient’s annual check-up. iii. you have used your best endeavours to get the patient to present for their further scheduled treatment, including at least two documented recalls for treatment; and iv. and you have reported such non-Completion to us. v. . You agree to only claim payment from us for services provided within your local Te Whatu Ora Health New Zealand district for the Service Area outlined in Part G. The price paid to you for each patient will be according to the school EQI applicable. The relevant price is set out in the table below (as amended from time to time under clause A39). 569 to 491 Band 1 COM1 $233.33 239.19 490 to 448 Band 2 COM2 $179.76 184.27 447 to 365 Band 3 COM3 $147.15 150.84 If a patient is attending a high school that is not assigned an EQI number by the Ministry of Education, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 3. If a patient is not enrolled at a high school, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 2. You agree to only claim payment from us for Services provided within the geographical areas for which we are responsible as specified in Part G whether or not a patient is resident within our geographical area. If you provide Services from a facility located outside the agreed geographical areas, then you agree not to claim for payment for those Services under this Agreement. You must have in place a separate contract for the additional facility with Te Whatu OraHealth New Zealand Area. If you do not have a contract for the additional facility facility, you will be responsible for arranging such contract and payment with Te Whatu Ora. Health New Zealand. F2.1 Schedule of prices for Additional Oral Health Services for Adolescents not Requiring Prior Approval Items Code Price The additional Services not requiring prior approval, described in clause E5.4 of this Agreement, will be purchased on a fee-for-service basis. You will receive payment for these additional Services for each patient after the date you have achieved Completion for that patient, or, if further treatments are required after the date, you have achieved Completion for that patient, after those further treatments are Completed. Payment for these additional services will be based on the information reported by you in accordance with clause E10. The payment you will receive, per Service provided, will be in accordance with the table below. Two surface (GST excl.approximo-occlusal) 2023/24 Item Code Price restorations in posterior teeth FIL2 $103.75 Three surface (GST excl.mesio-occlusal-distal) 2023/24 restorations in posterior teeth FIL3 $127.69 Complex coronal reconstructions in amalgam (including restoration of one or more cusps) FIL4 $143.32 Simple restorations in anterior teeth FIL5 $94.04 More than one surface restoration in anterior teeth FIL6 $126.46 Performed metal crowns CRN1 $81.31 Extractions (excluding extractions for orthodontic purposes) with LA EXT1 $153.77 Re-cement inlay or crown RCM1 $29.11 Panoramic radiographs RAD2 $48.15 Occlusal radiographs RAD3 $32.40 Root canal treatment and root filling in permanent anterior or premolar teeth (per canal) including all necessary radiographs performed during treatment and mandatory post-operative radiology for patient's record RCT1 $321.22 Pulp removal and root filling in deciduous tooth (maximum fees per deciduous tooth treated) RCT2 $176.22 Pulpotomy in deciduous teeth RCT3 $113.02 Pulpotomy in permanent teeth RCT4 $113.02 Emergency dressings EMD1 $33.31 Initial oral consultation for school dental clinic patients referred for Special Dental Services or for school dental clinic patients or adolescents who are not able to access their regular health provider in an emergency during normal practice hours CON3 $86.23 Emergency consultations outside normal hours CON4 $127.34 F2.2 Schedule of Prices for Additional Oral Health Services for Adolescents Requiring Prior Approval The additional Services requiring prior approval, as described in clause E5.5 of this Agreement, will be purchased on a fee-for-service basis. You will receive payment for these additional Services for each patient after the date you have achieved Completion for that patient. If further treatments are required after the date you have achieved Completion for that patient, then payment will be made after those further treatments are Completed. Payment for these Services will be based on the information reported by you in accordance with clause E10 of this Agreement. These additional Services may only be provided with the prior approval of Approving Dental Officer. Where the prior approval of an Approving Dental Officer is not sought but an application is made subsequently and not approved, then neither we nor the patient will be liable to pay for those Services. The payment you will receive, per Service provided, will be in accordance with the table below: Minor surgical operation or other time-based procedures (first half hour) MSO1 $99.97 Minor surgical operation or other time-based procedures (each additional quarter hour) MSO2 $49.96 Treatment of periodontal disease PDT1 $78.53 Precision-cast metal partial denture DENT1 $1,804.17 Precision-cast metal partial denture - each extra tooth DENT2 $60.75 Acrylic partial dentures DENT3 $784.29 Acrylic partial dentures - each extra tooth DENT4 $60.82 Acrylic partial dentures - each clasp DENT5 $31.59 Adessive Bridges (Maryland Type) ABMT $1,210.69 Ceramic to metal crowns CRN2 $1,049.35 All ceramic crowns (partial or full coverage, bonded or cemented) CRN3 $1,046.65 Gold Crown (Partial or full coverage) CRN4 $994.91 Full coverage composite crowns CRN5 $207.09 Bite Splints SPLT $526.30 Cast posts and cores PST1 $280.66 Preformed posts (para, flexi, etc) PST2 $116.52 Porcelain veneer VEN1 $902.03 Labial composite veneer VEN2 $139.27 Denture full upper or lower DEN6 $1,111.72 Denture upper and lower DEN7 $2,457.50 Apexification/root filling with an open apex APX1 $176.22 F3 Schedule of prices for Oral Health Services for Adolescents Requiring High Caries Treatment Planning Additional services for adolescents require