Alliance Midmed 2020 Rates€¦ · Dental Practice (54) Maxillo-Facial & Oral Surgery (62)...

*-

Trf

CodeTariffDescription

*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8025 HANDLING FEE - DIRECT

MATERIALS (26% OF MATERIAL

COST TO A MAXIMUM OF R26.00)

43.30R 43.30R 43.30R 43.30R - 43.30R - -

8101 ORAL EXAMINATION 240.00R 240.00R 240.00R 240.00R - 240.00R 124.90R -8102 COMPREHENSIVE ORAL

EXAMINATION

387.70R 387.70R 387.70R 387.70R - 387.70R 201.70R -

8104 LIMITED ORAL EXAMINATION 116.40R 116.40R 116.40R 116.40R - 116.40R 97.30R -8106 SPECIAL REPORT 246.50R 246.50R 246.50R 246.50R - 246.50R - -8107 INTRAORAL RADIOGRAPH -

PERIAPICAL

97.20R 97.20R 97.20R 97.20R - 97.20R 93.70R 93.70R

8108 INTRAORAL RADIOGRAPHS -

COMPLETE SERIES

752.20R 752.20R 752.20R 752.20R - 752.20R 721.70R 721.70R

8109 INFECTION CONTROL/BARRIER

TECHNIQUES

21.60R 21.60R 21.60R 21.60R - 21.60R 21.60R 21.60R

8110 STERILIZED INSTRUMENTATION 55.80R 55.80R 55.80R 55.80R - 55.80R 55.70R 55.40R 8112 INTRAORAL RADIOGRAPH -

BITEWING

97.20R 97.20R 97.20R 97.20R - 97.20R 93.70R -

8113 INTRAORAL RADIOGRAPH -

OCCLUSAL

167.40R 167.40R 167.40R 167.40R - 167.40R - -

8114 EXTRAORAL RADIOGRAPH - HAND-

WRIST

388.50R 388.50R 388.50R 388.50R - 388.50R - -

8115 EXTRAORAL RADIOGRAPH -

PANORAMIC

388.50R 388.50R 388.50R 388.50R - 388.50R - -

8116 EXTRAORAL RADIOGRAPH -

CEPHALOMETRIC

388.50R 388.50R 388.50R 388.50R - 388.50R - -

DENIS shall be entitled to update the tariff schedule from time to time.

The tariffs listed do not consider scheme exclusions and scope of practice and is by no means a commitment of funding.

Benefit entitlement is governed by the relevant scheme option and rules as well as risk management interventions and protocols.

If the clinical code requires managed care intervention, all associated lab codes will be included in the authorisation process. Pre-authorisation is required for the dental code to attract benefitTariff amount not applicable

Alliance Midmed 2020 Rates

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8117 DIAGNOSTIC MODELS 104.40R 104.40R 104.40R 104.40R - 104.40R - -8118 EXTRAORAL RADIOGRAPH -

SKULL/FACIAL BONE

388.50R 388.50R 388.50R 388.50R - 388.50R - -

8119 DIAGNOSTIC MODELS MOUNTED 262.60R 262.60R 262.60R 262.60R - 262.60R - -

8120 TREATMENT PLAN COMPLETED - - - - - - - -8121 ORAL AND/OR FACIAL IMAGE

(DIGITAL/CONVENTIONAL)

104.40R 104.40R 104.40R 104.40R - 104.40R - 100.50R

8123 CARIES SUSCEPTIBILITY TESTS (BY

ARRANGEMENT)

- - - - - - - -

8124 PULP TESTS 28.70R - - - - - - -8129 OFFICE/HOSPITAL VISIT – AFTER

REGULARLY SCHEDULED HOURS

361.60R 361.60R - 361.60R - 361.60R 299.80R -

8131 EMERGENCY DENTAL TREATMENT 147.40R 147.40R 147.40R 147.40R - 300.50R 124.90R 125.00R

8132 PULP REMOVAL (PULPECTOMY) 241.10R 241.10R - - - 320.50R - -8133 RECEMENT INLAY, ONLAY, CROWN

OR VENEER

147.40R 147.40R - - - 187.10R - -

8135 REMOVE INLAY, ONLAY OR CROWN 293.30R 293.30R - - - 293.30R - -

8136 ACCESS THROUGH A PROSTHETIC

CROWN OR INLAY TO FACILITATE

ROOT CANAL TREATMENT

131.30R 131.30R - 131.30R - 131.30R - -

8137 EMERGENCY CROWN (CHAIR-SIDE) 505.50R 505.50R - - - 505.50R - -

8138 REMOVE RETENTION POST

(PREFABRICATED OR CAST)

192.50R 192.50R - - - 192.50R - -

8139 APPOINTMENT NOT KEPT /30MIN - - - - - - - -

8140 HOUSE/EXTENDED CARE

FACILITY/HOSPITAL CALL

* 239.30R 239.30R - 239.30R - 239.30R 198.30R -

8141 INHALATION SEDATION - FIRST 15

MINUTES OR PART THEREOF

108.00R 108.00R - 108.00R - 108.00R - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8143 INHALATION SEDATION - EACH

ADDNL 15 MINUTES

55.80R 55.80R - 55.80R - 55.80R - -

8144 INTRAVENOUS SEDATION * 64.80R 64.80R - 64.80R - 64.80R - -8145 LOCAL ANAESTHETIC - PER VISIT 93.70R 93.70R 93.70R 93.70R - 93.70R 21.20R 21.30R 8146 RESIN BONDING FOR

RESTORATIONS

- - - - - - - -

8147 MONITORING EQUIPMENT FOR

INTRAVENOUS SEDATION

230.30R 230.30R - 230.30R - 230.30R - -

8151 ORAL HYGIENE INSTRUCTION 147.40R - - 295.10R - 295.10R 98.10R 98.10R 8153 ORAL HYGIENE INSTRUCTION -

EACH ADDITIONAL VISIT

108.00R - - 142.00R - 142.00R 71.80R 71.80R

8154 ORAL EXAMINATION - ORAL

HYGIENIST

- - - - - - - 124.90R

8155 POLISHING - COMPLETE DENTITION 147.40R 147.40R - 203.20R - 147.40R 120.00R 119.10R

8157 RE-BURNISHING AND POLISHING

OF RESTORATIONS - COMPLETE

DENTITION

147.40R - - - - - - -

8158 ENAMEL MICROABRASION 134.90R - - - - - - -8159 PROPHYLAXIS - COMPLETE

DENTITION

289.70R 289.70R - 408.50R - 289.70R 218.50R 218.40R

8160 REMOVAL OF GROSS CALCULUS - - - - - - - -8161 TOPICAL APPLICATION OF

FLUORIDE - CHILD

147.40R 147.40R - 147.40R - 147.40R 120.00R 119.90R

8162 TOPICAL APPLICATION OF

FLUORIDE - ADULT

147.40R - - 147.40R - 147.40R 120.00R 120.00R

8163 DENTAL SEALANT 97.20R 97.20R - 97.20R - 97.20R 88.80R 88.80R 8164 LIMITED ORAL EXAMINATION -

ORAL HYGIENIST

- - - - - - - 97.30R

8165 SEDATIVE FILLING 147.40R 147.40R - 147.40R - 147.40R 124.90R 125.00R 8166 APPLICATION OF DESENSITISING

RESIN, PER TOOTH

97.20R 97.20R - 97.20R - 97.20R 82.50R 82.60R

8167 APPLICATION OF DESENSITISING

MEDICAMENT, PER VISIT

113.40R 113.40R - 113.40R - 113.40R 96.10R 96.00R

8169 OCCLUSAL GUARD 566.60R 566.60R 566.60R 566.60R - 566.60R - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8171 MOUTH PROTECTOR 171.50R 171.50R 171.50R 171.50R - 171.50R - 128.60R 8172 COST OF ORTHOTIC APPLIANCE * - - - - - - - -8173 SPACE MAINTAINER - FIXED, PER

ABUTMENT

273.60R 273.60R 273.60R 273.60R - 273.60R - -

8175 SPACE MAINTAINER - REMOVABLE 352.70R 352.70R 352.70R 352.70R - 352.70R - -

8176 PERIODONTAL SCREENING 202.20R 190.70R - 202.20R - 202.20R - 146.60R 8177 ORAL HYGIENE INSTRUCTION

(PERIODONTALLY COMPROMISED

PATIENT)

223.20R - - - - - - -

8178 ORAL HYGIENE INSTRUCTION -

EACH ADDITIONAL VISIT


PATIENT)

120.50R - - - - - - -

8179 POLISHING - COMPLETE DENTITION


PATIENT)

169.20R 169.20R - 169.20R - 169.20R - 122.70R

8180 PROPHYLAXIS - COMPLETE

DENTITION (PERIODONTALLY

COMPROMISED PATIENT)

* 314.80R 314.80R - 314.80R - 169.20R - 176.30R

8183 THERAPEUTIC DRUG INJECTION 64.80R - - - - - - -8189 RE-EXAMINATION - EXISTING

CONDITION

116.40R - - - - - 97.30R 97.30R

8190 CONSULTATION - SECOND OPINION

OR ADVICE

240.00R 240.00R 240.00R 240.00R - 240.00R - -

8192 SUTURE - MINOR 726.80R 726.80R - 726.80R - 726.80R - -8194 CBCT CAPTURE AND

INTERPRETATION WITH LIMITED

FIELD OF VIEW - LESS THAN ONE

WHOLE JAW

388.50R 388.50R 388.50R 388.50R - 388.50R - -

8195 CBCT CAPTURE AND


FIELD OF VIEW OF ONE FULL ARCH -

MANDIBLE

388.50R 388.50R 388.50R 388.50R - 388.50R - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)




MAXILLA WITHOUT ORBITS

AND/OR CRANIUM

388.50R 388.50R 388.50R 388.50R - 388.50R - -



FIELD OF VIEW OF BOTH DENTAL

ARCHES - WITHOUT ORBITS

AND/OR CRANIUM

388.50R 388.50R 388.50R 388.50R - 388.50R - -


INTERPRETATION FOR TMJ SERIES

INCLUDING TWO OR MORE

EXPOSURES

388.50R 388.50R 388.50R 388.50R - 388.50R - -




MAXILLA WITH ORBITS AND/OR

CRANIUM

388.50R 388.50R 388.50R 388.50R - 388.50R - -


INTERPRETATION WITH FIELD OF

VIEW OF BOTH DENTAL ARCHES -

WITH ORBITS AND/OR CRANIUM

388.50R 388.50R 388.50R 388.50R - 388.50R - -

8201 EXTRACTION - TOOTH OR EXPOSED

TOOTH ROOTS (FIRST PER

QUADRANT)

147.40R 221.10R 147.40R 147.40R - 147.40R 139.90R -

8202 EXTRACTION - EACH ADDITIONAL

TOOTH OR EXPOSED TOOTH ROOTS

59.40R 89.10R 59.40R 59.40R - 59.40R 54.00R -

8213 SURGICAL REMOVAL OF RESIDUAL

ROOTS, FIRST TOOTH PER

QUADRANT

637.00R 637.00R - 637.00R - 637.00R - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)


ROOTS, SECOND AND SUBSEQUENT

TEETH'S ROOTS

491.10R 491.10R - 491.10R - 491.10R - -

8220 COST OF SUTURE MATERIAL 231.10R 231.10R - 231.10R - 231.10R 231.10R -8228 ART RESTORATIONS - - - - - - - 255.90R 8231 COMPLETE DENTURES - MAXILLARY

AND MANDIBULAR

* 2 378.50R - - 2 378.50R - 4 965.80R - -

8232 COMPLETE DENTURE - MAXILLARY

OR MANDIBULAR

* 1 466.30R - - 1 466.30R - 3 474.30R - -

8233 PARTIAL DENTURE - RESIN BASE -

ONE TOOTH

* 681.80R - - 681.80R - 681.80R - -


TWO TEETH

* 681.80R - - 681.80R - 681.80R - -


THREE TEETH

* 1 020.10R - - 1 020.10R - 1 020.10R - -


FOUR TEETH

* 1 020.10R - - 1 020.10R - 1 020.10R - -


FIVE TEETH

* 1 020.10R - - 1 020.10R - 1 020.10R - -


SIX TEETH

* 1 353.10R - - 1 353.10R - 1 353.10R - -


SEVEN TEETH

* 1 353.10R - - 1 353.10R - 1 353.10R - -


EIGHT TEETH

* 1 353.10R - - 1 353.10R - 1 353.10R - -


NINE OR MORE TEETH

* 1 353.10R - - 1 353.10R - 1 353.10R - -

8244 IMMEDIATE DENTURE - MAXILLARY * 1 466.30R - - 1 466.30R - 2 199.50R - -

8245 IMMEDIATE DENTURE -

MANDIBULAR

* 1 466.30R - - 1 466.30R - 2 199.50R - -

8251 CLASP OR REST - CAST GOLD 134.90R - - - - - - -8253 CLASP OR REST - WROUGHT GOLD 134.90R - - - - - - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8255 CLASP OR REST - STAINLESS STEEL 142.00R - - - - - - -

