Child Dental Benefit Schedule

What is the Child Dental Benefits Schedule, and can my child use it at Smile Solutions?

The Child Dental Benefits Schedule (CDBS) is an Australian Government program that pays for basic dental treatment for eligible children who are 0 to 17 years old for at least one day that calendar year. Eligibility is tied to the family receiving a relevant Australian Government payment — most commonly Family Tax Benefit Part A — not to the child's dental need.

We treat families eligible for the CDBS. Appointments are at Level 1, 220 Collins Street, Manchester Unity Building, Melbourne CBD.

The single most important thing on this page: the CDBS is significantly under-claimed. A large share of eligible families never use it, in most cases because they do not know it exists or assume they have to apply. There is no application. If your family receives a qualifying payment, the entitlement is already there and it expires unused.

Who is eligible

Services Australia sets three conditions, which must all be met, and each has to be true for at least one day in the calendar year:

1. The child is 0 to 17 years old for at least one day that calendar year.
2. The child is eligible for Medicare.
3. The child, or their family, receives a qualifying Australian Government payment.

Family Tax Benefit Part A is by far the most common qualifying payment. A number of others also qualify, including several parenting, carer, disability, veterans' and student payments — and a payment received by the child in their own right can qualify them, which matters for older teenagers. The definitive list is held by Services Australia and changes from time to time — check it there rather than assuming you do not qualify.

‘At least one day' is doing real work in that sentence. A family that received Family Tax Benefit Part A for a single fortnight in February and came off it in March has an eligible child for that whole calendar year. Seasonal work, a period of parental leave, a relationship change, a short spell between jobs — any of these can create eligibility that the family never realises it has, because by the time they think about the dentist they are no longer receiving the payment.

Eligibility is reassessed each calendar year. A child eligible last year is not automatically eligible this year, and a child who was not eligible last year may be eligible now. It is worth re-checking annually, particularly if your circumstances have changed.

How to check, in about three minutes

• Your Medicare online account through myGov, or the Express Plus Medicare app, shows both whether a child is eligible and how much of their cap remains.
• Services Australia writes to eligible families, usually early in the calendar year. That letter increasingly lands in the myGov inbox rather than the letterbox, which is one reason it is missed.
• Call Services Australia on the Medicare enquiries line (132 011) if the online account is not set up.
• The practice can check eligibility and the remaining balance with your consent, which is the fastest route if you are already booking.

Why eligible families miss it

The four assumptions that cost families the benefit, in rough order of how often they come up:

• ‘We would have had to apply.' There is no application and no form.
• ‘It is only for concession card holders.' Family Tax Benefit Part A reaches a much broader range of household incomes than most people assume, including many two-income families.
• ‘It is only usable at public clinics.' It is usable at any participating provider, public or private.
• ‘We got the letter last year, so we would have got one this year.' Eligibility is assessed annually and the notification is easy to miss. Check rather than infer.

What the schedule covers

The CDBS covers basic dental services:

• examinations
• radiographs (x-rays)
• cleaning
• fissure sealing
• fillings
• root canal treatment
• extractions
• partial dentures

What those categories mean in a chair, and why each is there:

• The examination is the whole point of the scheme. It is where decay is found while it is still small, where the bite and the eruption sequence are checked, and where soft tissues and habits get looked at. See First Visit to the Dentist for what actually happens in one.
• Radiographs matter because the two surfaces where children's decay starts most often — the contact points between adjacent back teeth — cannot be seen by looking. A small bitewing film shows those surfaces and shows nothing else useful; that is what it is for.
• Cleaning removes what a toothbrush has been missing, and just as importantly it shows the clinician where the brushing is missing, which turns a general instruction into a specific one. See Dental Cleans and Hygienists.
• Fissure sealing is covered below.
• Fillings in children are often materials chosen for a shorter service life than an adult filling would need, because a baby molar is going to be replaced. That is a legitimate clinical choice, not a cheaper one — see Tooth Fillings.
• Root canal treatment on a baby tooth is a different and simpler procedure from adult root canal therapy, and its purpose is usually to hold the tooth until it would naturally be lost.
• Extractions and partial dentures are the end of the road, and the schedule covers them because a child with an infected tooth should not be left with it.

The exact item numbers covered are published by Services Australia in the Dental Benefits Schedule, and providers work from that list. If you want to know whether a specific proposed treatment is covered, the item number is the question to ask.

Fissure sealants are the item worth knowing about. They are a thin resin coating placed in the deep grooves of the permanent back teeth, they require no drilling and normally no anaesthetic, and they are among the best-evidenced preventive measures in dentistry. The first permanent molars arrive at around age six, behind the baby teeth, with nothing falling out first — which is why most parents never notice they have come through. Those teeth are the ones most often lost first, and sealing them shortly after they erupt is the highest-value thing the schedule pays for.