High Caries Treatment Planning, as described in clause E5.2 of this Agreement, will be purchased on a fee-for-service basis. You will receive payment for these Services once the patient has Completed the course of treatment agreed between you and the Approving Dental Officer. Any further non-schedule treatments, necessary within the same Calendar Year, will also require the prior approval of the Approving Dental Officer. It is expected that High Caries Treatment Planning will arise in one of three ways: a. the enrolling adolescent is in Year 9 and has left the school dental service with extensive unmet treatment need. The Principal Dental Officer of the relevant school dental service should be made aware, if not already so, of such individuals leaving the service; or b. the adolescent has not attended the school dental service or any other health provider for an extended period of time, resulting in a large amount of unmet treatment need; OR c. the adolescent has recently entered New Zealand from overseas and, being an Eligible Person, presents to the oral health service provider with a large amount of unmet treatment need; or d. the adolescent’s caries risk has changed dramatically. The criteria for access to High Caries Treatment Planning funding is - where the adolescent can be shown to be in need of one surface fillings in four or more posterior teeth (molars and pre- pre-molars) in addition to any other treatment needed. Once High Caries Treatment Planning has been approved the fees for the capitated items within the consultation package are able to be separately charged for as a fee for service as in clause F3.2 below.

Service Delivery Information. The Provider will report all treatments provided to patients to the Payment Agent. This data, along with the treatment claims, will be submitted after the patient’s treatment has been Completed. All reporting will be as per the Operational Guidelines. The eligibility criteria that patients must meet before they can receive the Services listed below are specified in the service specifications contained in Part E of this Agreement. The pricing terms applicable to the Services are set out in this Part F. The standard services described in clause E5.1 of this Agreement will be purchased as a package. You will receive one payment per patient per year for these standard Services after the date you have either: a. achieved Completion for that patient; or b. you have reported to us nonNon-Completion relating to that patient, provided that: i. the patient attended their annual check-up.; ii. the patient failed to present for further treatment, scheduled in accordance with the action plan of services to be carried out for that patient following that patient’s annual check-up.; iii. you have used your best endeavours to get the patient to present for their further scheduled treatment, including at least two documented recalls for treatment; and iv. you have reported such nonNon-Completion to us. v. You agree to only claim payment from us for services provided within your local Te Whatu Ora district for the Service Area outlined in Part G. . The price paid to you for each patient will be according to the school EQI Decile applicable. The relevant price is set out in the table below (as amended from time to time under clause A39). 569 to 491 Band 1 Decile Score Code Price (GST Exc.) 2020/21 Decile 1-3 COM1 $233.33 490 to 448 Band 2 $ 160.19 Decile 4-6 COM2 $179.76 447 to 365 Band 3 $ 139.31 Decile 7-10 COM3 $147.15 $ 118.51 If a patient is not enrolled at a high school, or is attending a high school that is not assigned an EQI number by included on the Ministry list of Educationhigh schools provided to you under clause D1.3, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 3. If a patient is not enrolled at a high school, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 2school with a Decile Score of 4 – 6. You agree to only claim payment from us for Services provided within the geographical areas for which we are responsible as specified in Part G Schedule 1 to the Act, whether or not a patient is resident within our geographical area. If you provide Services from a facility located outside the agreed in another District Health Board’s geographical areas, then you agree not to claim for payment for those Services under this Agreementfrom us. You must have in place a separate contract for the additional facility with Te Whatu Ora. If you do not have a contract for the additional facility you Instead, it will be responsible your responsibility to claim for arranging such contract and payment with Te Whatu Orafrom the relevant District Health Board. F2.1 Schedule of prices for Additional Oral Health Services for Adolescents not Requiring Prior Approval Items Code Price (GST excl.) 2023/24 Item Code Price (GST excl.) 2023/24 F3 Schedule of prices for Oral Health Services for Adolescents Requiring High Caries Treatment Planning a. the enrolling adolescent is in Year 9 and has left the school dental service with extensive unmet treatment need. The Principal Dental Officer of the relevant school dental service should be made aware, if not already so, of such individuals leaving the service; or b. the adolescent has not attended the school dental service or any other health provider for an extended period of time, resulting in a large amount of unmet treatment need; OR c. the adolescent has recently entered New Zealand from overseas and, being an Eligible Person, presents to the oral health service provider with a large amount of unmet treatment need; or d. the adolescent’s caries risk has changed dramatically. The criteria for access to High Caries Treatment Planning funding is - where the adolescent can be shown to be in need of one surface fillings in four or more posterior teeth (molars and pre- pre-molars) in addition to any other treatment needed. Once High Caries Treatment Planning has been approved the fees for the capitated items within the consultation package are able to be separately charged for as a fee for service as in clause F3.2 below.