8257 BAR - LINGUAL OR PALATAL 167.40R - - - - - - -8259 REBASE COMPLETE OR PARTIAL

DENTURE (LABORATORY)

555.90R - - 555.90R - 802.40R - -

8261 REMODEL COMPLETE OR PARTIAL

DENTURE

892.40R - - 892.40R - 892.40R - -

8263 RELINE COMPLETE OR PARTIAL

DENTURE (CHAIR-SIDE)

352.70R - - 352.70R - 440.70R - -

8265 TISSUES CONDITIONING PER ARCH

(INCLUDING SOFT SELF-CURE

RELINE)

230.30R 230.30R - 230.30R - 295.10R - 167.10R

8267 RELINE COMPLETE OR PARTIAL

DENTURE (LABORATORY)

811.60R - - 811.60R - 811.60R - -

8269 REPAIR DENTURE OR OTHER INTRA-

ORAL APPLIANCE

187.10R - - - - 201.40R - -

8270 ADD CLASP TO EXISTING PARTIAL

DENTURE

134.90R - - - - - - -

8271 ADD TOOTH TO EXISTING PARTIAL

DENTURE

134.90R - - - - - - -

8273 IMPRESSION TO REPAIR OR

MODIFY A DENTURE OR OTHER

INTRA-ORAL APPLIANCE

108.00R - - 108.00R - 108.00R - -

8275 ADJUST COMPLETE OR PARTIAL

DENTURE

108.00R - - 108.00R - 108.00R - -

8277 INLAY IN DENTURE 440.10R - - - - 867.70R - -8281 PARTIAL DENTURE - CAST METAL

FRAMEWORK ONLY

* 1 590.60R - - 1 590.60R - 1 590.60R - -

8301 PULP CAP - DIRECT 196.00R - - - - - - -8303 PULP CAP - INDIRECT 196.00R - - - - - 177.40R -8304 RUBBER DAM PER ARCH 115.20R 115.20R - 115.20R - 115.20R - -8306 COST OF MTA - - - - - - - -8307 PULP AMPUTATION (PULPOTOMY) 192.50R 192.50R - 192.50R - 192.50R - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8310 SUPPLY OF BLEACHING MATERIALS - - - - - - - -

8325 INTERNAL BLEACHING - PER TOOTH 349.10R - - - - 523.70R - -

8327 INTERNAL BLEACHING - EACH

ADDITIONAL VISIT

167.40R - - - - 251.10R - -

8328 ROOT CANAL OBTURATION -

ANTERIORS AND PREMOLARS -

EACH ADDITIONAL CANAL

273.60R 273.60R - - - 363.80R - -

8329 ROOT CANAL THERAPY -


EACH ADDITIONAL CANAL

341.90R 341.90R - - - 454.70R - -

8330 REMOVAL OF ROOT CANAL

OBSTRUCTION

192.50R 192.50R - 192.50R - 192.50R - -

8332 ROOT CANAL PREPARATORY VISIT -

SINGLE CANAL TOOTH

147.40R 147.40R - - - 196.00R - -

8333 ROOT CANAL PREPARATORY VISIT -

MULTI CANAL TOOTH

206.80R 206.80R - - - 206.80R - -

8334 RE-TREATMENT OF PREVIOUSLY

COMPLETED ROOT CANAL

THERAPY, PER CANAL

217.80R 217.80R - 217.80R - 262.60R - -



FIRST CANAL

669.30R 669.30R - - - 890.10R - -


POSTERIORS - FIRST CANAL

921.10R 921.10R - - - 1 224.90R - -


POSTERIORS - EACH ADDITIONAL

CANAL

273.60R 273.60R - - - 363.80R - -



FIRST CANAL

1 023.70R 1 023.70R - - - 1 361.60R - -


POSTERIORS - FIRST CANAL

1 406.80R 1 406.80R - - - 1 870.90R - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)


POSTERIORS - EACH ADDITIONAL

CANAL

341.90R 341.90R - - - 454.70R - -

8341 AMALGAM - ONE SURFACE 293.30R 293.30R - 293.30R - 293.30R 256.00R -8342 AMALGAM - TWO SURFACES 361.60R 361.60R - 361.60R - 361.60R 315.60R -8343 AMALGAM - THREE SURFACES 440.70R 440.70R - 440.70R - 440.70R 384.70R -8344 AMALGAM - FOUR OR MORE

SURFACES

491.10R 491.10R - 491.10R - 491.10R 428.50R -

8345 PREFABRICATED POST RETENTION,

PER POST (IN ADDITION TO

RESTORATION)

289.70R 289.70R - 289.70R - 289.70R - -

8347 PIN RETENTION - FIRST PIN (IN

ADDITION TO RESTORATION)

145.60R 145.60R - 145.60R - 145.60R - -

8348 PIN RETENTION - EACH

ADDITIONAL PIN (IN ADDITION TO

RESTORATION)

134.90R 134.90R - 134.90R - 134.90R - -

8349 CARVE RESTORATION TO

ACCOMMODATE EXISTING

REMOVABLE PROSTHESIS

59.40R - - - - - - -

8350 RESIN CROWN - ANTERIOR

PRIMARY TOOTH (DIRECT)

639.80R 639.80R - 639.80R - 639.80R 558.10R -

8351 RESIN - ONE SURFACE, ANTERIOR 322.00R 322.00R - 322.00R - 322.00R 309.70R -

8352 RESIN - TWO SURFACES, ANTERIOR 404.90R 404.90R - 404.90R - 404.90R 389.30R -

8353 RESIN - THREE SURFACES,

ANTERIOR

484.00R 484.00R - 484.00R - 484.00R 465.20R -

8354 RESIN - FOUR OR MORE SURFACES,

ANTERIOR

539.80R 539.80R - 539.80R - 539.80R 519.20R -

8355 VENEER - RESIN (CHAIR-SIDE) 511.10R 511.10R - 511.10R - 511.10R - -8357 PREFABRICATED METAL CROWN 300.50R 300.50R - 300.50R - 300.50R - -8361 INLAY - METAL - ONE SURFACE 447.90R - - - - 883.50R - -8362 INLAY/ONLAY - METAL - TWO

SURFACES

654.90R - - - - 1 280.90R - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8363 INLAY/ONLAY - METAL - THREE

SURFACES

1 092.10R - - - - 1 986.30R - -

8364 INLAY/ONLAY - METAL - FOUR OR

MORE SURFACES

1 320.60R - - - - 1 986.30R - -

8366 PIN RETENTION AS PART OF CAST

RESTORATION (ANY NUMBER OF

PINS)

217.80R - - - - 295.10R - -

8367 RESIN - ONE SURFACE, POSTERIOR 349.10R 349.10R - 349.10R - 349.10R 335.80R -

8368 RESIN - TWO SURFACES,

POSTERIOR

431.80R 431.80R - 431.80R - 431.80R 415.30R -

8369 RESIN - THREE SURFACES,

POSTERIOR

521.80R 521.80R - 521.80R - 521.80R 501.70R -

8370 RESIN - FOUR OR MORE SURFACES,

POSTERIOR

561.30R 561.30R - 561.30R - 561.30R 539.60R -

8371 INLAY - PORCELAIN - ONE SURFACE 539.80R - - - - 1 067.00R - -

8372 INLAY/ONLAY - PORCELAIN - TWO

SURFACES

797.00R - - - - 1 536.60R - -

8373 INLAY/ONLAY - PORCELAIN - THREE

SURFACES

1 313.40R - - - - 2 387.60R - -

8374 INLAY/ONLAY - PORCELAIN - FOUR

OR MORE SURFACES

1 590.60R - - - - 2 387.60R - -

8375 PREFABRICATED RESIN CROWN 300.50R 300.50R - 300.50R - 300.50R - -8376 CORE BUILD-UP WITH

PREFABRICATED POSTS

802.40R - - - - 802.40R - -

8379 COST OF PREFABRICATED POSTS 111.70R - - - - 111.70R - -8381 INLAY - RESIN - ONE SURFACE 539.80R - - - - 1 067.00R - -8382 INLAY/ONLAY - RESIN - TWO

SURFACES

797.00R - - - - 1 536.60R - -

8383 INLAY/ONLAY - RESIN - THREE

SURFACES

1 313.40R - - - - 2 387.60R - -

8384 INLAY/ONLAY - RESIN - FOUR OR

MORE SURFACES

1 590.60R - - - - 2 387.60R - -

8391 CAST CORE WITH SINGLE POST * 338.30R - - - - 338.30R - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8392 CAST POST (EACH ADDITIONAL) 201.40R - - - - 201.40R - -8397 CAST CORE WITH PINS (ANY

NUMBER OF PINS)

* 539.80R - - - - 701.80R - -

8398 CORE BUILD-UP WITH PINS 654.90R - - - - 654.90R - -8401 CROWN - FULL CAST METAL * 1 684.00R - - - - 2 479.20R - -8403 CROWN - 3/4 CAST METAL * 1 684.00R - - - - 2 479.20R - -8404 CROWN - 3/4 PORCELAIN/CERAMIC * 1 590.40R - - - - 2 387.60R - -

8405 CROWN - RESIN LABORATORY * 1 590.40R - - - - 2 387.60R - -8407 CROWN - RESIN WITH METAL * 1 684.00R - - - - 2 479.20R - -8409 CROWN - PORCELAIN/CERAMIC * 1 684.00R - - - - 2 479.20R - -8410 PROVISIONAL CROWN 327.30R - - 327.30R - 491.10R - -8411 CROWN - PORCELAIN VENEERED

TO METAL

* 1 684.00R - - - - 2 479.20R - -

8413 REPAIR CROWN (PERMANENT OR

PROVISIONAL)

327.30R 327.30R - - - 327.30R - -

8414 ADDITIONAL FEE FOR PROVISION

OF CROWN WITHIN AN EXISTING

CLASP OR REST

97.20R - - - - 97.20R - -

8415 PONTIC - CERAMIC * 1 374.60R - - - - 1 374.60R - -8416 PONTIC - CAST METAL * 1 092.10R - - - - 1 092.20R - -8417 PONTIC - RESIN WITH METAL * 1 374.60R - - - - 1 374.60R - -8418 PONTIC - PORCELAIN VENEERED TO

METAL

* 1 374.60R - - - - 1 374.60R - -

8419 PROVISIONAL PONTIC 327.30R - - - - 491.10R - -8432 INLAY/ONLAY RETAINER - METAL -

TWO SURFACES

* 654.90R - - - - 1 280.90R - -

8433 INLAY/ONLAY RETAINER - METAL -

THREE SURFACES

* 1 092.10R - - - - 1 986.30R - -

8434 INLAY/ONLAY RETAINER - METAL -

FOUR OR MORE SURFACES

* 1 320.60R - - - - 1 986.30R - -

8436 INLAY/ONLAY RETAINER -

PORCELAIN - TWO SURFACES

* 797.00R - - - - 1 536.60R - -


PORCELAIN - THREE SURFACES

* 1 313.40R - - - - 2 387.60R - -

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Dental

Technicians

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Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)


PORCELAIN - FOUR OR MORE

SURFACES

* 1 590.60R - - - - 2 387.60R - -

8441 CROWN RETAINER - FULL CAST

METAL

* 1 684.00R - - - - 2 479.20R - -

8442 CROWN RETAINER - 3/4 CAST

METAL

* 1 684.00R - - - - 2 479.20R - -

8443 CROWN RETAINER - CERAMIC * 1 684.00R - - - - 2 479.20R - -8444 CROWN RETAINER - 3/4 CERAMIC * 1 684.00R - - - - 2 479.20R - -

8445 CROWN RETAINER - PORCELAIN

VENEERED TO METAL

* 1 684.00R - - - - 2 479.20R - -

8446 CROWN RETAINER - RESIN WITH

METAL

* 1 684.00R - - - - 2 479.20R - -

8447 PROVISIONAL CROWN RETAINER 327.30R - - - - 491.10R - -8499 GENERAL ANAESTHETIC - - - - - - - -8501 CONSULTATION - PROSTHODONTIS - - - - - 305.90R - -