The timing is narrow, which is the argument for a check-up in the year a child turns six or seven rather than when something hurts. A groove that has already begun to decay cannot simply be sealed over; it needs to be opened and restored first, which costs more of the cap and more of the tooth.

What it does not cover

• Orthodontic treatment — braces, aligners, plates
• Cosmetic dental work
• Any treatment provided in a hospital
• General anaesthetic for dental treatment

The hospital and general-anaesthetic exclusions are the ones that cause financial shock, so they are worth understanding before you are in the middle of them.

A three- or four-year-old with decay in several teeth is a common presentation, and in some of those children the treatment genuinely cannot be completed in a dental chair — not because the child is difficult, but because the amount of work, their age and their ability to cooperate do not line up. The options are then a course of treatment under general anaesthetic in a hospital or day-surgery facility, or in some cases sedation. The CDBS contributes nothing to either, and the cost has several components — the facility, the anaesthetist and the dental treatment itself — which is why quotes for it are structured differently from ordinary dental quotes.

What this means practically: private health hospital cover, the public waiting list and a plan to stage treatment in the chair are the three realistic routes, and which is available depends on the child. See Sleep Dentistry and Paediatric Dentists for how the decision is actually made.

If a child needs orthodontics, the CDBS does not contribute and a separate conversation about cost is needed — Children's Braces and Invisalign sets out what that involves and when assessment is usually worthwhile.

How the cap works

The benefit is capped per child across a two-year period, and the cap amount is indexed annually by the Australian Government.

Because the figure changes each year, confirm the current amount with Services Australia rather than relying on any published number — including any number quoted on a dental practice website.

The mechanics that catch people out:

• The period is two consecutive calendar years, and the first of them is the year the child first receives a service. It is not a rolling twenty-four months from the appointment date.
• That makes the timing of the first visit matter. A first appointment in December means most of year one is already gone; the same appointment in February gives the family close to the full two years to use the balance. If nothing is urgent and the year is nearly over, it is worth asking whether to start the course now or in January.
• Any balance left at the end of year one carries into year two only if the child is still eligible in year two. Eligibility is reassessed annually, so a change in family circumstances can close the window on money you were counting on.
• Unused balance does not carry over once the two-year period closes. It is not a savings account.
• The cap is per child, so each eligible child in a family has their own. Three eligible children means three separate caps, not one shared pool.
• A course of treatment can span the period boundary, which occasionally means part of a treatment plan falls outside the remaining balance. Ask about this if the plan is a long one.

Check the remaining balance before a large appointment. You can do this through your Medicare online account via myGov, the Express Plus Medicare app, or by calling Services Australia. The practice can also check it with your consent.

Making the cap go furthest

The cap is finite, so the order in which it is spent changes how much good it does.

Preventive first, if nothing is urgent. An examination, the radiographs that go with it, a clean and — at the right age — fissure sealants is the sequence that buys the most future. It is also the sequence most likely to mean the rest of the cap is never needed.

Urgent first, always, if something hurts. Pain, swelling or a broken tooth is not a budgeting question. See Children's Dental Emergencies and Tooth Pain and Ache.

Ask for the whole plan in writing, not one appointment at a time. A plan tells you the total against the remaining cap before you start, which is the only way to find out early that a course of treatment will run past the balance. It also lets you and the clinician decide together what is done this year and what waits.

Stage deliberately rather than by accident. Where a plan exceeds the cap and nothing is urgent, treating the most at-risk teeth first and reviewing the rest is a normal clinical approach, not a compromise. Say the constraint out loud — a practitioner who does not know about it cannot plan around it.

Do not let the sealant window close while you save the cap for something else. Sealing a sound molar is cheap; restoring a decayed one is not.

How payment works at Smile Solutions

We do not bulk bill the CDBS. The process is:

1. The child is examined and treatment is quoted beforehand.
2. Fees are payable on the day of the appointment.
3. The rebate is then claimed back through Medicare, up to the remaining balance of the child's cap.

Depending on the procedure, there may be an out-of-pocket expense — the gap between the practice's fee and the Medicare benefit for that item number.

This is worth understanding rather than being surprised by. Providers may choose to bulk bill the schedule, in which case there is no gap, or to charge above the schedule fee, in which case there is. Practices that do not bulk bill must obtain your informed financial consent before treatment, which means telling you the cost and the expected gap in advance.

Informed financial consent is a real requirement, not a formality. It means the specific figures for the specific treatment, given before it starts and in a form you can take away — not a general statement that fees may apply, and not a signature collected at the front desk after the appointment.