Service Delivery Information. The Provider will report all treatments provided to patients to the Payment Agent. This data, along with the treatment claims, will be submitted after the patient’s treatment has been Completed. All reporting will be as per the Operational Guidelines. The eligibility criteria that patients must meet before they can receive the Services listed below are specified in the service specifications contained in Part E of this Agreement. The pricing terms applicable to the Services are set out in this Part F. The standard services described in clause E5.1 of this Agreement will be purchased as a package. You will receive one payment per patient per year for these standard Services after the date you have either: a. achieved Completion for that patient; or b. you have reported to us nonNon-Completion relating to that patient, provided that: i. the patient attended their annual check-up.; ii. the patient failed to present for further treatment, scheduled in accordance with the action plan of services to be carried out for that patient following that patient’s annual check-up.; iii. you have used your best endeavours to get the patient to present for their further scheduled treatment, including at least two documented recalls for treatment; and iv. you have reported such nonNon-Completion to us. v. You agree to only claim payment from us for services provided within your local Te Whatu Ora district for the Service Area outlined in Part G. . The price paid to you for each patient will be according to the school EQI Decile applicable. The relevant price is set out in the table below (as amended from time to time under clause A39). 569 to 491 Band Decile 1 - 3 COM1 $233.33 490 to 448 Band 2 148.23 Decile 4 - 6 COM2 $179.76 447 to 365 Band 3 128.91 Decile 7 -10 COM3 $147.15 109.66 If a patient is not enrolled at a high school, or is attending a high school that is not assigned an EQI number by included on the Ministry list of Educationhigh schools provided to you under clause D1.3, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 3. If a patient is not enrolled at a high school, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 2school with a Decile Score of 4 – 6. You agree to only claim payment from us for Services provided within the geographical areas for which we are responsible as specified in Part G Schedule 1 to the Act, whether or not a patient is resident within our geographical area. If you provide Services from a facility located outside the agreed in another District Health Board’s geographical areas, then you agree not to claim for payment for those Services under this Agreementfrom us. You must have in place a separate contract for the additional facility with Te Whatu Ora. If you do not have a contract for the additional facility you Instead, it will be responsible your responsibility to claim for arranging such contract and payment with Te Whatu Orafrom the relevant District Health Board. F2.1 Schedule of prices for Additional Oral Health Services for Adolescents not Requiring Prior Approval Items Code Price (GST excl.) 2023/24 Item Code Price (GST excl.) 2023/24 excl.)2016/17 F3 Schedule of prices for Oral Health Services for Adolescents Requiring High Caries Treatment Planning a. the enrolling adolescent is in Year 9 and has left the school dental service with extensive unmet treatment need. The Principal Dental Officer of the relevant school dental service should be made aware, if not already so, of such individuals leaving the service; or b. the adolescent has not attended the school dental service or any other health provider for an extended period of time, resulting in a large amount of unmet treatment need; OR c. the adolescent has recently entered New Zealand from overseas and, being an Eligible Person, presents to the oral health service provider with a large amount of unmet treatment need; or d. the adolescent’s caries risk has changed dramatically. The criteria for access to High Caries Treatment Planning funding is - where the adolescent can be shown to be in need of one surface fillings in four or more posterior teeth (molars and pre- pre-molars) in addition to any other treatment needed. Once High Caries Treatment Planning has been approved the fees for the capitated items within the consultation package are able to be separately charged for as a fee for service as in clause F3.2 below.