8503 OCCLUSION ANALYSIS MOUNTED 327.30R - - - - 491.10R - -

8505 PANTOGRAPHIC RECORDING 475.00R - - - - 712.50R - -8506 DETAILED CONSULTATION -

PROSTHODONTIST

- - - - - 800.60R - -

8507 COMPREHENSIVE CONSULTATION -

PROSTHODONTIST

- - - - - 491.10R - -

8508 ELECTROGNATHOGRAPHIC

RECORDING

508.50R - - - - 762.90R - -

8509 ELECTROGNATHOGRAPHIC

RECORDING WITH COMPUTER

ANALYSIS

844.30R - - - - 1 266.60R - -

8514 RECEMENT BRIDGE 147.40R 147.40R - - - 187.10R - -8516 REMOVE BRIDGE 293.30R 293.30R - - - 293.30R - -

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Dental

Technicians

(93)

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Therapists

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Oral

Hygiene

(113)

8517 REIMPLANTATION OF AVULSED

TOOTH (INCLUDE STABILISATION)

340.60R 340.60R - 340.60R - 511.10R - -

8518 REPAIR BRIDGE 327.30R 327.30R - - - 327.30R - -8533 IMPLANT SUPPORTED REMOVABLE

COMPLETE OVERDENTURE

* 2 643.50R - - - - 3 965.40R - -

8534 IMPLANT SUPPORTED REMOVABLE

PARTIAL OVERDENTURE

* 2 114.80R - - - - 3 172.30R - -

8536 CROWN-IMPLANT/ABUTMENT

SUPPORTED CROWN -

PORCELAIN/CERAMIC

* 2 185.90R - - - - 2 891.30R - -


SUPPORTED CROWN - PORCELAIN

WITH METAL

* 2 185.90R - - - - 2 891.30R - -


SUPPORTED CROWN - CAST METAL

* 2 185.90R - - - - 2 891.30R - -

8546 IMPLANT SUPPORTED CROWN

RETAINER - CERAMIC

* 2 185.90R - - - - 2 891.30R - -

8547 IMPLANT SUPPORTED CROWN

RETAINER - PORCELAIN VENEERED

TO METAL

* 2 185.90R - - - - 2 891.30R - -

8548 CROWN RETAINER -

IMPLANT/ABUTMENT SUPPORTED -

CAST METAL

* 2 185.90R - - - - 2 891.30R - -

8551 OCCLUSAL ADJUSTMENT - MAJOR 933.10R - 1 399.70R - - 1 399.70R - -

8552 VENEER - PORCELAIN

(LABORATORY)

1 131.00R - - - - 1 696.60R - -

8553 OCCLUSAL ADJUSTMENT - MINOR 325.50R 446.10R 446.10R 446.10R - 446.10R - -

8554 VENEER - RESIN (LABORATORY) 1 131.00R - - - - 1 696.60R - -8560 COST OF CERAMIC BLOCK * 661.40R - - - - 661.40R - -

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Technicians

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Therapists

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Hygiene

(113)

8561 GOLD FOIL CLASS I OR IV 854.00R - - - - 1 280.90R - -8563 GOLD FOIL CLASS V 999.10R - - - - 1 498.70R - -8565 GOLD FOIL CLASS III 1 256.90R - - - - 1 885.50R - -8570 FABRICATION OF COMPUTER

GENERATED CERAMIC

RESTORATION

* 1 604.60R - - - - 1 604.60R - -

8578 PREFABRICATED ABUTMENT 273.60R - - - - 410.30R - -8579 CUSTOM ABUTMENT 1 247.40R - - - - 1 871.10R - -8580 CUSTOMISED PREFABRICATED

ABUTMENT

* - - - - - - - -

8581 CAST CORE WITH SINGLE POST * - - - - - 500.10R - -8582 CAST CORE WITH DOUBLE POST * - - - - - 712.50R - -8583 CAST CORE WITH TRIPLE POST * - - - - - 883.50R - -8584 CONNECTOR BAR - IMPLANT

SUPPORTED

* - - - - - 3 965.40R - -

8585 CONNECTOR BAR - - - - - 3 965.40R - -8586 STRESS BREAKER - - - - - 1 479.00R - -8587 COPING METAL 219.60R - - - - 410.30R - -8590 IMPLANT MAINTENANCE

PROCEDURES - PER IMPLANT

121.10R - - - - 181.70R - -

8592 CROWN - IMPLANT/ABUTMENT

SUPPORTED

* 2 185.40R - - - - 2 891.30R - -

8594 REPAIR OF IMPLANT SUPPORTED

PROSTHESIS

134.40R - - - - 201.40R - -

8595 REPAIR OF IMPLANT ABUTMENT 134.40R - - - - 201.40R - -8597 LOCKS AND MILLED RESTS 134.40R - - - - 201.40R - -8599 PRECISION ATTACHMENT

(REMOVABLE DENTURE)

327.30R - - - - 491.10R - -

8600 COST OF IMPLANT COMPONENTS * - - - - - - - -

8611 PONTIC - SANITARY * - - - - - 1 498.70R - -8613 PONTIC - POSTERIOR * - - - - - 1 833.50R - -8615 PONTIC - ANTERIOR/PREMOLAR * - - - - - 1 980.90R - -8617 RETAINER CAST METAL

(MARYLAND TYPE RETAINER)

* 654.90R - - - - 1 280.90R - -

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(92)

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Technicians

(93)

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(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8631 ROOT CANAL THERAPY - FIRST

CANAL SPECIALIST

PROSTHODONTIST

- - - - - 1 738.00R - -

8633 ROOT CANAL THERAPY - EACH

ADDITIONAL CANAL SPECIALIST

PROSTHODONTIST

- - - - - 437.10R - -

8635 APEXIFICATION/APEXOGENESIS/RE

CALCIFICATION – PER VISIT

196.00R 196.00R - 196.00R - 260.70R - -

8640 REMOVAL OF FRACTURED ROOT

CANAL INSTRUMENT

* 511.00R - - - - 511.10R - -

8643 COMPLETE DENTURES - MAXILLARY

AND MANDIBULAR. ONLY FOR

PROSTHODONTISTS

* - - - - - 6 444.60R - -

8645 COMPLETE DENTURES - MAXILLARY

OR MANDIBULAR. ONLY FOR

PROSTHODONTISTS

* - - - - - 7 927.20R - -


MAXILLARY. ONLY FOR

PROSTHODONTIST

* - - - - - 3 965.40R - -


MANDIBULAR. ONLY FOR

PROSTHODONTIST

* - - - - - 4 460.10R - -

8652 OVERDENTURE - COMPLETE * 2 643.50R - - - - 3 965.40R - -8653 OVERDENTURE - PARTIAL * 2 114.80R - - - - 3 172.30R - -8654 IMPLANT SUPPORTED FIXED-

DETACHABLE COMPLETE

OVERDENTURE

* 2 973.40R - - - - 4 460.10R - -

8655 IMPLANT SUPPORTED FIXED-

DETACHABLE PARTIAL

OVERDENTURE

* 2 378.60R - - - - 3 056.30R - -

8657 REPLACEMENT OF PRECISION

ATTACHMENT

187.10R - - - - 201.40R - -

8658 INTERIM COMPLETE DENTURE 1 466.20R - - - - 2 199.50R - -8659 INTERIM PARTIAL DENTURE 1 172.90R - - - - 1 759.50R - -

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Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8660 ADDITIONAL FEE TO IMPLANT

SUPPORTED FIXED-DETACHABLE

DENTURE - PER IMPLANT

410.30R - - - - 410.30R - -

8661 DIAGNOSTIC DENTURES

(INCLUDING TISSUE

CONDITIONING)

- - - - - - - -

8662 ADJUST COMPLETE OR PARTIAL

DENTURES (REMOUNTING)

381.60R - - - - 572.30R - -

8663 METAL BASE TO COMPLETE

DENTURE

796.50R - - - - 1 194.70R - -

8664 REMOUNT CROWN OR BRIDGE FOR

ADJUSTMENT

381.60R - - - - 597.90R - -

8667 SOFT BASE TO DENTURE (HEAT

CURED)

796.50R - - - - 1 194.70R - -

8671 PARTIAL DENTURE - CAST METAL

FRAMEWORK WITH RESIN

DENTURE BASE

* - - - - - 3 965.40R - -

8672 ALTERED CAST TECHNIQUE (IN

ADDITION TO PARTIAL DENTURE)

102.10R - - 102.10R - 153.00R - -

8674 ADDITIVE PARTIAL DENTURE 1 199.50R - - - - 1 799.20R - -8701 CONSULTATION - PERIODONTIST - - - 305.90R - - - -8703 CONSULTATION - PERIODONTIST

(DETAILED)

- - - 800.60R - - - -

8705 RE-EXAMINATION - PERIODONTIST - - - 239.30R - - - -

8707 PERIODONTAL SCREENING -

PERIODONTIST

- - - 239.30R - - - -

8723 PROVISIONAL SPLINTING -

EXTRACORONAL (WIRE) - PER

SEXTANT

273.60R 273.60R - 410.30R - 410.30R - 273.60R


EXTRACORONAL (WIRE PLUS

RESIN) - PER SEXTANT

397.00R 397.00R - 595.60R - 595.60R - 397.00R

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Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)


INTRACORONAL - PER TOOTH

124.60R 124.60R - 187.10R - 187.10R - -

8731 INCISION & DRAINAGE OF ABSCESS -

INTRA-ORAL

* 235.20R 235.20R - 352.70R - - - -

8737 ROOT PLANING - FOUR OR MORE

TEETH PER QUADRANT

* 590.20R - - 800.60R - 590.20R - 383.60R

8739 ROOT PLANING - ONE TO THREE

TEETH PER QUADRANT

* 469.60R - - 638.80R - 469.50R - 341.90R

8741 GINGIVECTOMY/GINGIVOPLASTY -

FOUR OR MORE TEETH PER

QUADRANT

770.10R - - 1 056.20R - - - -

8743 GINGIVECTOMY OR

GINGIVOPLASTY - ONE TO THREE

TEETH PER QUADRANT

615.30R - - 838.40R - - - -

8749 FLAP PROCEDURE, ROOT PLANING

AND ONE TO THREE SURGICAL

SERVICES - PER QUADRANT

1 598.80R - - 2 398.30R - - - -


AND ONE TO THREE SURGICAL

SERVICES - PER SEXTANT

1 324.20R - - 1 986.30R - - - -


AND FOUR OR MORE SURGICAL

SERVICES - PER QUADRANT

1 981.70R - - 2 972.40R - - - -


AND FOUR OR MORE SURGICAL

SERVICES - PER SEXTANT

1 606.00R - - 2 409.10R - - - -

8756 CLINICAL CROWN LENGTHENING

(ISOLATED PROCEDURE)

* 973.80R - - 1 460.90R - - - -

8759 PEDICLE FLAPPED GRAFT


731.70R - - 1 097.40R - - - -

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Technicians

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(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8761 MASTICATORY MUCOSAL

AUTOGRAFT - ONE TO FOUR TEETH


795.20R 1 192.90R - 1 192.90R - - - -

8762 MASTICATORY MUCOSAL

AUTOGRAFT - FOUR OR MORE

TEETH (ISOLATED PROCEDURE)

1 194.70R 1 792.00R - 1 792.00R - - - -

8763 WEDGE RESECTION (ISOLATED

PROCEDURE)

* 467.80R 467.80R - 701.80R - - - -

8765 HEMISECTION OF A TOOTH,

RESECTION OF A ROOT OR TUNNEL

PREPARATION (ISOLATED

PROCEDURE)

642.90R - - 964.40R - 964.40R - -

8766 BONE REGENERATION/REPAIR

PROCEDURE - AS PART OF A FLAP

OPERATION

382.60R - - 574.10R - - - -

8767 BONE REGENERATION/REPAIR

PROCEDURE - AT A SINGLE SITE

992.00R 1 488.00R - 1 488.00R - - - -

8768 UNLISTED PERIODONTAL

PROCEDURE

467.80R - - 701.80R - - - -

8769 MEMBRANE REMOVAL (USED FOR

GUIDED TISSUE REGENERATION)

467.80R 701.80R - 701.80R - - - -

8770 COST OF BONE

REGENERATIVE/REPAIR MATERIAL

- - - - - - - -

8772 SUBMUCOSAL CONNECTIVE TISSUE

AUTOGRAFT (ISOLATED

PROCEDURE)

803.60R 1 205.40R - 1 205.40R - - - -

8773 COST OF INTRAPOCKET

CHEMOTHERAPEUTIC AGENT

- - - - - - - -

8781 CONSULTATION - ORAL MEDICINE

(SIMPLE)

- - - - - - - -


(COMPLEX)

- - - - - - - -

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Practice (54)

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(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)


(SUBSEQUENT)

- - - - - - - -

8787 UNLISTED ORAL MEDICINE

PROCEDURE

167.90R - - 251.80R - - - -

8801 CONSULTATION - ORTHODONTIST - - 305.90R - - - - -

8803 CONSULTATION - ORTHODONTIS

(SUBSEQUENT, RETENTION AND

POST TREATMENT)

