Are Dental Implants Covered by Health Insurance in Australia?
Dental Implants Health Insurance is one of the first things to consider when you’re planning implant treatment in Australia. You’ve decided you want dental implants and you’ve got private health insurance. Naturally, the next question is: how much of this will my fund actually cover?
Private health insurance in Australia can provide a meaningful rebate toward dental implant treatment, but it doesn’t cover the full cost, and the rules around what qualifies, how much you’ll get back, and when you can claim are more complicated than most people realise.
This guide explains exactly how health insurance works for dental implants in Australia. We’ll decode the ADA item numbers your dentist uses, show you how rebates are actually calculated, walk you through Medicare and DVA eligibility, and give you practical tips to get the most out of your cover.
Dental Implants Health Insurance: Does Private Health Insurance Cover Dental Implants?
Yes — partially. Most major Australian health funds provide rebates on dental implant treatment through their extras cover. However, there are important conditions:
- You must hold Major Dental or Comprehensive Extras cover. Basic and mid-level extras policies typically exclude implants entirely.
- You must have served the waiting period — usually 12 months of continuous membership for major dental services.
- Your rebate is capped by annual limits and sub-limits, which vary by fund and policy tier.
- The rebate is calculated against the fund’s internal schedule fee, not your dentist’s actual fee. This is why the gap (your out-of-pocket cost) is often larger than expected.
At Atria Dental Gordon, we accept all major Australian health funds and process claims on the spot via HICAPS, so you see your rebate instantly.
General Dental vs Major Dental: Why It Matters
Understanding Dental Implants Health Insurance starts with knowing which level of extras cover you have. Private health insurance extras cover is split into categories, and each has its own limits, waiting periods and covered items.
| General Dental | Major Dental | |
|---|---|---|
| What it covers | Check-ups, scale and cleans, x-rays, basic fillings, fluoride treatments | Crowns, bridges, dentures, root canals, implants, bone grafting |
| Waiting period | Usually 2 months | Usually 12 months |
| Annual limit (typical) | $300–$800 | $1,000–$2,500 |
| Covers implants? | No | Yes (if item numbers are listed in the policy) |
The key point: dental implants are classified as a Major Dental service. If your extras policy only includes General Dental, you will receive zero rebate on implant treatment — regardless of how long you’ve been a member.
Before booking a consultation, check whether your policy includes Major Dental extras and confirm that implant-related ADA item numbers (especially 684, 688, 661 and 672) appear in your benefit schedule.
ADA Item Numbers for Dental Implants
The Australian Dental Association (ADA) assigns a three-digit item number to every clinical dental procedure. These codes are used across the entire industry — by dentists, health funds, Medicare and WorkCover — so everyone is describing the same procedure in the same way.
When your dentist gives you an itemised quote, every line will include an ADA item number. When you contact your health fund to check your rebate, these are the numbers you’ll need to provide.
