The clinical care itself does not change: the same examination, the same clinician, the same standard, whether a child's visit is bulk-billed under Medicare or paid privately. What changes is who pays for it, and what sits inside the scope of the benefit.
That is the honest answer, and it is worth saying plainly, because parents often assume that a bulk-billed appointment is a shorter or lesser version of a paid one. It is not.
Families are welcome to ask which pathway applies to their child before booking anything.
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What is the Child Dental Benefits Schedule?
The Child Dental Benefits Schedule, usually shortened to CDBS, is a Medicare programme that contributes towards basic dental services for eligible children and teenagers. At this practice it is bulk-billed, which means Medicare pays the clinic directly and there is no out-of-pocket cost to the family for the services covered.
The benefit is capped over two calendar years rather than being unlimited, and the cap figure is set by the Department of Health and changes over time, so it is not reproduced here. The current amount and the current rules are published on the Department of Health website.
Who is eligible?
Broadly, CDBS applies to children and teenagers whose family receives a qualifying government payment, most commonly Family Tax Benefit Part A, and who meet the age requirements for the programme.
That is a summary, not a determination. Eligibility depends on the family's circumstances in a given calendar year, and it can start or stop as those circumstances change. Rather than assuming either way, a parent can check the child's status through their Medicare online account, or use the CDBS checker on this site.
There is also a fuller explanation of the programme in the parents' guide to Medicare CDBS.
How does bulk-billing work at the practice?
Bulk-billing means the practice claims the benefit from Medicare directly and accepts it as full payment for the covered services. Nothing is paid at the desk and nothing is claimed back afterwards.
Practically, it looks like this:
- Eligibility is checked before or at the appointment.
- A consent form is signed at the visit, authorising the practice to claim on the child's behalf.
- The treatment is provided and the claim is lodged.
- Medicare pays the clinic directly.
The consent form is a Medicare requirement rather than a practice one, and it also confirms that the family has been told what the treatment involves.
What happens if the benefit runs out mid-treatment?
Because the benefit is capped over two calendar years, it can be exhausted partway through a course of treatment, particularly where several teeth need attention.
This is the main reason treatment is sequenced rather than done all at once. The clinical team works through what is most urgent first, and tells the family where the remaining balance sits as it goes, so nobody discovers at the last appointment that the benefit ran out two visits ago.
If the balance does run out and further treatment is needed, the family is told the private fee for the remaining work before it is booked, and can decide on timing from there.
What does CDBS not cover?
The benefit covers the routine, preventive and restorative basics. It does not extend to orthodontic treatment, cosmetic work, or treatment provided in hospital. The detail is set out in what CDBS does not cover, which is worth reading before assuming an item is included.
Where something falls outside the benefit, it is quoted privately and the family is told before it is booked.
If a family is unsure what their remaining balance covers, the practice can look it up and explain it.
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What does a private children's visit cost?
For children who are not CDBS-eligible, or where the benefit has been used up, these are the practice's out-of-pocket fees:
- Check-up, clean and X-rays, under 10: $150
- Check-up, clean and X-rays, 10 and over: $250
- Filling on a baby tooth: $150 to $250
- Filling on an adult tooth in a child: $250 to $450
- Stainless steel crown: $250
- Pulpotomy: $300, plus $250 for the crown that follows, so $550 in total
- Extraction: $250 to $300
- Happy gas: $120
- Fissure sealant: $80 per tooth
Every one of those figures assumes no health-fund contribution. A fund may contribute towards some of these items depending on the policy and the level of extras cover, and the only reliable way to find out is for the family to check with their own fund. A written quotation is provided before any treatment begins, so nothing is agreed to without a figure in front of the parent.
The full adult and children's fee list sits on the fees page.
How do those fees compare with what Medicare itself pays?
This is worth stating factually, because it is the fairness test parents most often want applied.
For the same style of visit, Medicare's own CDBS benefit works out at around $204.90 without X-rays, and around $275 where two X-rays are taken. The practice's private fee of $250 for a check-up, clean and X-rays in a child aged 10 and over therefore sits at or below what Medicare itself pays for that visit.
That is the comparison, without any claim attached to it. Again, those figures assume no health-fund contribution, a fund may contribute, and a written quote is given first.
So what actually differs between the two?
Three things, and only three.
Who pays
Medicare pays the clinic directly under CDBS. The family pays under a private visit, with a fund possibly contributing.
Scope
CDBS covers a defined list of services. A private visit is not limited to that list, but it is also not funded from it.
Sequencing
A capped benefit encourages treatment to be staged over time so the balance is used where it does the most good. A privately funded course of treatment can be sequenced on clinical priority and family preference alone.
The examination, the clinician, the equipment, the time allowed and the standard of care are the same in both cases.
Quick answers
Is a bulk-billed visit shorter than a private one?
No. The appointment length is set by what the child needs, not by how it is funded.
Do we have to pay anything at a bulk-billed visit?
For the services covered by the benefit, there is no out-of-pocket cost, because Medicare pays the clinic directly. If something outside the benefit is needed, it is quoted separately and agreed beforehand.
What if only one of our children is eligible?
That is common, since eligibility is assessed per child. One child can be bulk-billed while a sibling is seen privately, at the fees listed above. Those fees assume no fund contribution, a fund may contribute, and a written quote is given before treatment.
Can we start under CDBS and finish privately?
Yes, and it happens whenever a benefit balance runs out mid-course. The remaining work is quoted in writing before it goes ahead.
Where to go next
Parents can check a child's status with the CDBS checker, read the wider explanation in the parents' guide to Medicare CDBS, and see what else is offered for children on the children's dentistry hub.
Questions about eligibility, balances or fees are answered over the phone without an appointment.
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Written and reviewed by Humzah Aly, Oral Health Therapist. This article is general information only and is not a substitute for personalised dental advice. Please see a dental practitioner to discuss what is right for you.
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