Service Delivery Information. The Provider will report all treatments provided to patients to the Payment Agent. This data, along with the treatment claims, will be submitted after the patient’s treatment has been Completed. All reporting will be as per the Operational Guidelines. The eligibility criteria that patients must meet before they can receive the Services listed below are specified in the service specifications contained in Part E of this Agreement. The pricing terms applicable to the Services are set out in this Part F. The standard services described in clause E5.1 of this Agreement will be purchased as a package. You will receive one payment per patient per year for these standard Services after the date you have either: a. achieved Completion for that patient; or b. you have reported to us nonNon-Completion relating to that patient, provided that: i. the patient attended their annual check-up.; ii. the patient failed to present for further treatment, scheduled in accordance with the action plan of services to be carried out for that patient following that patient’s annual check-up.; iii. you have used your best endeavours to get the patient to present for their further scheduled treatment, including at least two documented recalls for treatment; and iv. you have reported such nonNon-Completion to us. v. You agree to only claim payment from us for services provided within your local Te Whatu Ora district for the Service Area outlined in Part G. . The price paid to you for each patient will be according to the school EQI Decile applicable. The relevant price is set out in the table below (as amended from time to time under clause A39). 569 to 491 Band 1 COM1 $233.33 490 to 448 Band 2 COM2 $179.76 447 to 365 Band 3 COM3 $147.15 If a patient is not enrolled at a high school or is attending a high school that is not assigned an EQI number by included on the Ministry list of Educationhigh schools provided to you under clause D1.3, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 3. If a patient is not enrolled at a high school, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 2school with a Decile Score of 4 – 6. You agree to only claim payment from us for Services provided within the geographical areas for which we are responsible as specified in Part G Schedule 1 to the Act, whether or not a patient is resident within our geographical area. If you provide Services from a facility located outside the agreed in another District Health Board’s geographical areas, then you agree not to claim for payment for those Services under this Agreementfrom us. You must have in place a separate contract for the additional facility with Te Whatu Ora. If you do not have a contract for the additional facility you Instead, it will be responsible your responsibility to claim for arranging such contract and payment with Te Whatu Orafrom the relevant District Health Board. F2.1 Schedule of prices for Additional Oral Health Services for Adolescents not Requiring Prior Approval Items Code Price (GST excl.) 2023/24 Item Code Price (GST excl.) 2023/24 2022/23 F3 Schedule of prices for Oral Health Services for Adolescents Requiring High Caries Treatment Planning a. the enrolling adolescent is in Year 9 and has left the school dental service with extensive unmet treatment need. The Principal Dental Officer of the relevant school dental service should be made aware, if not already so, of such individuals leaving the service; or b. the adolescent has not attended the school dental service or any other health provider for an extended period of time, resulting in a large amount of unmet treatment need; OR c. the adolescent has recently entered New Zealand from overseas and, being an Eligible Person, presents to the oral health service provider with a large amount of unmet treatment need; or d. the adolescent’s caries risk has changed dramatically. The criteria for access to High Caries Treatment Planning funding is - where the adolescent can be shown to be in need of one surface fillings in four or more posterior teeth (molars and pre- molars) in addition to any other treatment needed. Once High Caries Treatment Planning has been approved the fees for the capitated items within the consultation package are able to be separately charged for as a fee for service as in clause F3.2 below.

Service Delivery Information. The Provider will report all treatments provided to patients to the Payment Agent. This data, along with the treatment claims, will be submitted after the patient’s treatment has been Completed. All reporting will be as per the Operational Guidelines. PART F: SERVICE PRICING FOR ORAL HEALTH SERVICES FOR ADOLESCENTS AND SPECIAL DENTAL SERVICES FOR CHILDREN AND ADOLESCENTS F1 Eligibility for and Pricing of Services The eligibility criteria that patients must meet before they can receive the Services listed below are specified in the service specifications contained in Part E of this Agreement. The pricing terms applicable to the Services are set out in this Part F. F2 Pricing for Standard Oral Health Services for Adolescents The standard services described in clause E5.1 of this Agreement will be purchased as a package. You will receive one payment per patient per year for these standard Services after the date you have either: a. achieved Completion for that patient; or b. you have reported to us non-Completion relating to that patient, provided that: i. : the patient attended their annual check-up. ii. the patient failed to present for further treatment, scheduled in accordance with the action plan of services to be carried out for that patient following that patient’s annual check-up. iii. you have used your best endeavours to get the patient to present for their further scheduled treatment, including at least two documented recalls for treatment; and iv. and you have reported such non-Completion to us. v. . You agree to only claim payment from us for services provided within your local Te Whatu Ora district for the Service Area outlined in Part G. Band 1 COM1 $233.33 Band 2 COM2 $179.76 Band 3 COM3 $147.15 The price paid to you for each patient will be according to the school EQI applicable. The relevant price is set out in the table below (as amended from time to time under clause A39). 569 to 491 Band 1 COM1 $233.33 490 to 448 Band 2 COM2 $179.76 447 to 365 Band 3 COM3 $147.15 If a patient is not enrolled at a high school or is attending a high school that is not assigned an EQI number by included on the Ministry list of Educationhigh schools provided to you under clause D1.3, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 3. If a patient is not enrolled at a high school, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 2. 3 You agree to only claim payment from us for Services provided within the geographical areas for which we are responsible as specified in Part G whether or not a patient is resident within our geographical area. If you provide Services from a facility located outside the agreed geographical areasServices Area (Additional Service Area), then you agree not to claim for payment for those Services under this Agreement. You must have in place a separate contract for the additional facility with Te Whatu OraOther Service Area. If you do not have a contract for the additional facility Additional Service Area you will be responsible for arranging such contract and payment with Te Whatu Ora. F2.1 Schedule of prices for Additional Oral Health Services for Adolescents not Requiring Prior Approval Items Code Price (GST excl.) 2023/24 Item Code Price (GST excl.) 2023/24 F3 Schedule of prices for Oral Health Services for Adolescents Requiring High Caries Treatment Planning2023/24 a. the enrolling adolescent is in Year 9 and has left the school dental service with extensive unmet treatment need. The Principal Dental Officer of the relevant school dental service should be made aware, if not already so, of such individuals leaving the service; or b. the adolescent has not attended the school dental service or any other health provider for an extended period of time, resulting in a large amount of unmet treatment need; OR c. the adolescent has recently entered New Zealand from overseas and, being an Eligible Person, presents to the oral health service provider with a large amount of unmet treatment need; or d. the adolescent’s caries risk has changed dramatically. The criteria for access to High Caries Treatment Planning funding is - where the adolescent can be shown to be in need of one surface fillings in four or more posterior teeth (molars and pre- pre-molars) in addition to any other treatment needed. Once High Caries Treatment Planning has been approved the fees for the capitated items within the consultation package are able to be separately charged for as a fee for service as in clause F3.2 below.