Here are the most common ADA item numbers for dental implant treatment:
| ADA item | Description | What it means |
|---|---|---|
| 011 | Comprehensive oral examination | Your initial full examination at the first visit. |
| 022 | Intraoral x-ray (periapical) | A small x-ray to check individual teeth and implant positions. |
| 037 | Cone beam CT scan (CBCT) | The 3D scan used to plan implant placement. Essential for treatment planning. |
| 311 | Extraction — simple | Removal of a tooth that comes out without surgical cutting. |
| 314 / 324 | Extraction — surgical | Removal of a tooth requiring surgical access. More complex than a simple extraction. |
| 684 | Insertion of first stage of two-stage implant — per implant | Surgical placement of the titanium implant into the jawbone where the gum is closed over the implant. A second surgery (691) is needed later to uncover it. |
| 688 | Insertion of one-stage implant — per implant | Surgical placement of the implant with a healing abutment visible above the gum. The most common procedure for modern implant placement. |
| 691 | Second stage surgery of two-stage implant | The follow-up surgery to uncover a submerged implant and attach a healing abutment. |
| 661 | Fitting of implant abutment — per abutment | Attaching the connector piece (abutment) to the implant. The abutment holds the final crown or bridge. |
| 671 | Implant crown — non-metallic (all-ceramic) | A fully ceramic crown attached to an implant via an abutment. |
| 672 | Implant crown — veneered (porcelain-fused-to-metal) | A porcelain crown with a metal sub-structure attached to an implant. |
| 666 | Fixed prosthesis attached to implants — per arch | The fixed bridge or prosthesis in a full-arch treatment like All-on-4. Secured to the implants and not removable by the patient. |
| 679 | Surgical implant guide | A custom-made template used during surgery to position implants at the exact planned angle and depth. |
| 678 | Diagnostic template | A setup of teeth on a model to visualise the final appearance before surgery. |
| 235 / 243 | Bone graft / bone augmentation | Adding bone material to the jaw to create adequate volume for implant placement. |
How Rebates Are Actually Calculated
This is where Dental Implants Health Insurance can become confusing for patients. Your health fund doesn’t rebate a percentage of what your dentist charges. It rebates a percentage of its own internal schedule fee for each item number.
Here’s how it works in practice:
| Example | |
|---|---|
| Your dentist charges for item 688 (implant placement) | $3,200 |
| Your fund’s schedule fee for item 688 | $2,100 |
| Your fund’s rebate rate | 60% |
| Rebate you receive | $1,260 (60% of $2,100 — not 60% of $3,200) |
| Your gap (out-of-pocket) | $1,940 ($3,200 minus $1,260) |
This is why a fund that advertises “60% back on major dental” doesn’t actually give you 60% of your bill. The rebate percentage applies to the fund’s schedule fee, which is almost always lower than what the dentist charges. The difference between the dentist’s fee and the fund’s schedule fee is called the gap, and it’s your responsibility.
Waiting Periods, Annual Limits and Benefit Periods
Waiting periods
When you first take out Major Dental extras (or upgrade to a tier that includes it), you’ll need to wait 12 months before you can claim for implant-related treatment. This is a one-off requirement — once served, it doesn’t reset.
Before starting treatment, check your Dental Implants Health Insurance waiting period and annual limits. These can have a significant impact on how much you actually pay out of pocket.
Annual limits
Every extras policy has an annual benefit limit — the maximum your fund will pay toward dental treatment in a given year. For major dental, this typically ranges from $1,000 to $2,500 per year on top-tier policies.
Since a single dental implant can cost $4,500–$6,500 and a full-arch All-on-4 starts from $18,000, annual limits mean your fund covers only a fraction of the total cost. This is normal and expected.
Benefit replacement periods
Some funds apply a benefit replacement period — typically 36 months — for specific item numbers. This means once you’ve claimed for item 688 (implant placement), you may not be able to claim for the same item again within three years. Check your policy wording for details.
Splitting treatment across benefit years
Because implant treatment takes several months (the surgical phase, healing, then the crown or bridge), it naturally spans more than one calendar year in many cases. This means you can potentially use two years’ worth of annual limits:
- Year 1: Claim for the surgical phase — consultation, imaging, extractions, implant placement (items 011, 037, 311/314, 684/688)
- Year 2: Claim for the prosthetic phase — abutment, crown or bridge (items 661, 672, 666)
Ask your dentist and your fund whether this timing strategy works for your specific situation.
Preferred Provider Networks — Do They Matter?
Many health funds operate preferred provider (or “members’ choice”) networks. When you visit a dentist within your fund’s network, the rebate is calculated against a higher schedule fee, which usually means a smaller gap.
You are not restricted to preferred providers. You can visit any AHPRA-registered dentist in Australia and still claim your rebate. However, at a non-network clinic, the fund’s schedule fee is typically lower, which means your out-of-pocket gap will be larger.