- - 178.10R - - - - -

8811 TRACING AND ANALYSIS OF EXTRA-

ORAL FILM

45.10R 45.10R 45.10R 45.10R - 45.10R - -

8837 DIAGNOSIS AND TREATMENT

PLANNING - ORTHODONTIST

- - 142.00R - - - - -

8839 DIAGNOSTIC SETUP 200.40R 200.40R 300.50R - - - - -8840 TREATMENT PLANNING FOR

ORTHOGNATHIC SURGERY - ALL

690.80R 1 036.30R 1 036.30R - - - - -

8841 ORTHO TX - FIXED LINGUAL

APPLIANCE - ONE ARCH

* - - - - - - - -


APPLIANCE - ONE ARCH, MODEATE

* - - - - - - - -


APPLIANCE - ONE ARCH, SEVERE

* - - - - - - - -

8846 REPAIR ORTHODONTIC APPLIANCE -

REMOVABLE

135.40R - 203.20R - - - - -

8847 REPLACE ORTHODONTIC

APPLIANCE - REMOVABLE

467.80R - 701.80R - - - - -

8848 REPAIR ORTHODONTIC APPLIANCE -

FIXED

200.40R - 300.50R - - - - -

8849 RETAINER (ORTHODONTIC) 467.80R - 701.80R - - - - -8850 TREATMENT OF MPDS - FIRST VISIT 225.50R 225.50R 338.30R 225.50R - 338.30R - -

8851 TREATMENT OF MPDS -

SUBSEQUENT VISIT

118.70R 118.70R 178.10R 118.70R - 178.10R - -

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Practice (54)

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(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8852 OCCLUSAL ORTHOTIC APPLIANCE 566.60R 746.60R 746.60R 746.60R - 746.60R - -

8855 CONSULTATION - CLEFT PALATE

THERAPY (HOUSE OR HOSPITAL)

273.60R - 410.30R - - 410.30R - -


(SUBSEQUENT)

134.40R - 201.40R - - 201.40R - -


(MAXIMUM)

934.40R - 1 401.50R - - 1 401.50R - -

8858 ORTHO TX - FUNCTIONAL

APPLIANCE

* - - - - - - - -

8861 ORTHO TX - PARTIAL FIXED

APPLIANCE - MINOR

* - - - - - - - -

8862 ORTHO TX - REMOVABLE

APPLIANCE

* - - - - - - - -

8863 ORTHO TX - EACH ADDITIONAL

REMOVABLE APPLIANCE

* - - - - - - - -


APPLIANCE - ONE ARCH

* - - - - - - - -


APPLIANCE - BOTH ARCHES

* - - - - - - - -

8867 ORTHO TX - FIXED APPLIANCE -

ONE ARCH

* - - - - - - - -


ONE ARCH, MODEATE

* - - - - - - - -


ONE ARCH, SEVERE

* - - - - - - - -


BOTH ARCHES, CLASS 1 MILD

* - - - - - - - -


APPLIANCE - BOTH ARCHES, CLASS

1 MILD

* - - - - - - - -


BOTH ARCHES, CLASS 1 MODERATE

* - - - - - - - -

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Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)



1 MODERATE

* - - - - - - - -


BOTH ARCHES, CLASS 1 SEVERE

* - - - - - - - -



1 SEVERE

* - - - - - - - -


BOTH ARCHES, CLASS 1 SEVERE W/

COMPLICATIONS

* - - - - - - - -



1 SEVERE W/ COMPLICATIONS

* - - - - - - - -


BOTH ARCHES, CLASS 2/3 MILD

* - - - - - - - -



2/3 MILD

* - - - - - - - -


BOTH ARCHES, CLASS 2/3

MODERATE

* - - - - - - - -



2/3 MODERATE

* - - - - - - - -


BOTH ARCHES, CLASS 2/3 SEVERE

* - - - - - - - -



2/3 SEVERE

* - - - - - - - -


BOTH ARCHES, CLASS 2/3 SEVERE

W/ COMPLICATIONS

* - - - - - - - -

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Dental

Technicians

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(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)



2/3 SEVERE W/ COMPLICATIONS

* - - - - - - - -

8890 MONTHLY INSTALMENT ORTHO TX * - - - - - - - -

8891 ORTHODONTIC TRANSFER * - - - - - - - -8892 ORTHODONTIC RE-TREATMENT * - - - - - - - -8901 CONSULTATION - MFOS - 305.90R - - - - - -8902 CONSULTATION - MFOS (DETAILED) - 800.60R - - - - - -

8903 HOUSE/HOSP/NURSING HOME

CONSULTATION - MFOS

- 268.00R - - - - - -


CONSULTATION (SUBSEQUENT) -

MFOS

- 178.10R - - - - - -

8905 AFTER REGULARLY HOURS

CONSULTATION - MFOS

- 392.40R - - - - - -


CONSULTATION (MAXIMUM PER

WEEK) - MFOS

- 446.10R - - - - - -

8908 SURGICAL REMOVAL OF ROOTS

FROM MAXILLARY ANTRUM

1 947.90R 2 922.00R - - - - - -

8909 ORAL ANTRAL FISTULA CLOSURE 1 493.40R 2 239.90R - - - - - -8911 CALDWELL-LUC PROCEDURE 584.30R 876.30R - - - - - -8917 BIOPSY OF ORAL TISSUE - SOFT 372.40R 496.50R - 496.50R - - - -8919 BIOPSY OF BONE - NEEDLE * 573.30R 859.90R - - - - - -8921 BIOPSY – EXTRA-ORAL BONE/SOFT

TISSUE

* 938.00R 1 406.80R - - - - - -

8931 TREATMENT OF POST-EXTRACTION

HAEMORRHAGE

108.00R 647.80R - 108.00R - 108.00R 91.20R -

8933 TREATMENT OF HAEMORRHAGE

(BLOOD DYSCRACIAS)

1 493.40R 2 239.90R - 1 493.40R - 1 493.40R - -

8935 TREATMENT OF SEPTIC SOCKET 108.00R 169.20R - 108.00R - 108.00R 91.20R -8937 SURGICAL REMOVAL OF TOOTH 637.00R 859.90R - 637.00R - - - -

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General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

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Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8941 SURGICAL REMOVAL OF IMPACTED

TOOTH - FIRST TOOTH

1 056.20R 1 388.90R - 1 056.20R - - - -


TOOTH - SECOND TOOTH

566.60R 748.30R - 566.60R - - - -


TOOTH - THIRD AND SUBSEQUENT

TEETH

322.00R 424.60R - 322.00R - - - -


ROOTS, FIRST TOOTH - PER TOOTH

* 637.00R 859.90R - 860.00R - - - -

8957 ALVEOLOTOMY OR

ALVEOLECTOMY (INCLUDING

EXTRACTIONS)

782.10R 1 173.20R - 782.10R - - - -

8958 EMERGENCY TRACHEOTOMY * - - - - - - - -8959 PHARYNGOSTOMY * - - - - - - - -8961 TOOTH TRANSPLANTATION 1 282.20R 1 923.30R - - - - - -8962 HARVEST ILIAC CREST GRAFT 472.70R 581.00R - - - - - -8963 HARVEST RIB GRAFT 542.30R 813.30R - - - - - -8964 HARVEST CRANIUM GRAFT 424.60R 637.00R - - - - - -8965 PERIPHERAL NEURECTOMY 1 282.20R 1 923.30R - - - - - -8966 REPAIR OF ORONASAL FISTULA

(LOCAL FLAPS)

* - - - - - - - -

8967 SURGICAL REMOVAL OF JAW CYST -

INTRA-ORAL APPROACH

1 781.30R 2 671.90R - - - - - -

8969 SURGICAL REMOVAL OF JAW CYST -

EXTRA-ORAL APPROACH

2 853.40R 4 280.20R - - - - - -

8971 EXCISION OF TUMOUR OF THE

SOFT TISSUE

573.30R 859.90R - 859.90R - - - -

8973 SURGICAL EXCISION OF TUMOURS

OF THE JAW

2 853.40R 4 280.20R - - - - - -

8975 HEMIRESECTION OF JAW

EXCLUDING CONDYL

* - - - - - - - -

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Orthodontics

(64)

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Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8977 SURGICAL REPAIR OF MAXILLA OR

MANDIBLE - MAJOR

* 2 995.20R 4 492.60R - - - - - -

8979 HARVESTING OF AUTOGENOUS

GRAFTS (INTRA-ORAL)

247.00R 370.60R - 370.60R - - - -

8981 SURGICAL EXPOSURE OF IMPACTED

OR UNERUPTED TEETH TO AID

ERUPTION

1 176.80R 1 603.20R - 1 603.20R - - - -

8983 CORTICOTOMY - FIRST TOOTH 851.50R 1 277.40R - - - - - -8984 CORTICOTOMY - EACH ADDITIONAL

TOOTH

431.80R 647.80R - - - - - -

8985 FRENULECTOMY/FRENULOTOMY 782.10R 1 173.20R - 1 173.20R - - - -8987 REDUCTION OF MYLOHYOID

RIDGES - PER SIDE

1 282.20R 1 923.30R - - - - - -

8989 REMOVAL TORUS MANDIBULARIS 1 282.20R 1 923.30R - - - - - -

8991 REMOVAL OF TORUS PALATINUS 1 282.20R 1 923.30R - - - - - -8993 SURGICAL REDUCTION OF

OSSEOUS TUBEROSITY - PER SIDE

573.30R 859.90R - - - - - -

8995 GINGIVECTOMY - PER JAW 1 140.70R 1 711.20R - - - - - -8997 SULCOPLASTY / VESTIBULOPLASTY 2 939.90R 4 410.00R - 4 410.00R - - - -

9003 REPOSITION MENTAL FORAMEN

AND NERVE - PER SIDE

1 781.30R 2 671.90R - - - - - -

9004 LATERALIZATION OF INFERIOR

DENTAL NERVE

2 870.30R 4 305.50R - - - - - -

9005 ALVEOLAR RIDGE AUGMENTATION -

TOTAL (BY BONE GRAFT)

2 997.50R 4 496.20R - 4 496.20R - - - -


TOTAL (BY ALLOPLASTIC MATERIAL)

1 886.70R 2 830.10R - - - - - -


ONE TO TWO TOOTH SITES

583.30R 1 067.00R - 1 067.00R - - - -

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Technicians

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Therapists

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Hygiene

(113)


THREE ACROSS 3 OR MORE TOOTH

SITES

1 296.60R 1 944.80R - 1 944.80R - - - -

9010 SINUS LIFT PROCEDURE 1 947.90R 2 922.00R - 2 922.00R - - - -9011 INCISION & DRAINAGE OF ABSCESS -

INTRA-ORAL (PYOGENIC)

364.70R 546.90R - - - - 172.30R -

9013 INCISION & DRAINAGE OF ABSCESS -

EXTRA-ORAL (PYOGENIC)

* - - - - - - - -

9015 APICECTOMY/PERIRADICULAR

SURGERY - ANTERIORS (INCLUDING

RETROGRADE FILLING)

726.80R 964.40R - 964.40R - 964.40R - -

9016 APICECTOMY/PERIRADICULAR

SURGERY - MOLARS (INCLUDING

RETROGRADE FILLING)

1 282.20R 1 923.30R - 1 923.30R - 1 923.30R - -

9017 DECORTICATION, SAUCERISATION

AND SEQUESTRECTOMY

* - - - - - - - -

9019 SEQUESTRECTOMY - INTRA ORAL

PER SEXTANT AND OR RAMUS

573.30R 859.90R - - - - - -

9021 SUTURE - RECONSTRUCTION,

MINOR (EXCLUDES CLOSURE OF

SURGICAL INCISIONS)

726.80R 964.40R - - - - - -

9023 SUTURE - RECONSTRUCTION,

MAJOR (EXCLUDES CLOSURE OF

SURGICAL INCISIONS)

1 353.10R 2 029.50R - - - - - -

9024 DENTO-ALVEOLAR FRACTURE - PER

SEXTANT

642.90R 964.40R - - - - - -

9025 MANDIBLE FRACTURE - CLOSED

REDUCTION

* - - - - - - - -

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(113)