Service Delivery Information. The Provider will report all treatments provided to patients to the Payment Agent. This data, along with the treatment claims, will be submitted after the patient’s treatment has been Completed. All reporting will be as per the Operational Guidelines. The eligibility criteria that patients must meet before they can receive the Services listed below are specified in the service specifications contained in Part E of this Agreement. The pricing terms applicable to the Services are set out in this Part F. The standard services described in clause E5.1 of this Agreement will be purchased as a package. You will receive one payment per patient per year for these standard Services after the date you have either: a. achieved Completion for that patient; or b. you have reported to us non-Completion relating to that patient, provided that: i. the patient attended their annual check-up. ii. i. the patient failed to present for further treatment, scheduled in accordance with the action plan of services to be carried out for that patient following that patient’s annual check-up. iiiii. you have used your best endeavours to get the patient to present for their further scheduled treatment, including at least two documented recalls for treatment; and iviii. you have reported such non-Completion to us. v. iv. You agree to only claim payment from us for services provided within your local Te Whatu Ora district for the Service Area outlined in Part G. Band 1 COM1 $233.33 Band 2 COM2 $179.76 Band 3 COM3 $147.15 The price paid to you for each patient will be according to the school EQI applicable. The relevant price is set out in the table below (as amended from time to time under clause A39). 569 to 491 Band 1 COM1 $233.33 490 to 448 Band 2 COM2 $179.76 447 to 365 Band 3 COM3 $147.15 If a patient is not enrolled at a high school or is attending a high school that is not assigned an EQI number by included on the Ministry list of Educationhigh schools provided to you under clause D1.3, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 3. If a patient is not enrolled at a high school, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 2. 3 You agree to only claim payment from us for Services provided within the geographical areas for which we are responsible as specified in Part G whether or not a patient is resident within our geographical area. If you provide Services from a facility located outside the agreed geographical areasServices Area (Additional Service Area), then you agree not to claim for payment for those Services under this Agreement. You must have in place a separate contract for the additional facility with Te Whatu OraOther Service Area. If you do not have a contract for the additional facility Additional Service Area you will be responsible for arranging such contract and payment with Te Whatu Ora. F2.1 Schedule of prices for Additional Oral Health Services for Adolescents not Requiring Prior Approval Items Code Price (GST excl.) 2023/24 Item Code Price (GST excl.) 2023/24 F3 Schedule of prices for Oral Health Services for Adolescents Requiring High Caries Treatment Planning a. the enrolling adolescent is in Year 9 and has left the school dental service with extensive unmet treatment need. The Principal Dental Officer of the relevant school dental service should be made aware, if not already so, of such individuals leaving the service; or b. the adolescent has not attended the school dental service or any other health provider for an extended period of time, resulting in a large amount of unmet treatment need; OR c. the adolescent has recently entered New Zealand from overseas and, being an Eligible Person, presents to the oral health service provider with a large amount of unmet treatment need; or d. the adolescent’s caries risk has changed dramatically. The criteria for access to High Caries Treatment Planning funding is - where the adolescent can be shown to be in need of one surface fillings in four or more posterior teeth (molars and pre- pre-molars) in addition to any other treatment needed. Once High Caries Treatment Planning has been approved the fees for the capitated items within the consultation package are able to be separately charged for as a fee for service as in clause F3.2 below.