At Atria Dental Gordon, we’re a CBHS Preferred Health Provider and accept all major funds including Bupa, Medibank, HCF, NIB, AHM, HBF, Australian Unity, Defence Health, Westfund, Peoplecare, GU Health, TUH and more. We process HICAPS claims on the spot so you see your rebate before you leave the clinic.
Does Medicare Cover Dental Implants?
Dental Implants Health Insurance and Medicare work differently in Australia. Private health insurance may provide a rebate through Major Dental extras, while Medicare generally does not cover routine dental implants.
The one exception is MBS item 45845 — which covers implant placement when it’s required following:
- Trauma (e.g. teeth lost in an accident)
- Tumour removal or cancer treatment affecting the jaw
- Certain congenital conditions (e.g. hypodontia or cleft palate)
Even under MBS 45845, Medicare covers only the surgical placement of the implant fixture — not the crown, not the abutment, and not any preparatory procedures. The prosthetic components still come out of pocket or through private extras cover.
Check with Services Australia for current eligibility criteria.
Public dental waiting lists
Some states offer subsidised dental treatment through public hospital dental clinics. However, waiting times are long (often 12–24+ months), and dental implants are rarely available through public services. Most public clinics offer extractions and basic dentures only.
DVA Entitlements for Veterans
If you hold a Department of Veterans’ Affairs (DVA) Gold Card, you may be entitled to dental treatment including implants, subject to clinical approval. DVA covers a broader range of dental services than Medicare, but all treatment must be pre-approved by DVA before it begins.
White Card holders are entitled to dental treatment only where the condition is related to their accepted disability.
Speak to your DVA case manager or contact DVA directly to confirm your entitlement before booking a consultation.
Six Practical Tips to Maximise Your Health Fund Rebate
1. Get an itemised quote with ADA numbers before treatment
Ask your dentist for a quote listing every procedure with its ADA item number. At Atria Dental Gordon, we do this as standard. Take the quote to your health fund (or check online through your member portal) and ask for the specific dollar rebate per item — not just whether implants are “covered.”
2. Check your annual limit and sub-limits
Your policy may have a combined dental limit or separate sub-limits for general and major dental. Know exactly how much is available before you start treatment.
3. Time your treatment across two benefit years
If your implant treatment starts late in the calendar year and the prosthetic phase falls the following year, you can use two years’ worth of annual limits. Discuss timing with your dentist.
4. Confirm your waiting period has been served
If you took out or upgraded your Major Dental extras less than 12 months ago, you won’t be able to claim for implant items yet. Don’t assume — call your fund and confirm.
5. Consider a preferred provider clinic
Visiting a clinic in your fund’s preferred provider network often reduces the gap on major dental items. Ask your fund for a list of network dentists in your area.
6. Review your cover annually
Health fund products change every year. Benefits, limits and preferred provider networks are updated regularly. Before starting any major dental treatment, review your policy against the privatehealth.gov.au comparison tool to make sure you’re on the best available plan for your needs.
Common Insurance Mistakes Patients Make
1. Assuming “dental extras” includes implants
Basic and mid-tier extras policies usually cover General Dental only. Implants require Major Dental extras. Check your policy schedule before assuming coverage.
2. Not checking the schedule fee
Asking “am I covered?” isn’t enough. Ask “what is my exact dollar rebate for ADA item 688?” The answer will tell you whether the cover is meaningful or nominal.
3. Starting treatment during the waiting period
If you upgrade your cover and begin treatment within 12 months, your claims will be rejected. The waiting period starts from the date your upgraded cover takes effect, not when you first joined the fund.
4. Forgetting about benefit replacement periods
Some funds won’t pay for the same item number twice within a set period (typically 36 months). This matters if you need implants on both sides of your mouth in stages.
5. Not using HICAPS for on-the-spot claiming
If your dental clinic supports HICAPS (as we do at Atria Dental Gordon), your rebate is processed instantly and you only pay the gap amount. Without HICAPS, you pay the full fee upfront and claim later — which can mean weeks waiting for your rebate.