9027 MANDIBLE FRACTURE -

COMPOUND, WITH EYELET WIRING

* - - - - - - - -

9029 MANDIBLE FRACTURE - SPLINTS * - - - - - - - -9031 MANDIBLE FRACTURE - OPEN

REDUCTION

* - - - - - - - -

9032 REDUCTION OF MASSETER MUSCLE

AND BONE - EXTRA-ORAL

APPROACH

* - - - - - - - -

9033 OPEN TREATMENT OF CONDYLAR

FRACTURE

* - - - - - - - -

9035 MAXILLA FRACTURE - LE FORT I OR

GUERIN

* - - - - - - - -

9036 OPEN TREATMENT OF MAXILLARY

FRACTURE - LE FORT I

* - - - - - - - -

9037 MAXILLA FRACTURE - LE FORT II OR

MIDDLE THIRD FACE

* - - - - - - - -

9038 OPEN TREATMENT OF MAXILLARY

FRACTURE - LE FORT II MIDDLE

THIRD OF FACE

* - - - - - - - -

9039 MAXILLA FRACTURE - LE FORT III

OR CRANIOFACIAL DISJUNCTION

* - - - - - - - -

9041 ZYGOMATIC ARCH FRACTURE -

CLOSED REDUCTION

* - - - - - - - -


OPEN REDUCTION

* - - - - - - - -


OPEN REDUCTION (REQUIRING

OSTEOSYNTHESIS AND/OR

GRAFTING)

* - - - - - - - -

9046 PLACEMENT OF ZYGOMATICUS

FIXTURE, PER FIXTURE

* - - - - - - - -

9047 OSTEOTOMY - OPEN WITH

STABILISATION

* - - - - - - - -

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Dental

Therapists

(95)

Oral

Hygiene

(113)

9048 SURGICAL REMOVAL OF INTERNAL

FIXATION DEVICES, PER SITE

* - - - - - - - -

9049 OSTEOTOMY - MANDIBLE BODY,

ANTERIOR SEGMENTAL

* - - - - - - - -

9050 OSTEOTOMY - TOTAL SUBAPICAL * - - - - - - - -9051 GENIOPLASTY * - - - - - - - -9052 MIDFACIAL EXPOSURE * - - - - - - - -9053 CORONOIDECTOMY (INTRA-ORAL

APPROACH)

* - - - - - - - -

9055 OSTEOTOMY - SEGMENTED,

POSTERIOR

* - - - - - - - -

9057 OSTEOTOMY - SEGMENTED,

ANTERIOR

* - - - - - - - -

9059 RECONSTRUCT MAXILLA - LE FORT I

OSTEOTOMY, ONE PIECE

* - - - - - - - -

9060 RECONSTRUCT MAXILLA - LE FORT I

OSTEOTOMY W/ REPOSITIONING

AND GRAFT

* - - - - - - - -

9061 PALATAL OSTEOTOMY * - - - - - - - -9062 RECONSTRUCT MAXILLA - LE FORT I

OSTEOTOMY, MULTIPLE

SEGMENTS

* - - - - - - - -

9063 RECONSTRUCT MAXILLA - LE FORT

2 OSTEOTOMY (FACIAL AND POST-

TRAUMATIC DEFORMITIES)

* - - - - - - - -

9065 RECONSTRUCT MAXILLA - LE FORT

3 OSTEOTOMY (SEVERE

CONGENITAL DEFORMITIES)

* - - - - - - - -

9066 SURGICAL EXPANSION -

MAXILLIARY OR MANDIBULAR

* - - - - - - - -

9067 DISTRACTION OSTEOGENESIS -

ACROSS ONE TO TWO TOOTH SITES

* - - - - - - - -

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(94)

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Therapists

(95)

Oral

Hygiene

(113)

9068 DISTRACTION OSTEOGENESIS -

ACROSS THREE TO FIVE TOOTH

SITES

* - - - - - - - -

9069 GLOSSECTOMY - PARTIAL * - - - - - - - -9070 DISTRACTION OSTEOGENESIS -

FULL ARCH

* - - - - - - - -

9071 GENIOHYOIDOTOMY * - - - - - - - -9072 CLOSE SECONDARY ORO-NASAL

FISTULA W/ BONE GRAFTING

(COMPLETE PROCEDURE)

* - - - - - - - -

9074 TMJ ARTHROSCOPY DIAGNOSTIC * - - - - - - - -9075 CONDYLECTOMY,

CORONOIDECTOMY OR BOTH

* - - - - - - - -

9076 TMJ ARTROCENTESIS * - - - - - - - -9077 TMJ INTRA-ARTICULAR INJECTION * - - - - - - - -

9079 TRIGGER POINT INJECTION * - - - - - - - -9081 CONDYLECTOMY

(WARD/KOSTECKA)

* - - - - - - - -

9083 TMJ SRTHROPLASTY * - - - - - - - -9085 REDUCTION OF TMJ DISLOC W/O

ANAESTHETIC

* - - - - - - - -

9087 REDUCTION OF TMJ DISLOC W/

ANAESTHETIC

* - - - - - - - -

9089 REDUCTION OF TMJ DISLOC W/

ANAESTHETIC AND

IMMOBOBILISATION

* - - - - - - - -

9091 REDUCTION OF TMJ DISLOCATION -

OPEN REDUCTION

* - - - - - - - -

9092 JOINT RECONSTRUCTION * - - - - - - - -9093 REMOVAL OF SALIVARY STONE

(SIALOLITHOTOMY)

642.90R 964.40R - - - - - -

9095 EXCISION OF SUBLINGLUAL

SALIVARY GLAND

* - - - - - - - -

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Dental

Therapists

(95)

Oral

Hygiene

(113)

9096 EXCISION OF SALIVARY GLAND -

EXTRA ORAL APPROACH

* - - - - - - - -

9099 UNLISTED DENTAL PROCEDURE OR

SERVICE (BY REPORT)

* - - - - - - - -

9101 OBTURATOR PROSTHESIS,

SURGICAL - MODIFIED DENTURE

* - - - - - - - -


SURGICAL - CONTINUOUS BASE

* - - - - - - - -


SURGICAL - SPLIT BASE

* - - - - - - - -

9104 OBTURATOR PROSTHESIS, INTERIM

- ON EXISTING DENTURE

* - - - - - - - -

9105 OBTURATOR PROSTHESIS, INTERIM

- ON NEW DENTURE

* - - - - - - - -


DEFINITIVE - OPEN/HOLLOW BOX

* - - - - - - - -


DEFINITIVE - SILICONE GLOVE

* - - - - - - - -

9108 MANDIBULAR RESECTION

PROSTHESIS W/ GUIDE FLANGE

* - - - - - - - -


PROSTHESIS W/O GUIDE FLANGE

* - - - - - - - -


PROSTHESIS, PALATAL

AUGMENTATION

* - - - - - - - -

9111 GLOSSAL RESECTION PROSTHESIS -

SIMPLE

* - - - - - - - -

9112 GLOSSAL RESECTION PROSTHESIS -

COMPLEX

* - - - - - - - -

9113 RADIATION CARRIER - SIMPLE * - - - - - - - -9114 RADIATION CARRIER - COMPLEX * - - - - - - - -9115 RADIATION SHIELD - SIMPLE * - - - - - - - -

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Dental

Technicians

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Dental

Therapists

(95)

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Hygiene

(113)

9116 RADIATION SHIELD - COMPLEX * - - - - - - - -9117 RADIATION CONE LOCATOR * - - - - - - - -9118 CHEMOTHERAPEUTIC AGENT

CARRIER

* - - - - - - - -

9119 FEEDING AID PROSTHESIS,

NEONATAL

* - - - - - - - -

9120 ORTHOPAEDIC APPLIANCE, ACTIVE

PRESURGICAL - MINOR

* - - - - - - - -


PRESURGICAL - MODERATE

* - - - - - - - -


PRESURGICAL - SEVERE

* - - - - - - - -


PRESURGICAL - MODIFICATION

* - - - - - - - -

9125 SPEECH AID/OBTURATOR

PROSTHESIS - PALATAL

ALTERATION

* - - - - - - - -


PROSTHESIS - VELAR ALTERATION

* - - - - - - - -


PROSTHESIS - PHARYNGEAL

ALTERATION

* - - - - - - - -


PROSTHESIS - MODIFICATION

* - - - - - - - -


PROSTHESIS - SURGICAL

* - - - - - - - -

9130 SPEECH AID APPLIANCE - PALATAL

LIFT

* - - - - - - - -

9131 SPEECH AID APPLIANCE - PALATAL

STIMULATING

* - - - - - - - -

9132 SPEECH AID APPLIANCE - BULB * - - - - - - - -

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Technicians

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Dental

Therapists

(95)

Oral

Hygiene

(113)

9133 SPEECH AID APPLIANCE -

MODIFICATION

* - - - - - - - -

9134 UNSPECIFIED SPEECH AID

APPLIANCE

* - - - - - - - -

9135 AURICULAR PROSTHESIS - SIMPLE * - - - - - - - -

9136 AURICULAR PROSTHESIS -

COMPLEX

* - - - - - - - -

9137 NASAL PROSTHESIS - SIMPLE * - - - - - - - -9138 NASAL PROSTHESIS - COMPLEX * - - - - - - - -9139 OCULAR PROSTHESIS - INTERIM * - - - - - - - -9140 OCULAR PROSTHESIS - MODIFIED

STOCK APPLIANCE

* - - - - - - - -

9141 OCULAR PROSTHESIS - CUSTOM

APPLIANCE

* - - - - - - - -

9142 ORBITAL PROSTHESIS - SIMPLE * - - - - - - - -9143 ORBITAL PROSTHESIS - COMPLEX * - - - - - - - -

9148 UNSPECIFIED BODY PROSTHESIS -

SIMPLE

* - - - - - - - -

9149 UNSPECIFIED BODY PROSTHESIS -

COMPLEX

* - - - - - - - -

9150 FACIAL PROSTHESIS, SURGICAL -

SIMPLE

* - - - - - - - -

9151 FACIAL PROSTHESIS, SURGICAL -

COMPLEX

* - - - - - - - -

9155 CRANIAL PROSTHESIS * - - - - - - - -9156 CRANIAL IMPLANT PROSTHESIS,

CUSTOM MADE

* - - - - - - - -

9157 FACIAL IMPLANT PROSTHESIS,

CUSTOM MADE - SIMPLE

* - - - - - - - -

9158 FACIAL IMPLANT PROSTHESIS,

CUSTOM MADE - COMPLEX

* - - - - - - - -

9159 OCULAR IMPLANT PROSTHESIS,

CUSTOM MADE

* - - - - - - - -

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Dental

Technicians

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(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9160 BODY IMPLANT PROSTHESIS -

CUSTOM MADE

* - - - - - - - -

9161 SURGICAL SPLINT - SIMPLE * - - - - - - - -9162 SURGICAL SPLINT - COMPLEX * - - - - - - - -9163 SURGICAL TEMPLATE - SIMPLE * - - - - - - - -9164 SURGICAL TEMPLATE - COMPLEX * - - - - - - - -9165 SURGICAL CONFORMER - SIMPLE * - - - - - - - -

9166 SURGICAL CONFORMER - COMPLEX * - - - - - - - -

9167 TRISMUS APPLIANCE (SIMPLE) * - - - - - - - -9168 TRISMUS APPLIANCE (COMPLEX) * - - - - - - - -9169 ORTHOSES APPLIANCE * - - - - - - - -9170 FACIAL PALSY APPLIANCE * - - - - - - - -9171 COMMISSURE SPLINT * - - - - - - - -9172 ORAL RETRACTOR, DYNAMIC - PER

ARM

* - - - - - - - -

9174 UNSPECIFIED BURN APPLIANCE - - - - - - - -9175 THEATRE ATTENDANCE (MAXFAC

PROSTHOD) /HOUR

- - - - - - - -

9180 SURGICAL PLACEMENT OF SUB-

PERIOSTEAL IMPLANT -

PREPARATORY STAGE

* - - - - - - - -

9181 SURGICAL PLACEMENT OF SUB-

PERIOSTEAL IMPLANT -

PLACEMENT STAGE

* - - - - - - - -

9182 SURGICAL PLACEMENT OF

ENDOSTEAL IMPLANT PLATE

* - - - - - - - -


ENDOSSEUS IMPLANT - FIRST PER

QUADRANT

* - - - - - - - -


ENDOSSEUS IMPLANT - SECOND

PER QUADRANT

* - - - - - - - -

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Therapists

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Hygiene

(113)


ENDOSSEUS IMPLANT - THIRD AND

SUBSEQUENT PER QUADRANT

* - - - - - - - -

9187 COST OF ENDOSTEAL IMPLANT

BODY

* - - - - - - - -

9188 COST OF PREFABRICATED

ABUTMENT

* - - - - - - - -

9189 COST OF OTHER IMPLANT

COMPNTS

* - - - - - - - -

9190 SURGICAL EXPOSURE OF

ENDOSSEUS IMPLANT - FIRST PER

QUADRANT

* - - - - - - - -


ENDOSSEUS IMPLANT - SECOND

PER QUADRANT

* - - - - - - - -


ENDOSSEUS IMPLANT - THIRD AND

SUBSEQUENT PER QUADRANT

* - - - - - - - -

9198 SURGICAL REMOVAL OF IMPLANT * - - - - - - - -

9201 CONSULTATION - ORAL

PATHOLOGIST

- - - - - - - -


CONSULTATION - ORAL

PATHOLOGIST

- - - - - - - -

9205 CONSULTATION - ORAL

PATHOLOGIST (SUBSEQUENT)

