DENIS 2020 Rates · Dental Practice (54) Maxillo-Facial & Oral Surgery (62) Orthodontics (64) Periodontics (92) Dental Technicians (93) Prostodontics (94) Dental Therapists (95) Oral

*-

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) 42.00R 42.00R 42.00R 42.00R - 42.00R - -8101 ORAL EXAMINATION 233.80R 233.80R 233.80R 233.80R - 233.80R 121.60R -

8102

COMPREHENSIVE ORAL

EXAMINATION 377.60R 377.60R 377.60R 377.60R - 377.60R 196.40R -8104 LIMITED ORAL EXAMINATION 113.40R 113.40R 113.40R 113.40R - 113.40R 94.80R -8106 SPECIAL REPORT 240.00R 240.00R 240.00R 240.00R - 240.00R - -

8107

INTRAORAL RADIOGRAPH -

PERIAPICAL 94.70R 94.70R 94.70R 94.70R - 94.70R 91.20R 91.10R

8108

INTRAORAL RADIOGRAPHS -

COMPLETE SERIES 732.50R 732.50R 732.50R 732.50R - 732.50R 702.00R 702.00R

8109

INFECTION CONTROL/BARRIER

TECHNIQUES 21.00R 21.00R 21.00R 21.00R - 21.00R 21.00R 21.00R 8110 STERILIZED INSTRUMENTATION 54.30R 54.30R 54.30R 54.30R - 54.30R 54.20R 54.20R

8112


BITEWING 94.70R 94.70R 94.70R 94.70R - 94.70R 91.20R -

8113


OCCLUSAL 163.00R 163.00R 163.00R 163.00R - 163.00R - -

8114

EXTRAORAL RADIOGRAPH - HAND-

WRIST 378.40R 378.40R 378.40R 378.40R - 378.40R - -

8115

EXTRAORAL RADIOGRAPH -

PANORAMIC 378.40R 378.40R 378.40R 378.40R - 378.40R - -

8116


CEPHALOMETRIC 378.40R 378.40R 378.40R 378.40R - 378.40R - -8117 DIAGNOSTIC MODELS 101.70R 101.70R 101.70R 101.70R - 101.70R - -

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

DENIS 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)

8118


SKULL/FACIAL BONE 378.40R 378.40R 378.40R 378.40R - 378.40R - -

8119 DIAGNOSTIC MODELS MOUNTED 255.70R 255.70R 255.70R 255.70R - 255.70R - -8120 TREATMENT PLAN COMPLETED - - - - - - - -

8121

ORAL AND/OR FACIAL IMAGE

(DIGITAL/CONVENTIONAL) 101.70R 101.70R 101.70R 101.70R - 101.70R - 97.90R

8123

CARIES SUSCEPTIBILITY TESTS (BY

ARRANGEMENT) - - - - - - - -8124 PULP TESTS 27.90R - - - - - - -

8129

OFFICE/HOSPITAL VISIT – AFTER

REGULARLY SCHEDULED HOURS 352.20R 352.20R - 352.20R - 352.20R 291.90R -

8131 EMERGENCY DENTAL TREATMENT 143.60R 143.60R 143.60R 143.60R - 292.60R 121.60R 121.70R 8132 PULP REMOVAL (PULPECTOMY) 234.80R 234.80R - - - 312.20R - -

8133

RECEMENT INLAY, ONLAY, CROWN

OR VENEER 143.60R 143.60R - - - 182.20R - -

8135 REMOVE INLAY, ONLAY OR CROWN 285.60R 285.60R - - - 285.60R - -

8136

ACCESS THROUGH A PROSTHETIC

CROWN OR INLAY TO FACILITATE

ROOT CANAL TREATMENT 127.90R 127.90R - 127.90R - 127.90R - -

8137 EMERGENCY CROWN (CHAIR-SIDE) 492.30R 492.30R - - - 492.30R - -

8138

REMOVE RETENTION POST

(PREFABRICATED OR CAST) 187.40R 187.40R - - - 187.40R - -

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

8140

HOUSE/EXTENDED CARE

FACILITY/HOSPITAL CALL * 233.00R 233.00R - 233.00R - 233.00R 193.10R -

8141

INHALATION SEDATION - FIRST 15

MINUTES OR PART THEREOF 105.20R 105.20R - 105.20R - 105.20R - -

8143

INHALATION SEDATION - EACH

ADDNL 15 MINUTES 54.30R 54.30R - 54.30R - 54.30R - -

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)

