sion of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the den- tal procedure, requires hospitaliza- tion in connection with the provision of such services.”
Thus, items connected to the care, treat- ment, filling, removal, or replacement of teeth or structures directly supporting teeth are exempt from Missouri sales and use tax.
Regulatory guidance in 12 CSR 10-110.013 confirms that items specified in Section 1862(a)(12) of the Social Security Act are exempt from sales tax including items used in connection with the treatment, removal or replacement of teeth or struc- tures directly supporting teeth and, pro- vides specific examples of exempt items. These enumerated examples include: • Dentures • Bridge work • Braces (In its advocacy with DOR, the MDA explained the braces example should be expanded to include modern methods such as orthodontic appliances, orthodontic brackets, orthodontic resins and orthodontic separators.)
• Artificial dentistry and dental recon- structions, which are made, manu- factured, or fabricated from molds or impressions made by dentists of the mouths of their particular patients and sold to dentists for insertion in the patient’s mouth as the direct support of, substitution for, or part of the patient’s teeth
• Restorative materials, prosthetic devices and supportive materials and orthodontic devices in any variety of materials (e.g., acrylics, metals, por- celains) and component parts (e.g., brackets, anchors, bonding materials)
QUESTION: When is this change to the tax matrix effective? Do we need to contact vendors for refunds on exempt products purchased? The issuance date of that matrix was August 27, 2024 and the revision date is July 22, 2025. The MDA believes you could send letters to the manufacturers addressing the change and
22 focus | FALL 2025 | ISSUE 3
that this should be retroactive to the is- suance date; however, we can’t guarantee you will receive a positive response. We know of members who are doing this and are using a letter MDA formatted to serve as a template. To find a copy of the letter, scan the QR code on the previous page.
QUESTION: Can you clarify the differ- ence between Specialty Advertising and Media Advertising? Doctors can refer to the Rules, which define the following:
Specialty advertising — items of tangible personal property on which advertising is placed but which have a use and value separate from the advertising. Such items include, but are not limited to tee shirts, key chains, glassware, frisbees, rulers, pens, calen- dars, matchbooks, calculators, clocks, notebooks and pocket protectors.
However, in that same PDF, there is nothing specific to Media advertising. The MDA inquired with DOR for its interpre- tation for which they stated:
The department uses Section 144.034, RSMo to help define media advertising. The bold part is what they consider media advertising “The sales of advertis- ing by legal newspapers pursuant to chapter 493, advertising agencies, broad- cast stations, and standardized outdoor billboard advertising shall be considered the sale of a service and not the sale of tangible personal property …”
Additionally, 12 CSR 10-103.610 Sales of Advertising, subsection (2)(A) defines advertising as “the expression of an idea created and produced for reproduction and distribution in the media, such as television, radio, newspapers, newsletters, periodicals, trade journals, publications, books, other printed materials, magazines, standardized outdoor billboards, direct mail or point-of-sale (POS) displays, and which is designed to promote sales of a particular product or service or otherwise affect consumer behavior.”
Although these sources do not explic- itly define media advertising, DOR uses this regulation and statute to define media advertising.
DO YOU KNOW WHAT THE MISSOURI DEPARTMENT OF REVENUE TAX MATRIX SAYS? The pages below are just two of five total for Dentists and Orthodontists and an additional matrix exists for Dental Supply Companies. Scan the QR Code to download these or go to
dor.mo.gov/taxation/business/ industry-tax-matrices.html
AUDIT SERVICES
DENTISTS & ORTHODONTISTS
The specific exemption for orthopedic, prosthetic, and dental items reads, in relevant part:
144.030. — 1. …
(18) All sales of….."prosthetic devices, and orthopedic devices as defined on January 1, 1980, by the federal Medicare program .” Sales by Dentists & Orthodontists:
Dental items placed permanently in patient's mouth, including but not limited to: bridges, fillings, crowns, inlays, full and partial dentures, denture anchors, and denture repair material
Orthodontic devices and materials including but not limited to: appliances, braces, brackets, elastics, resins, separators, waxes, wires, retainers, dental straighteners, and aligners
Prosthetic devices and supporting materials such as acrylics, bonding materials, chrome alloys, composed materials, implant materials, and metal alloys
Dental services which include tangible personal property including but not limited to: electric toothbrushes, waterpiks, water flossers, whitening kits, boil & bite and laminate mouth guards, prescribed mouth guards, retainers, dental straighteners, aligners etc.
Sales of tangible personal property where no dental services were performed including but not limited to: electric toothbrushes, waterpiks, water flossers, whitening kits, boil & bite and laminate mouth guards, etc.
Custom-fitted trays designed for the delivery of prescribed medication Custom bleaching services Prescription strength fluoride
Non-prescription fluoride bottles sold to patients for home use Vitamins and minerals which may or may not require a prescription Anti-snoring sleep apnea device
Purchases by Dentists & Orthodontists:
Dental items placed permanently in patient's mouth, including but not limited to: bridges, fillings, crowns, inlays, full and partial dentures, denture anchors, and denture repair material
Orthodontic devices and materials including but not limited to: appliances, braces, brackets, elastics, resins, separators, waxes, wires, retainers, dental straighteners and aligners
Taxable/Exempt Exempt
Exempt
Exempt Exempt
Taxable
Exempt Exempt Exempt Taxable Taxable Taxable
Taxable/Exempt Exempt
Exempt
TAX MATRIX
AUDIT SERVICES
DENTISTS & ORTHODONTISTS
Purchases by Dentists & Orthodontists (continued):
Prosthetic devices and supporting materials such as acrylics, bonding materials, chrome alloys, composed materials, implant materials, and metal alloys Custom-fitted trays designed for the delivery of prescribed medication
Anti-snoring sleep apnea device that will be sold at retail to patients Bleaching agents
Prescription strength fluoride Non-prescription strength fluoride to sell to patients
Non-prescription strength fluoride to use on patient during dental services Polisher and polishing compound
Vitamins and minerals which may or may not require a prescription to be sold at retail Dental vibrators used to perform cleanings on patients’ teeth and gums Disinfectant towels and wipettes Gloves
Mirrors, probes, tweezers, and other dental kit Items Prescribed mouth guards
Boil & bite and laminate mouth guards to be sold at retail
Boil & bite and laminate mouth guards to be used as part of dental services Retainers, dental straighteners and aligners Nitrous oxide
Novocain and other prescription drugs Resin
Cements
Amalgam fillings Study models Lathes
TAX MATRIX
Taxable/Exempt Exempt
Exempt Exempt Taxable Exempt Exempt Taxable Taxable Exempt Taxable Taxable Taxable Taxable Exempt Exempt Taxable Exempt Taxable Exempt Exempt Exempt Exempt Taxable Taxable
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