- - - - - - - -

9207 AFTER HOURS VISIT - ORAL

PATHOLOGIST

- - - - - - - -

9220 REPAIR CLEFT HARD PALATE -

UNILATERAL

* - - - - - - - -


BILATERAL (ONE PROCEDURE)

* - - - - - - - -

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Therapists

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Hygiene

(113)


BILATERAL (TWO PROCEDURES)

* - - - - - - - -

9226 REPAIR CLEFT SOFT PALATE - W/O

MUSCLE RECONSTRUCTION

* - - - - - - - -

9228 REPAIR CLEFT SOFT PALATE - W/


* - - - - - - - -

9230 REPAIR SUBMUCOSAL CLEFT

AND/OR BIFID UVULA - W/ MUSCLE

RECONSTRUCTION

* - - - - - - - -

9232 VELOPHARYNGEAL

RECONSTRUCTION -

UNCOMPLICATED

* - - - - - - - -

9234 VELOPHARYNGEAL

RECONSTRUCTION - COMPLICATED

* - - - - - - - -

9238 REPAIR ORONASAL FISTULA (ONE

PROCEDURE)

* - - - - - - - -

9240 REPAIR ORONASAL FISTULA (TWO

PROCEDURES)

* - - - - - - - -

9246 SECONDARY PERIOSTEAL FLAPS * - - - - - - - -9248 LIPADHESION * - - - - - - - -9250 REPAIR CLEFT LIP - UNILATERAL

W/O MUSCLE RECONSTRUCTION

* - - - - - - - -

9252 REPAIR CLEFT LIP - UNILATERAL W/


* - - - - - - - -

9254 REPAIR CLEFT LIP - BILATERAL W/O


* - - - - - - - -

9256 REPAIR CLEFT LIP - BILATERAL W/


* - - - - - - - -

9258 REPAIR ANTERIOR NASAL FLOOR * - - - - - - - -9260 REVISION OF SECONDARY CLEFT LIP

DEFORMITY - PARTIAL

* - - - - - - - -

9262 REVISION OF SECONDARY CLEFT LIP

DEFORMITY - TOTAL W/ MUSCLE

RECONSTRUCTION

* - - - - - - - -

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Dental

Technicians

(93)

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(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9264 ABBE-FLAP - TWO STAGES * - - - - - - - -9266 RECONSTRUCT COLUMELLA * - - - - - - - -9268 RECONSTRUCT NOSE DUE TO CLEFT

DEFORMITY - PARTIAL

* - - - - - - - -

9270 RECONSTRUCT NOSE DUE TO CLEFT

DEFORMITY - COMPLETE

* - - - - - - - -

9272 PARANASAL AUGMENTATION FOR

NASAL BASE DEVIATION

* - - - - - - - -

9274 REPAIR ANTERIOR TABLE, FRONTAL

SINUS AND/OR SUPRAORBITAL RIM

* - - - - - - - -

9276 REPAIR ANTERIOR AND POSTERIOR

WALL W/ OBTURATION AND/OR

CRANIALISATION OF FRONTAL

SINUS

* - - - - - - - -

9278 REPAIR MEDIAL CANTHAL

LIGAMENT (CANTHOPEXY), PER

SIDE

* - - - - - - - -

9280 OPEN REDUCTION AND FIXATION

OF NASAL FRACTURES

* - - - - - - - -

9282 MANIPULATION AND

IMMOBILISATION OF NASAL

FRACTURE

* - - - - - - - -

9284 MUSCULOFASCIAL FLAP * - - - - - - - -9286 MUSCULOCRANIAL FLAP * - - - - - - - -9288 BUCCAL FAT PAD (MAJOR REPAIR) * - - - - - - - -

9290 MAXILLECTOMY - ALVEOLUS ONLY,

LEVEL I

* - - - - - - - -

9292 MAXILLECTOMY - ALVEOLUS AND

SINUS OR NASAL FLOOR, LEVEL II

* - - - - - - - -

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(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9294 MAXILLECTOMY - ALVEOLUS,

SINUS, NASAL FLOOR AND

ZYGOMA EXCLUDING ORBITAL RIM

LEVEL III

* - - - - - - - -


SINUS, NASAL FLOOR AND

ZYGOMA INCLUDING ORBITAL RIM

LEVEL IV

* - - - - - - - -


SINUS, NASAL FLOOR, ZYGOMA,

ORBITAL RIM AND PTERYGOID

PLATES LEVEL V

* - - - - - - - -

9300 HEMIRESECTION OF JAW

INCLUDING CONDYLE AND

CORONOID PROCESS

* - - - - - - - -

9301 CASTING AND TRIMMING OF

MODEL IN PLASTER

(YELLOW/WHITE), PER MODEL

42.00R 42.00R 42.00R 42.00R 42.00R 42.00R - -


MODEL IN SUPER-HARD STONE

(DIE-STONE) PER MODEL

59.70R 59.70R 59.70R 59.70R 59.70R 59.70R - -


STUDY MODEL, PER MODEL

110.50R 110.50R 110.50R 110.50R 110.50R 110.50R - -


GNATHOSTATIC MODEL, PER

MODEL.

143.70R 143.70R 143.70R 143.70R 143.70R 143.70R - -

9309 NEW TRIMMED BASE TO SUPPLIED

MODEL, PER MODEL

50.80R 50.80R 50.80R 50.80R 50.80R 50.80R - -

9311 TRIMMING OF SUPPLIED MODEL,

PER MODEL

30.90R 30.90R 30.90R 30.90R 30.90R 30.90R - -

9312 GINGIVAL TISSUE MASK PER

IMPLANT

238.70R 238.70R 238.70R 238.70R 238.70R 238.70R - -

9313 DUPLICATING MODEL, PER MODEL 128.20R 128.20R 128.20R 128.20R 128.20R 128.20R - -

9314 REFRACTORY MODEL, PER UNIT 126.00R 126.00R 126.00R 126.00R 126.00R 126.00R - -

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Dental

Technicians

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Dental

Therapists

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Oral

Hygiene

(113)

9315 MODELS AND DUPLICATE MODELS

(VIRGIN MODEL) FOR CROWN AND

BRIDGE, WORK INCLUSIVE OF ONE

REMOVABLE DIE

174.60R - - 174.60R 174.60R 174.60R - -

9317 SECTIONAL MODELS FOR CROWN

AND BRIDGE, WORK INCLUSIVE OF

ONE REMOVABLE DIE

154.70R - - - 154.70R 154.70R - -

9319 EACH ADDITIONAL REMOVABLE DIE

FOR ITEMS 9315 AND 9317 PER DIE

39.80R - - 39.80R 39.80R 39.80R - -

9320 INDEXED OR MODEL TRAY PER DIE

(NOT MORE THAN 9319)

39.80R - - - 39.80R 39.80R - -

9321 OCCLUSION BLOCK, PER BLOCK 152.50R 152.50R - - 152.50R 152.50R - -9323 OCCLUSION BLOCK ON BASEPLATE,

PER BLOCK

192.30R - - - 192.30R 192.30R - -

9327 INFECTION CONTROL PER

IMPRESSION, DENTURE (WAX OR

ACRYLIC) OR ANY ITEM IN

CONTACT WITH BODY FLUIDS

28.70R 28.70R 28.70R 28.70R 28.70R 28.70R - -

9329 FIT AND SUPPLY OF DISPOSABLE

ARTICULATOR

75.20R - 75.20R - 75.20R 75.20R - -

9330 DELIVERY / COLLECTION FEE PER

COMPLETED PROCEDURE

(MAXIMUM 4)

- - - - - - - -

9331 FULL UPPER AND LOWER

DENTURES

* 2 051.40R 2 051.40R - - 2 051.40R 2 051.40R - -

9333 FULL UPPER OR LOWER DENTURE * 1 200.30R - - - 1 200.30R 1 200.30R - -

9335 SET-UP AND WAXING OF FULL

UPPER AND LOWER DENTURES

707.40R - - - 707.40R 707.40R - -

9337 SET-UP AND WAXING OF FULL

UPPER OR LOWER DENTURE

* 473.10R - - - 473.10R 473.10R - -

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Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9339 WAXING AND FINISHING OF FULL

UPPER AND LOWER DENTURES

1 257.80R - - - 1 257.80R 1 257.80R - -

9341 WAXING AND FINISHING OF FULL

UPPER OR LOWER DENTURE

* 703.00R - - - 703.00R 703.00R - -

9343 ADDITIONAL FEE FOR DENTURES

ON FULLY ADJUSTABLE

ARTICULATOR AT REQUEST OF

DENTIST

2 002.80R - - - 2 002.80R 2 002.80R - -

9345 ADDITIONAL FEE FOR IMMEDIATE

DENTURES, OR TOOTH SOCKETED

28.70R - - - 28.70R 28.70R - -

9346 ADDITIONAL FEE FOR IMMEDIATE

DENTURES, PER TOOTH NOT

SOCKETED.

15.50R - - 15.50R 15.50R 15.50R - -

9347 ADDITIONAL FEE FOR EACH RETRY

FROM THE THIRD AND UPWARDS

AT AN AGREED QUANTUM OF TIME

TO BE CALCULATED AT HOURLY

RATE

455.40R - - - 455.40R 455.40R - -

9351 SET-UP AND FINISH OF ONE-TOOTH

DENTURE

* 550.40R - - 550.40R 550.40R 550.40R - -

9352 SET-UP AND FINISH OF TWO-

TOOTH DENTURE

* 585.80R - - 585.80R 585.80R 585.80R - -

9353 SET-UP AND FINISH OF THREE-

TOOTH DENTURE

* 627.80R - - 627.80R 627.80R 627.80R - -

9354 SET-UP AND FINISH OF FOUR-

TOOTH DENTURE

* 663.20R - - 663.20R 663.20R 663.20R - -

9355 SET-UP AND FINISH OF FIVE-TOOTH

DENTURE

* 716.20R - - 716.20R 716.20R 716.20R - -

9356 SET-UP AND FINISH OF SIX-TOOTH

DENTURE

* 855.50R - - 855.50R 855.50R 855.50R - -

9357 SET-UP AND FINISH OF SEVEN-

TOOTH DENTURE

* 1 016.90R - - 1 016.90R 1 016.90R 1 016.90R - -

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Technicians

(93)

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(94)

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Therapists

(95)

Oral

Hygiene

(113)

9358 SET-UP AND FINISH OF EIGHT-

TOOTH DENTURE

* 1 078.80R - - 1 078.80R 1 078.80R 1 078.80R - -

9359 SET-UP AND FINISH NINE OR MORE

TOOTH DENTURE

* 1 105.30R - - 1 105.30R 1 105.30R 1 105.30R - -

9361 SET-UP AND WAXING OF ONE-

TOOTH DENTURE

* 157.00R - - 157.00R 157.00R 157.00R - -

9362 SET-UP AND WAXING OF TWO-

TOOTH DENTURE

* 190.10R - - 190.10R 190.10R 190.10R - -

9363 SET-UP AND WAXING OF THREE-

TOOTH DENTURE

* 216.60R - - 216.60R 216.60R 216.60R - -

9364 SET-UP AND WAXING OF FOUR-

TOOTH DENTURE

* 252.00R - - 252.00R 252.00R 252.00R - -

9365 SET-UP AND WAXING OF FIVE-

TOOTH DENTURE

* 278.50R - - 278.50R 278.50R 278.50R - -

9366 SET-UP AND WAXING OF SIX-

TOOTH DENTURE

* 329.40R - - 329.40R 329.40R 329.40R - -

9367 SET-UP AND WAXING OF SEVEN-

TOOTH DENTURE

* 362.50R - - 362.50R 362.50R 362.50R - -

9368 SET-UP AND WAXING OF EIGHT-

TOOTH DENTURE

* 389.10R - - 389.10R 389.10R 389.10R - -

9369 SET-UP AND WAXING OF NINE OR

MORE TOOTH DENTURE

* 415.60R - - 415.60R 415.60R 415.60R - -

9371 WAXING AND FINISHING OF ONE-

TOOTH DENTURE

* 431.10R - - 431.10R 431.10R 431.10R - -

9372 WAXING AND FINISHING OF TWO-

TOOTH DENTURE

* 439.90R - - 439.90R 439.90R 439.90R - -

9373 WAXING AND FINISHING OF THREE-

TOOTH DENTURE

* 446.50R - - 446.50R 446.50R 446.50R - -

9374 WAXING AND FINISHING OF FOUR-

TOOTH DENTURE

* 455.40R - - 455.40R 455.40R 455.40R - -

9375 WAXING AND FINISHING OF FIVE-

TOOTH DENTURE

* 473.10R - - 473.10R 473.10R 473.10R - -

9376 WAXING AND FINISHING OF SIX-

TOOTH DENTURE

* 490.70R - - 490.70R 490.70R 490.70R - -

Trf


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Practice (54)