6. Not comparing funds before major treatment
Different funds offer very different rebates for the same ADA item numbers. If you’re planning implant treatment in the next 12–18 months, it’s worth comparing policies now using the government’s comparison tool.
How to Check Your Dental Implants Health Insurance Coverage
Before your first appointment, take these steps:
- Log into your health fund’s member portal or app
- Look up your Major Dental extras benefit — check the annual limit and whether implant item numbers (684, 688, 661, 672, 666) appear
- Note your remaining annual balance and when it resets
- Confirm your waiting period for Major Dental has been served
- If you’re unsure, call your fund’s member hotline and ask: “What is my specific dollar rebate for ADA items 688, 661 and 672?”
Bring this information to your consultation. At Atria Dental Gordon, our team can also help you check your coverage and estimate your out-of-pocket gap during your visit.
Frequently Asked Questions
Does private health insurance cover dental implants in Australia?
Yes, partially. Most top-tier extras policies with Major Dental cover provide rebates on implant-related procedures. However, annual limits and schedule fees mean the fund covers only a portion of the total cost. Expect a rebate of $1,000–$2,500 per year depending on your policy.
Does Medicare cover dental implants?
Not for routine cases. Medicare only covers implants required after trauma, tumour removal, or congenital conditions (MBS item 45845). The vast majority of dental implant patients are not eligible for Medicare coverage.
What ADA item numbers should I give my health fund?
The key numbers for a standard dental implant are: 688 (implant placement), 661 (abutment fitting), and 672 (implant crown). For All-on-4, add 666 (fixed prosthesis per arch). Your dentist will provide all relevant codes in your itemised quote.
How much will my health fund pay for an implant?
Typically $800–$2,500 per implant per year, depending on your policy tier, the fund’s schedule fee, and your annual limit. The rebate applies to the fund’s schedule fee, not your dentist’s actual fee, so there is almost always a gap.
What is a “gap” payment?
The gap is the difference between what your dentist charges and what your health fund rebates. For dental implants, gap payments are standard because the procedure cost exceeds what funds will cover under annual limits.
Can I claim for dental implants straight away after joining a fund?
No. Major dental services like implants have a 12-month waiting period. You must hold Major Dental extras cover for 12 continuous months before your first claim.
Can I split my treatment across two benefit years to maximise rebates?
Yes, in many cases. Since implant treatment takes several months, the surgical phase can fall in one benefit year and the prosthetic phase in the next. Discuss timing strategy with your dentist.
What is a preferred provider, and do I have to use one?
A preferred provider is a dentist who has agreed to a fee schedule with a specific health fund. Using one usually reduces your gap. You’re not required to use one — you can visit any AHPRA-registered dentist and still claim your rebate.
Does DVA cover dental implants?
Gold Card holders may be entitled to dental implant treatment, subject to DVA clinical approval before treatment begins. White Card holders are covered for dental treatment related to their accepted disability only.
Are dental implants tax deductible?
Generally, no. Dental treatment is not tax deductible for individual taxpayers in Australia under ordinary circumstances. There may be limited exceptions for people with specific medical conditions — consult a registered tax agent for advice.
What health funds does Atria Dental Gordon accept?
We accept all major Australian health funds, including Bupa, Medibank, HCF, NIB, CBHS, AHM, HBF, Australian Unity, Defence Health, Westfund, Peoplecare, GU Health, TUH, Frank Health and many more. We’re a CBHS Preferred Health Provider and process HICAPS claims on the spot.
What if my health fund doesn’t cover implants at all?
If your policy doesn’t include Major Dental extras, you’ll need to pay the full cost out of pocket. We offer flexible payment plans through Humm, Zip Pay, Zip Money, Afterpay, SuperCare and National Dental Plan. See our fees and finance page for details.