8144 INTRAVENOUS SEDATION * 63.10R 63.10R - 63.10R - 63.10R - -8145 LOCAL ANAESTHETIC - PER VISIT 91.20R 91.20R 91.20R 91.20R - 91.20R 20.70R 20.70R

8146

RESIN BONDING FOR

RESTORATIONS - - - - - - - -

8147

MONITORING EQUIPMENT FOR

INTRAVENOUS SEDATION 224.30R 224.30R - 224.30R - 224.30R - -8151 ORAL HYGIENE INSTRUCTION 143.60R - - 287.40R - 287.40R 95.50R 95.50R

8153

ORAL HYGIENE INSTRUCTION -

EACH ADDITIONAL VISIT 105.20R - - 138.30R - 138.30R 69.90R 69.90R

8154

ORAL EXAMINATION - ORAL

HYGIENIST - - - - - - - 121.70R

8155 POLISHING - COMPLETE DENTITION 143.60R 143.60R - 197.90R - 143.60R 116.80R 116.70R

8157

RE-BURNISHING AND POLISHING

OF RESTORATIONS - COMPLETE

DENTITION 143.60R - - - - - - -8158 ENAMEL MICROABRASION 131.30R - - - - - - -

8159

PROPHYLAXIS - COMPLETE

DENTITION 282.10R 282.10R - 397.80R - 282.10R 212.70R 212.70R 8160 REMOVAL OF GROSS CALCULUS - - - - - - - -

8161

TOPICAL APPLICATION OF

FLUORIDE - CHILD 143.60R 143.60R - 143.60R - 143.60R 116.80R 116.70R

8162

TOPICAL APPLICATION OF

FLUORIDE - ADULT 143.60R - - 143.60R - 143.60R 116.80R 116.70R 8163 DENTAL SEALANT 94.70R 94.70R - 94.70R - 94.70R 86.50R 86.50R

8164

LIMITED ORAL EXAMINATION -

ORAL HYGIENIST - - - - - - - 94.80R 8165 SEDATIVE FILLING 143.60R 143.60R - 143.60R - 143.60R 121.60R 121.70R

8166

APPLICATION OF DESENSITISING

RESIN, PER TOOTH 94.70R 94.70R - 94.70R - 94.70R 80.30R 80.30R

8167

APPLICATION OF DESENSITISING

MEDICAMENT, PER VISIT 110.40R 110.40R - 110.40R - 110.40R 93.60R 93.60R 8169 OCCLUSAL GUARD 551.80R 551.80R 551.80R 551.80R - 551.80R - -8171 MOUTH PROTECTOR 167.00R 167.00R 167.00R 167.00R - 167.00R - 125.20R 8172 COST OF ORTHOTIC 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)

8173

SPACE MAINTAINER - FIXED, PER

ABUTMENT 266.40R 266.40R 266.40R 266.40R - 266.40R - -

8175 SPACE MAINTAINER - REMOVABLE 343.50R 343.50R 343.50R 343.50R - 343.50R - -8176 PERIODONTAL SCREENING 196.90R 185.80R - 196.90R - 196.90R - 147.60R

8177

ORAL HYGIENE INSTRUCTION

(PERIODONTALLY COMPROMISED

PATIENT) 217.30R - - - - - - -

8178

ORAL HYGIENE INSTRUCTION -

EACH ADDITIONAL VISIT


PATIENT) 117.40R - - - - - - -

8179

POLISHING - COMPLETE DENTITION


PATIENT) 164.80R 164.80R - 164.80R - 164.80R - 123.50R

8180

PROPHYLAXIS - COMPLETE

DENTITION (PERIODONTALLY

COMPROMISED PATIENT) * 306.60R 306.60R - 306.60R - - - 170.30R 8183 THERAPEUTIC DRUG INJECTION 63.10R - - - - - - -

8189

RE-EXAMINATION - EXISTING

CONDITION 113.40R - - - - - 94.80R 94.80R

8190

CONSULTATION - SECOND

OPINION OR ADVICE 233.80R 233.80R 233.80R 233.80R - 233.80R - -8192 SUTURE - MINOR 707.90R 707.90R - 707.90R - 707.90R - -