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(92)

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Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9377 WAXING AND FINISHING OF SEVEN-

TOOTH DENTURE

* 612.30R - - 612.30R 612.30R 612.30R - -

9378 WAXING AND FINISHING OF

EIGHTH-TOOTH DENTURE

* 636.60R - - 636.60R 636.60R 636.60R - -

9379 WAXING AND FINISHING OF NINE

OR MORE TOOTH DENTURE

* 672.00R - - 672.00R 672.00R 672.00R - -

9383 ADDITIONAL FEE FOR FINISHING

DENTURE IN TOOTH COLOUR

MATERIAL, PER TOOTH

106.10R - - 106.10R 106.10R 106.10R - -

9385 ADDITIONAL FEE FOR SUPPLYING

FINISHED DENTURE ON DUPLICATE

MODEL

201.20R - - 201.20R 201.20R 201.20R - -

9391 BASIC CHARGE WHICH INCLUDES

REPAIR OF ONE FRACTURE, OR

ADDITION OF ONE TOOTH, OR

ADDITION OF ONE CLASP

349.30R - 349.30R 349.30R 349.30R 349.30R - -

9393 ADDITIONAL CHARGE FOR EACH

ADDITIONAL FRACTURE, OR

TOOTH, OR CLASP

108.30R - 108.30R 108.30R 108.30R 108.30R - -

9395 ADDITIONAL FEE FOR USING WIRE

STRENGTHENER

123.80R - 123.80R 123.80R 123.80R 123.80R - -

9397 ADDITIONAL FEE FOR USING PRE-

FORMED STRENGTHENER

132.60R - 132.60R 132.60R 132.60R 132.60R - -

9398 ADDITIONAL FEE FOR USING MESH

STRENGTHENER IN REPAIR

PROCEDURE

210.00R - - 210.00R 210.00R 210.00R - -

9401 CLEAR BASE - - - - - - - -9403 DOX GRINDING OF UPPER AND

LOWER DENTURES

196.70R - - 196.70R - 196.70R - -

9405 INLAY TO ARTIFICIAL TOOTH, ONE

SURFACE ONLY, PER INLAY

- - - - - - - -

Trf


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(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9406 INLAY TO ARTIFICIAL TOOTH,

MULTI-SURFACES E.G. HORSESHOE

OR L-TYPE INLAY, PER INLAY

- - - - 433.30R - - -

9407 HEKA BASE TECHNIQUE PER UPPER

OR LOWER DENTURE

464.20R - - 464.20R 464.20R 464.20R - -

9409 FREGO FRAME 201.20R - - 201.20R 201.20R 201.20R - -9410 BLEACHING TRAY - - - - - - - -9411 TEMPLATE PER UPPER OR LOWER

DENTURE

554.90R - - 554.90R 554.90R 554.90R - -

9413 RELINE/REBASE OF SINGLE

DENTURE

698.50R - - 698.50R 698.50R 698.50R - -

9415 REMODEL OF SINGLE DENTURE 1 074.30R - - 1 074.30R 1 074.30R 1 074.30R - -9417 SOFT BASE RELINE PER DENTURE 1 764.00R - - 1 764.00R 1 764.00R 1 764.00R - -9419 SOFT BASE TO NEW DENTURE, PER

DENTURE

1 764.00R - - 1 764.00R 1 764.00R 1 764.00R - -

9421 GUM TINTING PER DENTURE - - - - - - - -9423 LINGUAL OR PALATAL BAR 263.10R - 263.10R 263.10R 263.10R 263.10R - -9425 CLEANING AND POLISHING OF

EXISTING DENTURE, PER DENTURE

214.40R - - 214.40R 214.40R 214.40R - -

9427 MESH STRENGTHENER 183.50R - - 183.50R 183.50R 183.50R - -9429 THEATRE/ CONSULTATION OUT OF

LABORATORY PER HOUR OR PART

THEREOF

455.40R 455.40R - 455.40R 455.40R 455.40R - -

9431 SPECIAL TRAY, ACRYLIC, EACH 172.40R - - 172.40R 172.40R 172.40R - -9432 SPECIAL TRAY LIGHT CURE, EACH 187.90R - - 187.90R 187.90R 187.90R - -9433 SPECIAL TRAY IN BASE PLATE

MATERIAL, EACH

176.90R - - 176.90R 176.90R 176.90R - -

9435 PROVISION OF SINGLE ARM CLASP,

TO PARTIAL DENTURE

90.60R - - 90.60R 90.60R 90.60R - -

9437 PROVISION OF DOUBLE ARM

CLASP, TO PARTIAL DENTURE

157.00R - - 157.00R 157.00R 157.00R - -

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Technicians

(93)

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(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9439 PROVISION OF SINGLE ARM CLASP

WITH REST, TO PARTIAL DENTURE

203.40R - - 203.40R 203.40R 203.40R - -

9441 PROVISION OF DOUBLE ARM CLASP

WITH REST, TO PARTIAL DENTURE

274.10R - - 274.10R 274.10R 274.10R - -

9443 PROVISION OF PREFORMED ROACH

CLASP, TO PARTIAL DENTURE

117.20R - - 117.20R 117.20R 117.20R - -

9445 PROVISION OF REST ONLY TO

PARTIAL DENTURE

117.20R - - 117.20R 117.20R 117.20R - -

9447 CAST CLASP 411.20R - - 411.20R 411.20R 411.20R - -9448 CASTING AND TRIMMING OF

MODEL FROM IMPRESSION INSIDE

OCCLUSION BLOCK OR WAX TRY IN

75.20R - - 75.20R 75.20R 75.20R - -

9450 FINISHING OF ACRYLIC WORK ON

ANY CHROME COBALT OR GOLD

PROSTHESIS

157.00R 157.00R 157.00R 157.00R 157.00R 157.00R - -

9451 METAL BASE FOR FULL UPPER OR

FULL LOWER DENTURE EACH

- - - - - - - -

9453 BASIC CHARGE - WHICH EXCLUDES

MODELS AND ANY SPECIAL TRAYS

WHICH MAY BE REQUIRED BY THE

DENTIST, BUT INCLUDES

REFRACTORY MODEL

* 1 231.30R - - - 1 231.30R 1 231.30R - -


ONE ARM CLASP

50.80R - - - 50.80R 50.80R - -


ROACH CLASP

86.20R - - - 86.20R 86.20R - -


REST

46.40R - - - 46.40R 46.40R - -

9461 ADDITIONAL CHARGE FOR

CONTINUOUS CLASP, PER TOOTH

50.80R - - - 50.80R 50.80R - -

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(92)

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Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9463 ADDITIONAL CHARGE FOR LINGUAL

BAR, PER TOOTH PASSED

119.40R - - - 119.40R 119.40R - -

9465 ADDITIONAL CHARGE FOR PALATAL

BAR

190.10R - - - 190.10R 190.10R - -

9467 ADDITIONAL CHARGE FOR ONLAY - - - - - - - -

9469 ADDITIONAL CHARGE FOR SADDLE

WITH FINISHING LINE, PER TOOTH

84.00R - - - 84.00R 84.00R - -

9471 ADDITIONAL CHARGE FOR SADDLE

WITHOUT FINISHING LINE, PER

TOOTH

48.60R - - - 48.60R 48.60R - -


HORSESHOE SADDLE, PER TOOTH

84.00R - - - 84.00R 84.00R - -

9475 ADDITIONAL CHARGE FOR FITTING

OF TOOTH TO METAL BACKING,

PER TOOTH

57.50R - - - 57.50R 57.50R - -


ONE DISTAL-EXTENSION HINGE

170.20R - - - 170.20R 170.20R - -

9480 ADDITIONAL CHARGE PER MILLED

EDGE PER TOOTH

148.10R - - - 148.10R 148.10R - -


SOLDERING JOINT

207.80R - - - 207.80R 207.80R - -


SOLDERING RETENTION

252.00R - - - 252.00R 252.00R - -


ADDITIONAL RETENTION

SOLDERING JOINT

77.40R - - - 77.40R 77.40R - -


WELDING JOINT

254.20R - - - 254.20R 254.20R - -


SWING LOCK

207.80R - - - 207.80R 207.80R - -

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Technicians

(93)

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(94)

Dental

Therapists

(95)

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Hygiene

(113)


BACKING CAST

203.40R - - - 203.40R 203.40R - -


STEELS BACKING OR PONTIC CAST

(PLASTIC WORK TO BE CHARGED IN

ADDITION)

221.10R - - - 221.10R 221.10R - -

9495 BASIC FEE FOR THE REPAIRING OF

OR ADDITION TO ANY APPLIANCE

NECESSITATING THE CASTING OF A

MODEL (9301)

320.50R - - - 320.50R 320.50R - -

9497 BASIC FEE IF A NEW SECTION IS TO

BE FABRICATED AND WHERE ITEM

9495 DOES NOT APPLY (9301)

364.70R - - - 364.70R 364.70R - -

9501 CERAMIC JACKET

CROWN/CEROMER CROWN OR

PONTIC

* 1 399.30R - - - 1 399.30R 1 399.30R - -

9502 CERAMIC METAL SUBSTITUTE

COPING

* 1 129.60R - - - 1 129.60R 1 129.60R - -

9505 CERAMIC BONDED CROWN OR

PONTIC

* 1 848.00R - - 1 743.60R 1 848.00R 1 848.00R - -

9507 POST-SOLDER INVESTED JOINT, PER

JOINT

378.00R - - - 378.00R 378.00R - -

9511 INLAY IN PORCELAIN VENEER

CROWN

- - - - - - - -

9512 CERAMIC, INLAY/ONLAY, BRIDGE

RETAINER

* 1 434.70R - - - 1 434.70R 1 434.70R - -

9513 CERAMIC POST * - - - - - - - -9515 PORCELAIN SHOULDER PER UNIT

(NOT APPLICABLE TO PONTICS)

123.80R - - 123.80R 123.80R 123.80R - -

9520 ADDITIONAL FEE FOR CROWN- &

BRIDGE WORK PERFORMED ON A

MOVABLE CONDYLE ARTICULATOR

PER UNIT

59.70R - - - 59.70R 59.70R - -

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Technicians

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(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9521 FULL METAL CROWN, MOD, THREE-

QUARTER CROWN

* 1 142.90R - - - 1 142.90R 1 142.90R - -

9524 INDIRECT COMPOSITE RESIN INLAY - - - - - - - -

9525 CLASS IV, MO, DO,

CERVICAL/OCCLUSAL INLAY

* 941.70R - - - 941.70R 941.70R - -

9526 ADDITIONAL FEE FOR ONE PIECE

CASTING OF CROWN OR INLAY ON

POST

287.40R - - - 287.40R 287.40R - -

9531 PIN-LEDGE INLAY - - - - - - - -9533 FULL METAL PONTIC * 844.40R - - - 844.40R 844.40R - -9535 ABUTMENT THIMBLE CAST 791.40R - - - 791.40R 791.40R - -9537 PRECISION LOCK AND REST CAST - - - - - - - -9538 LOCK AND REST CAST - - - - - - - -9539 CASTING OF REST ONLY 320.50R - - - 320.50R 320.50R - -9541 METAL INLAY OR POST, CAST

DIRECT

- - - - 340.40R - - -

9543 GOLD/PRE-SOLDER INVESTED

JOINT

- - - - - - - -

9545 CAST POST WITH THIMBLE,

INDIRECT

* 563.70R - - - 563.70R 563.70R - -

9546 MULTIPLE POST * 932.90R - - - 932.90R 932.90R - -9547 MANUFACTURE CAST POST AND

CORE TO EXISTING CROWN

* 736.10R - - - 736.10R 736.10R - -

9549 C.S.P. ATTACHMENT (STEIGER) - - - - - 2 484.70R - -9550 MILLING MILLED EDGE PER UNIT 791.40R - - - 791.40R 791.40R - -9551 TELESCOPE CROWN - - - - - - - -9553 COMPOSITE/ACRYLIC VENEER

CROWN/PONTIC, INDIRECT

* 1 558.40R - - - 1 558.40R 1 558.40R - -

9557 COMPOSITE/ACRYLIC JACKET

CROWN, INDIRECT

* 1 100.90R - - - 1 100.90R 1 100.90R - -

9559 COMPOSITE/ACRYLIC VENEER POST

CROWN

* 1 540.80R - - - 1 540.80R 1 540.80R - -

9560 INDIRECT COMPOSITE RESIN

VENEER

- - - - - 652.10R - -

Trf


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Dental

Practice (54)