Service Delivery Information. The Provider will report all treatments provided to patients to the Payment Agent. This data, along with the treatment claims, will be submitted after the patient’s treatment has been Completed. All reporting will be as per the Operational Guidelines. The eligibility criteria that patients must meet before they can receive the Services listed below are specified in the service specifications contained in Part E of this Agreement. The pricing terms applicable to the Services are set out in this Part F. The standard services described in clause E5.1 of this Agreement will be purchased as a package. You will receive one payment per patient per year for these standard Services after the date you have either: a. achieved Completion for that patient; or b. you have reported to us non-Completion relating to that patient, provided that: i. the patient attended their annual check-up. ii. the patient failed to present for further treatment, scheduled in accordance with the action plan of services to be carried out for that patient following that patient’s annual check-up. iii. you have used your best endeavours to get the patient to present for their further scheduled treatment, including at least two documented recalls for treatment; and iv. you have reported such non-Completion to us. v. You agree to only claim payment from us for services provided within your local Te Whatu Ora Health New Zealand district for the Service Area outlined in Part G. Band 1 COM1 $239.19 Band 2 COM2 $184.27 Band 3 COM3 $150.84 The price paid to you for each patient will be according to the school EQI applicable. The relevant price is set out in the table below (as amended from time to time under clause A39). 569 to 491 Band 1 COM1 $233.33 490 to 448 Band 2 COM2 $179.76 447 to 365 Band 3 COM3 $147.15 If a patient is not enrolled at a high school or is attending a high school that is not assigned an EQI number by included on the Ministry list of Educationhigh schools provided to you under clause D1.3, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 3. If a patient is not enrolled at a high school, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 2. 3 You agree to only claim payment from us for Services provided within the geographical areas for which we are responsible as specified in Part G whether or not a patient is resident within our geographical area. If you provide Services from a facility located outside the agreed geographical areasServices Area (Additional Service Area), then you agree not to claim for payment for those Services under this Agreement. You must have in place a separate contract for the additional facility with Te Whatu OraOther Service Area. If you do not have a contract for the additional facility Additional Service Area you will be responsible for arranging such contract and payment with Te Whatu Ora. Health New Zealand. F2.1 Schedule of prices for Additional Oral Health Services for Adolescents not Requiring Prior Approval Items Code Price The additional Services not requiring prior approval, described in clause E5.4 of this Agreement, will be purchased on a fee-for-service basis. You will receive payment for these additional Services for each patient after the date you have achieved Completion for that patient, or, if further treatments are required after the date, you have achieved Completion for that patient, after those further treatments are Completed. Payment for these additional services will be based on the information reported by you in accordance with clause E10. The payment you will receive, per Service provided, will be in accordance with the table below. Two surface (GST excl.approximo-occlusal) 2023/24 Item Code Price restorations in posterior teeth FIL2 $103.75 Three surface (GST excl.mesio-occlusal-distal) 2023/24 F3 restorations in posterior teeth FIL3 $127.69 Complex coronal reconstructions in amalgam (including restoration of one or more cusps) FIL4 $143.32 Simple restorations in anterior teeth FIL5 $94.04 More than one surface restoration in anterior teeth FIL6 $126.46 Performed metal crowns CRN1 $81.31 Extractions (excluding extractions for orthodontic purposes) with LA EXT1 $153.77 Re-cement inlay or crown RCM1 $29.11 Panoramic radiographs RAD2 $48.15 Occlusal radiographs RAD3 $32.40 Root canal treatment and root filling in permanent anterior or premolar teeth (per canal) including all necessary radiographs performed during treatment and mandatory post-operative radiology for patient's record RCT1 $321.22 Pulp removal and root filling in deciduous tooth (maximum fees per deciduous tooth treated) RCT2 $176.22 Pulpotomy in deciduous teeth RCT3 $113.02 Pulpotomy in permanent teeth RCT4 $113.02 Emergency dressings EMD1 $33.31 Initial oral consultation for school dental clinic patients referred for Special Dental Services or for school dental clinic patients or adolescents who are not able to access their regular health provider in an emergency during normal practice hours CON3 $86.23 Emergency consultations outside normal hours CON4 $127.34 F2.2 Schedule of prices Prices for Additional Oral Health Services for Adolescents Requiring Prior Approval The additional Services requiring prior approval, as described in clause E5.5 of this Agreement, will be purchased on a fee-for-service basis. You will receive payment for these additional Services for each patient after the date you have achieved Completion for that patient. If further treatments are required after the date you have achieved Completion for that patient, then payment will be made after those further treatments are Completed. Payment for these Services will be based on the information reported by you in accordance with clause E10 of this Agreement. These additional Services may only be provided with the prior approval of Approving Dental Officer. Where the prior approval of an Approving Dental Officer is not sought but an application is made subsequently and not approved, then neither we nor the patient will be liable to pay for those Services. The payment you will receive, per Service provided, will be in accordance with the table below: Minor surgical operation or other time-based procedures (first half hour) MSO1 $99.97 Minor surgical operation or other time-based procedures (each additional quarter hour) MSO2 $49.96 Treatment of periodontal disease PDT1 $78.53 Precision-cast metal partial denture DENT1 $1,804.17 Precision-cast metal partial denture - each extra tooth DENT2 $60.75 Acrylic partial dentures DENT3 $784.29 Acrylic partial dentures - each extra tooth DENT4 $60.82 Acrylic partial dentures - each clasp DENT5 $31.59 Adessive Bridges (Maryland