So ask, before treatment begins:

• ‘What are the item numbers?'
• ‘What is your fee for each, and what is the Medicare benefit?'
• ‘What is my out-of-pocket cost on the day?'
• ‘How much of the cap will this use?'

Those four questions take a minute and remove essentially all of the uncertainty. A practice that will not answer them in writing is telling you something.

What to bring

Services Australia assesses eligibility automatically — families do not apply. If Medicare deems a child eligible it sends a letter confirming this. Bring that letter, though the practice can also verify eligibility directly.

Private health extras cover and the CDBS cannot both be claimed for the same service, but private cover can be used for treatment the CDBS excludes, or once the cap is exhausted. That is the practical answer for orthodontics and for treatment under general anaesthetic — and both usually carry waiting periods measured in months to years, which is an argument for knowing what your policy covers well before you need it.

When the cap runs out, or you are not eligible

This is the part most pages leave off, and it is the part that matters most to the families under the most pressure.

Victoria has a public dental system, and it is separate from the CDBS:

• Children under 13 are generally eligible for public dental care in Victoria.
• Children aged 13 to 17 are generally eligible if they or their family hold a concession card, or in certain other circumstances.
• Care is delivered through community dental agencies and the Royal Dental Hospital of Melbourne.
• Emergency care is triaged by clinical urgency, not by waiting-list position. Say clearly if a child is in pain, has facial swelling, or has had a tooth knocked out.

A child in pain should be seen regardless of what any scheme covers. Facial swelling with difficulty swallowing or breathing is a hospital emergency, not a dental appointment — see Children's Dental Emergencies.

And if cost is the barrier generally, say so plainly to the practice. Sequencing treatment over time, prioritising what is urgent, and choosing the more conservative option are all legitimate clinical decisions, and a practitioner who knows the constraint can plan around it.

Why the 0-to-17 range matters clinically

The age band is not arbitrary. It spans the whole of the mixed dentition — the years when baby teeth are being replaced.

Baby teeth start falling out from around age six and the last go at around eleven or twelve. That surprises most people, and it is the practical answer to ‘they're only baby teeth': a decayed baby molar in a five-year-old has around seven years left to cause trouble, and an early extraction lets neighbouring teeth drift into the space the permanent tooth needed — one of the common origins of crowding.

Decay is also the most common chronic disease of childhood in Australia, and it is largely preventable. The schedule pays for the examination that finds it early, when a small filling is the whole treatment rather than the first step in a long sequence.

The two ends of the band are both worth marking in a calendar. Eligibility can begin from birth, well before most families think of dentistry as relevant — see Kids Teeth Cleaning Tips for what to be doing in those early years. At the other end, eligibility runs to age 17 and stops; a teenager who has never used it has one last window, and the year they turn 18 is not it.

Related pages: Children's Dentistry, First Visit to the Dentist, Kids Teeth Cleaning Tips, Children's Dental Emergencies, Paediatric Dentists, Dental Anxiety.

Common questions

Do I need to apply? No. Services Australia assesses eligibility automatically and writes to you if your child qualifies.

Can I use it at any dentist? At any dentist who participates. Ask when booking, and ask whether they bulk bill the schedule.

Does using it affect Family Tax Benefit or any other payment? No.

My child is eligible but has no dental problems. Is it worth going? Yes — that is the point of it. The examination, clean and fissure sealants are exactly what the schedule is designed to pay for, and they are most valuable before anything is wrong.

We stopped receiving Family Tax Benefit in March. Are we out? Not necessarily for this calendar year. Eligibility needs the qualifying payment for at least one day in the year. Check rather than assume.

My children are 4, 9 and 15 and all eligible. Is there one cap between them? No — each child has their own cap.

Can I use the CDBS and my private health extras on the same filling? No, not for the same service. Extras cover is for what the schedule excludes, or for after the cap is used up.

Does it cover a mouthguard for sport? No. A custom mouthguard is not a covered item, though it is one of the better things to spend money on if your child plays a contact sport — see Sport Mouthguards.

What if my child is anxious about the dentist? Say so when booking. It changes how the appointment is run, and it is far better addressed at a check-up than at an emergency. See First Visit to the Dentist.

Practical details

Every practitioner's registration can be verified free on the AHPRA public register at ahpra.gov.au.

General information only — not a diagnosis or a treatment plan. Eligibility rules, covered item numbers and the cap amount are set by the Australian Government and change; confirm current details with Services Australia rather than relying on this page. Public dental eligibility in Victoria is set by the Victorian Department of Health.

Smile Solutions trades under ABN 28 193 514 103.