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(64)

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(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9561 COMPOSITE/ACRYLIC JACKET

CROWN, DIRECT

* 751.60R - - - 751.60R 751.60R - -

9563 TEMPORARY ACRYLIC/COMPOSITE

CROWN PER UNIT

- - - - - - - -

9564 HEAT FORMED TEMPLATE

SUPPLIED TO DENTIST FOR THE

MANUFACTURE OF TEMPORARY

RESTORATIONS

- - - - - - - -

9565 COMPOSITE/ACRYLIC-FACING

REPLACED

625.60R - - - 625.60R 625.60R - -

9566 PORCELAIN/ CEROMER FACING

REPLACED

1 134.00R - - - 1 134.00R 1 134.00R - -

9569 WAXING OF CROWN TO EXISTING

DENTURE

442.10R - - - 442.10R 442.10R - -

9570 ADDITIONAL FEE FOR EACH

REMAKE AT AN AGREED

QUANTUM OF TIME TO BE

CALCULATED AT AN HOURLY RATE

- - - - - - - -

9571 BASIC CHARGE WHICH INCLUDES

ACRYLIC BASE

559.30R 559.30R 559.30R 559.30R 559.30R 559.30R - -

9572 BASIC CHARGE NON ACRYLIC BASE 269.70R - 269.70R - 269.70R - - -


FIRST EXPANSION SCREW

106.10R - 106.10R - 106.10R - - -

9575 ADDITIONAL FEE FOR FITTING

SUBSEQUENT EXPANSION SCREWS

90.60R - 90.60R - 90.60R - - -

9576 ADDITIONAL FEE FOR FULL

ACLUSAL BITE PLATE

313.90R 313.90R 313.90R 313.90R 313.90R 313.90R - -

9577 ADDITIONAL FEE FOR BITE PLATE

ANTERIOR

106.10R 106.10R 106.10R - 106.10R 106.10R - -

Trf


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General

Dental

Practice (54)

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Oral Surgery

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(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9578 ADDITIONAL FEE FOR BITE PLATE

POSTERIOR

106.10R 106.10R 106.10R - 106.10R 106.10R - -


TONGUE GUARD

132.60R - 132.60R - 132.60R - - -

9581 ADDITIONAL FEE FOR FLAT OR

INCLINED PLANE

81.80R - 81.80R - 81.80R - - -

9583 ADDITIONAL FEE FOR ADAMS CRIB 97.30R - 97.30R - 97.30R - - -

9585 ADDITIONAL FEE FOR JACKSON

CRIB

101.70R - 101.70R - 101.70R - - -

9587 ADDITIONAL FEE FOR BALL CLASP 115.00R 115.00R 115.00R 115.00R 115.00R - - -

9589 ADDITIONAL FEE FOR SINGLE ARM

CLASP

88.40R - 88.40R - 88.40R - - -

9591 ADDITIONAL FEE FOR DOUBLE ARM

CLASP

154.70R - 154.70R - 154.70R - - -


SINGLE LOOP FINGER SPRING

72.90R - 72.90R - 72.90R - - -


DOUBLE LOOP FINGER SPRING

86.20R - 86.20R - 86.20R - - -


BUCCAL RETRACTION SPRING

64.10R - 64.10R - 64.10R - - -


APRON SPRING

165.80R - 165.80R - 165.80R - - -


COFFIN SPRING

159.20R - 159.20R - 159.20R - - -


QUAD HELIX

176.90R - 176.90R - 176.90R - - -


FLAPPER OR “T”-SPRING

132.60R - 132.60R - 132.60R - - -

9609 ADDITIONAL FEE FOR FITTING ALL

SPRINGS WITH TUBING, EACH

148.10R - 148.10R - 148.10R - - -


LABIAL ARCH

84.00R - 84.00R - 84.00R - - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)


BUCCAL ARCH

99.50R - 99.50R - 99.50R - - -


ROBERTS RETRACTOR

185.70R - 185.70R - 185.70R - - -

9617 INVISIBLE RETAINER - - - - - - - -9619 ADDITIONAL FEE FOR FITTING

TWIN WIRE ARCH EXTRA-ORAL

ARCH

232.10R - 232.10R - 232.10R - - -

9620 ADDITIONAL FEE LIP BUMPER 97.30R - 97.30R - 97.30R - - -9621 ADDITIONAL FEE FOR FITTING

EXTRA-ORAL ARCH

221.10R - 221.10R - 221.10R - - -


SPACE MAINTAINER ARCH

97.30R - 97.30R - 97.30R - - -

9623 ADDITIONAL FEE FOR EACH SPOT-

WELDING JOINT

44.20R - 44.20R - 44.20R - - -


SOLDERING JOINT

70.70R - 70.70R - 70.70R - - -


INVESTED SOLDERING JOINT

196.70R - 196.70R - 196.70R - - -

9629 ADDITIONAL FEE FOR EACH HOOK

FOR ELASTIC TRACTION

64.10R - 64.10R - 64.10R - - -

9631 MOUTH PROTECTOR (GUM

GUARD)

- - - - - - - -

9633 ORAL SCREEN 510.60R 510.60R 510.60R 510.60R 510.60R 510.60R - -9635 ANDRESEN OR NORWEGIAN

APPLIANCE

913.00R 913.00R 913.00R 913.00R 913.00R 913.00R - -

9637 TOOTH POSITIONER 1 052.20R - 1 052.20R 1 052.20R 1 052.20R 1 052.20R - -9639 GUNNING SPLINT 1 401.50R 1 401.50R 1 401.50R 1 401.50R 1 401.50R 1 401.50R - -9641 FRANKEL APPLIANCE 1 352.90R - 1 352.90R - 1 352.90R - - -9643 CHIN CAP 448.70R - 448.70R - 448.70R - - -9645 BIONATOR 915.20R - 915.20R - 915.20R - - -9646 DIAGNOSTIC SET-UP - - - - - - - -9647 SNORING APPLIANCE - - - - - - - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9651 PINCHED OR SWAGED BAND WITH

WELDED ATTACHMENT

(EXCLUDING COST OF

ATTACHMENT)

269.70R - 269.70R - 269.70R - - -

9653 PINCHED OR SWAGED BAND WITH

SOLDERED ATTACHMENT

353.70R - 353.70R - 353.70R - - -


REMAKE AT AN AGREED

QUANTUM OF TIME TO BE

CALCULATED AT AN HOURLY RATE

- - - - - - - -

9700 DIATORICS 1 X 6/8 221.00R 221.00R - 221.00R 221.00R 221.00R - -9702 DIATORICS, ODDS, ANTERIOR 75.30R - - 75.30R 75.30R 75.30R - -9704 DIATORICS, ODDS, POSTERIOR 75.30R - - 75.30R 75.30R 75.30R - -9706 COST OF BLEACHING TRAY

MATERIAL

- - - - - - - -

9720 SOFT BASE MATERIAL PER

DENTURE

800.10R - - 800.10R 800.10R 800.10R - -

9722 ACRYLIC PER DENTURE 90.50R 90.50R 90.50R 90.50R 90.50R 90.50R - -9724 COST OF PRECISION ATTACHMENT,

PER ATTACHMENT

- - - - - - - -

9726 PREFORMED BALL OR ROACH

CLASP

15.50R 15.50R 15.50R 15.50R 15.50R 15.50R - -

9728 COST OF LINGUAL / PALATAL BAR 181.10R - - - 181.10R 181.10R - -9729 COST OF MESH STRENGTHENER 95.00R - - - 95.00R 95.00R - -9730 COST OF PRE-FABRICATED BURN-

OUT COMPONENT, PER

COMPONENT

94.10R - - - 94.10R 94.10R - -

9732 COST OF OTHER ATTACHMENT

COMPONENTS E.G. NYLON CAPS,

SLEEVES ETC

- - - - - - - -

9734 COST OF DOLDER BAR AND CLIPS,

PER GRAM OR PER CLIP

- - - - - - - -

9736 COST OF IMPLANT COMPONENTS * - - - - - - - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9738 COST OF PREFORMED

STRENGTHENER

95.00R - - - 95.00R 95.00R - -

9739 ADDITIONAL CHARGE GOLD

PLATING

- - - - - - - -

9740 COST OF GOLD WIRE, PER GRAM - - - - - - - -9741 COST OF COBALT CHROME

CASTING ALLOY

150.20R - - - 150.20R 150.20R - -

9742 COST OF SPECIALISED COBALT

CHROME CASTING METAL E G

VITALLIUM, TITANIUM

- - - - - - - -

9744 COST OF PRECIOUS CASTING ALLOY - - - - - - - -

9746 COST OF SEMI-PRECIOUS CASTING

ALLOY

- - - - - - - -

9748 COST OF NON-PRECIOUS CASTING

ALLOY

* 170.30R - - 170.30R 170.30R 170.30R - -

9752 COST OF PLATINUM FOIL - - - - - - - -9754 COST OF GOLD SOLDER, PER GRAM - - - - - - - -

9755 ETCHING FOR BONDING (METAL

OR CERAMIC)

- - - - - - - -

9756 COST OF SILVER SOLDER, PER

GRAM

55.40R - - - 55.40R 55.40R - -

9757 CEROMER MATERIAL - PER UNIT * 1 129.80R - - - 1 129.80R 1 129.80R - -9758 FIBER RE-ENFORCED MATERIAL PER

UNIT

367.90R - 367.90R 367.90R 367.90R 367.90R - -

9759 FIBRE POST * - - - - - - - -9760 COMPOSITE RESTORATION

MATERIAL

- - - - - - - -

9761 CERAMIC MATERIAL - - - - - - - -9762 COST OF ANTERIOR ORTHODONTIC

ATTACHMENT, PER ATTACHMENT

33.10R - 33.10R - 33.10R - - -

9763 ORTHODONTIC MATERIAL 33.10R 33.10R 33.10R - 33.10R - - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9764 COST OF POSTERIOR

ORTHODONTIC ATTACHMENT, PER

ATTACHMENT

33.10R - 33.10R - 33.10R - - -

9765 PREFORMED COMPONENTS 17.80R - 17.80R - 17.80R 17.80R - -9766 COST OF EXPANSION SCREW, PER

SCREW

37.50R - 37.50R - 37.50R - - -

9767 SOLDERING MATERIAL 8.83R - 8.83R - 8.83R 8.83R - -9768 COST OF BUCCAL TUBE/TRANSFER

TUBE, PER TUBE

- - - - - - - -

9770 COST OF J-HOOK, PER HOOK 35.20R - 35.20R - 35.20R - - -9772 COST OF LINGUAL BUTTONS, PER

BUTTON

35.20R - 35.20R - 35.20R 35.20R - -

9774 COST OF INVISIBLE RETAINER

MATERIAL

- - - - - - - -

9775 R/A CASE - - - - - - - -9776 COST OF MOUTH PROTECTOR

MATERIAL

- - - - - - - -

9778 COST OF ARCH WIRE 8.83R - 8.83R - 8.83R - - -9779 DUAL LAMINATE MATERIAL - - - - - - - -9780 POSITIONING AND FINISHING OF

COMPLETE (MALE AND FEMALE)

PREFABRICATED BURN-OUT

ATTACHMENT

- - - - - - - -

9782 POSITIONING AND SOLDERING OF

COMPLETE (MALE AND FEMALE)

PRECISION ATTACHMENT

* - - - - - - - -

9783 IMPLANT STENT PER UNIT - - - - - - - -9784 ALIGNMENT OF DOLDER BAR AND

CLIPS

* - - - - - - - -

9786 TRIMMING, WAXING AND

FINISHING OF IMPLANT ABUTMENT

- CROWN AND BRIDGE WORK

ONLY, PER ABUTMENT

316.10R - - 316.10R 316.10R 316.10R - -

Trf


*Pre-

authorisation

required

General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9787 WAXING, MILLING AND FINISHING

OF A CUSTOM ABUTMENT

616.70R - - - 616.70R 616.70R - -

9788 IMPLANT SUPERSTRUCTURE

(EDENTULOUS CASES) INCLUDING

PLACING OF PREFORMED PARTS,

PER SECTION CAST

- - - - - - - -

9789 FINISHING OF PROSTHESIS ON

IMPLANT STRUCTURE PER ARCH

1 231.30R - - - 1 231.30R 1 231.30R - -

Alliance Midmed 2020 Rates€¦ · Dental Practice (54) Maxillo-Facial & Oral Surgery (62)...

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Transcript of Alliance Midmed 2020 Rates€¦ · Dental Practice (54) Maxillo-Facial & Oral Surgery (62)...