Type) ABMT $1,210.69 Ceramic to metal crowns CRN2 $1,049.35 All ceramic crowns (partial or full coverage, bonded or cemented) CRN3 $1,046.65 Gold Crown (Partial or full coverage) CRN4 $994.91 Full coverage composite crowns CRN5 $207.09 Bite Splints SPLT $526.30 Cast posts and cores PST1 $280.66 Preformed posts (para, flexi, etc) PST2 $116.52 Porcelain veneer VEN1 $902.03 Labial composite veneer VEN2 $139.27 Denture full upper or lower DEN6 $1,111.72 Denture upper and lower DEN7 $2,457.50 Apexification/root filling with an open apex APX1 $176.22 Additional services for adolescents require High Caries Treatment Planning, as described in clause E5.2 of this Agreement, will be purchased on a fee-for-service basis. You will receive payment for these Services once the patient has Completed the course of treatment agreed between you and the Approving Dental Officer. Any further non-schedule treatments, necessary within the same Calendar Year, will also require the prior approval of the Approving Dental Officer. It is expected that High Caries Treatment Planning will arise in one of three ways: a. the enrolling adolescent is in Year 9 and has left the school dental service with extensive unmet treatment need. The Principal Dental Officer of the relevant school dental service should be made aware, if not already so, of such individuals leaving the service; or b. the adolescent has not attended the school dental service or any other health provider for an extended period of time, resulting in a large amount of unmet treatment need; OR c. the adolescent has recently entered New Zealand from overseas and, being an Eligible Person, presents to the oral health service provider with a large amount of unmet treatment need; or d. the adolescent’s caries risk has changed dramatically. The criteria for access to High Caries Treatment Planning funding is - where the adolescent can be shown to be in need of one surface fillings in four or more posterior teeth (molars and pre- molars) in addition to any other treatment needed. Once High Caries Treatment Planning has been approved the fees for the capitated items within the consultation package are able to be separately charged for as a fee for service as in clause F3.2 below.

Service Delivery Information. The Provider will report all treatments provided to patients to the Payment Agent. This data, along with the treatment claims, will be submitted after the patient’s treatment has been Completed. All reporting will be as per the Operational Guidelines. The eligibility criteria that patients must meet before they can receive the Services listed below are specified in the service specifications contained in Part E of this Agreement. The pricing terms applicable to the Services are set out in this Part F. The standard services described in clause E5.1 of this Agreement will be purchased as a package. You will receive one payment per patient per year for these standard Services after the date you have either: a. achieved Completion for that patient; or b. you have reported to us nonNon-Completion relating to that patient, provided that: i. the patient attended their annual check-up.; ii. the patient failed to present for further treatment, scheduled in accordance with the action plan of services to be carried out for that patient following that patient’s annual check-up.; iii. you have used your best endeavours to get the patient to present for their further scheduled treatment, including at least two documented recalls for treatment; and iv. you have reported such nonNon-Completion to us. v. You agree to only claim payment from us for services provided within your local Te Whatu Ora district for the Service Area outlined in Part G. . The price paid to you for each patient will be according to the school EQI Decile applicable. The relevant price is set out in the table below (as amended from time to time under clause A39). 569 to 491 Band 1 Decile Score Code Price (GST Exc.) 2021/22 Decile 1-3 COM1 $233.33 490 to 448 Band 2 $ 163.39 Decile 4-6 COM2 $179.76 447 to 365 Band 3 $ 142.10 Decile 7-10 COM3 $147.15 $ 120.88 If a patient is not enrolled at a high school or is attending a high school that is not assigned an EQI number by included on the Ministry list of Educationhigh schools provided to you under clause D1.3, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 3. If a patient is not enrolled at a high school, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 2school with a Decile Score of 4 – 6. You agree to only claim payment from us for Services provided within the geographical areas for which we are responsible as specified in Part G Schedule 1 to the Act, whether or not a patient is resident within our geographical area. If you provide Services from a facility located outside the agreed in another District Health Board’s geographical areas, then you agree not to claim for payment for those Services under this Agreementfrom us. You must have in place a separate contract for the additional facility with Te Whatu Ora. If you do not have a contract for the additional facility you Instead, it will be responsible your responsibility to claim for arranging such contract and payment with Te Whatu Orafrom the relevant District Health Board. F2.1 Schedule of prices for Additional Oral Health Services for Adolescents not Requiring Prior Approval Items Code Price (GST excl.) 2023/24 Item Code Price (GST excl.) 2023/24 F3 Schedule of prices for Oral Health Services for Adolescents Requiring High Caries Treatment Planning a. the enrolling adolescent is in Year 9 and has left the school dental service with extensive unmet treatment need. The Principal Dental Officer of the relevant school dental service should be made aware, if not already so, of such individuals leaving the service; or b. the adolescent has not attended the school dental service or any other health provider for an extended period of time, resulting in a large amount of unmet treatment need; OR c. the adolescent has recently entered New Zealand from overseas and, being an Eligible Person, presents to the oral health service provider with a large amount of unmet treatment need; or d. the adolescent’s caries risk has changed dramatically. The criteria for access to High Caries Treatment Planning funding is - where the adolescent can be shown to be in need of one surface fillings in four or more posterior teeth (molars and pre- pre-molars) in addition to any other treatment needed. Once High Caries Treatment Planning has been approved the fees for the capitated items within the consultation package are able to be separately charged for as a fee for service as in clause F3.2 below.

Service Delivery Information. The Provider will report all treatments provided to patients to the Payment Agent. This data, along with the treatment claims, will be submitted after the patient’s treatment has been Completed. All reporting will be as per the Operational Guidelines. PART F: SERVICE PRICING FOR ORAL HEALTH SERVICES FOR ADOLESCENTS AND SPECIAL DENTAL SERVICES FOR CHILDREN AND ADOLESCENTS F1 Eligibility for and Pricing of Services The eligibility criteria that patients must meet before they can receive the Services listed below are specified in the service specifications contained in Part E of this Agreement. The pricing terms applicable to the Services are set out in this Part F. F2 Pricing for Standard Oral Health Services for Adolescents The standard services described in clause E5.1 of this Agreement will be purchased as a package. You will receive one payment per patient per year for these standard Services after the date you have either: a. achieved Completion for that patient; or b. you have reported to us non-Completion relating to that patient, provided that: i. : the patient attended their annual check-up. ii. the patient failed to present for further treatment, scheduled in accordance with the action plan of services to be carried out for that patient following that patient’s annual check-up. iii. you have used your best endeavours to get the patient to present for their further scheduled treatment, including at least two documented recalls for treatment; and iv. and you have reported such non-Completion to us. v. . You agree to only claim payment from us for services provided within your local Te Whatu Ora district for the Service Area outlined in Part G. The price paid to you for each patient will be according to the school EQI applicable. The relevant price is set out in the table below (as amended from time to time under clause A39). 569 to 491 Band 1 COM1 $233.33 490 to 448 Band 2 COM2 $179.76 447 to 365 Band 3 COM3 $147.15 If a patient is attending a high school that is not assigned an EQI number by the Ministry of Education, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 3. If a patient is not enrolled at a high school, the price paid to you for the patient will be the price we pay for patients attending high schools in Band 2. You agree to only claim payment from us for Services provided within the geographical areas for which we are responsible as specified in Part G whether or not a patient is resident within our geographical area. If you provide Services from a facility located outside the agreed geographical areas, then you agree not to claim for payment for those Services under this Agreement. You must have in place a separate contract for the additional facility with Te Whatu Ora. If you do not have a contract for the additional facility you will be responsible for arranging such contract and payment with Te Whatu Ora. F2.1 Schedule of prices for Additional Oral Health Services for Adolescents not Requiring Prior Approval Items Code Price (GST excl.) 2023/24 Item Code Price (GST excl.) 2023/24 F3 Schedule of prices for Oral Health Services for Adolescents Requiring High Caries Treatment Planning2023/24 a. the enrolling adolescent is in Year 9 and has left the school dental service with extensive unmet treatment need. The Principal Dental Officer of the relevant school dental service should be made aware, if not already so, of such individuals leaving the service; or b. the adolescent has not attended the school dental service or any other health provider for an extended period of time, resulting in a large amount of unmet treatment need; OR c. the adolescent has recently entered New Zealand from overseas and, being an Eligible Person, presents to the oral health service provider with a large amount of unmet treatment need; or d. the adolescent’s caries risk has changed dramatically. The criteria for access to High Caries Treatment Planning funding is - where the adolescent can be shown to be in need of one surface fillings in four or more posterior teeth (molars and pre- pre-molars) in addition to any other treatment needed. Once High Caries Treatment Planning has been approved the fees for the capitated items within the consultation package are able to be separately charged for as a fee for service as in clause F3.2 below.