8194

CBCT CAPTURE AND

INTERPRETATION WITH LIMITED

FIELD OF VIEW - LESS THAN ONE

WHOLE JAW 378.40R 378.40R 378.40R 378.40R - 378.40R - -

8195

CBCT CAPTURE AND


FIELD OF VIEW OF ONE FULL ARCH -

MANDIBLE 378.40R 378.40R 378.40R 378.40R - 378.40R - -

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)

8196

CBCT CAPTURE AND



MAXILLA WITHOUT ORBITS

AND/OR CRANIUM 378.40R 378.40R 378.40R 378.40R - 378.40R - -

8197

CBCT CAPTURE AND


FIELD OF VIEW OF BOTH DENTAL

ARCHES - WITHOUT ORBITS

AND/OR CRANIUM 378.40R 378.40R 378.40R 378.40R - 378.40R - -

8198

CBCT CAPTURE AND

INTERPRETATION FOR TMJ SERIES

INCLUDING TWO OR MORE

EXPOSURES 378.40R 378.40R 378.40R 378.40R - 378.40R - -

8199

CBCT CAPTURE AND



MAXILLA WITH ORBITS AND/OR

CRANIUM 378.40R 378.40R 378.40R 378.40R - 378.40R - -

8200

CBCT CAPTURE AND

INTERPRETATION WITH FIELD OF

VIEW OF BOTH DENTAL ARCHES -

WITH ORBITS AND/OR CRANIUM 378.40R 378.40R 378.40R 378.40R - 378.40R - -

8201

EXTRACTION - TOOTH OR EXPOSED

TOOTH ROOTS (FIRST PER

QUADRANT) 143.60R 215.30R 143.60R 143.60R - 143.60R 136.20R -

8202

EXTRACTION - EACH ADDITIONAL

TOOTH OR EXPOSED TOOTH

ROOTS 57.80R 86.70R 57.80R 57.80R - 57.80R 52.60R -

8213

SURGICAL REMOVAL OF RESIDUAL

ROOTS, FIRST TOOTH PER

QUADRANT 620.40R 620.40R - 620.40R - 620.40R - -

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)

8214


ROOTS, SECOND AND

SUBSEQUENT TEETH'S ROOTS 478.30R 478.30R - 478.30R - 478.30R - -8220 COST OF SUTURE MATERIAL 225.00R 225.00R - 225.00R - 225.00R 225.00R -8228 ART RESTORATIONS - - - - - - - 249.20R

8231

COMPLETE DENTURES - MAXILLARY

AND MANDIBULAR 2 316.40R - - 2 316.40R - 4 836.10R - -

8232

COMPLETE DENTURE - MAXILLARY

OR MANDIBULAR 1 428.00R - - 1 428.00R - 3 383.50R - -

8233

PARTIAL DENTURE - RESIN BASE -

ONE TOOTH 664.00R - - 664.00R - 664.00R - -

8234


TWO TEETH 664.00R - - 664.00R - 664.00R - -

8235


THREE TEETH 993.50R - - 993.50R - 993.50R - -

8236


FOUR TEETH 993.50R - - 993.50R - 993.50R - -

8237


FIVE TEETH 993.50R - - 993.50R - 993.50R - -

8238


SIX TEETH 1 317.80R - - 1 317.80R - 1 317.80R - -

8239


SEVEN TEETH 1 317.80R - - 1 317.80R - 1 317.80R - -

8240


EIGHT TEETH 1 317.80R - - 1 317.80R - 1 317.80R - -

8241


NINE OR MORE TEETH 1 317.80R - - 1 317.80R - 1 317.80R - -

8244 IMMEDIATE DENTURE - MAXILLARY 1 428.00R - - 1 428.00R - 2 142.10R - -

8245

IMMEDIATE DENTURE -

MANDIBULAR 1 428.00R - - 1 428.00R - 2 142.10R - -8251 CLASP OR REST - CAST GOLD 131.30R - - - - - - -

8253 CLASP OR REST - WROUGHT GOLD 131.30R - - - - - - -

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)

8255 CLASP OR REST - STAINLESS STEEL 138.30R - - - - - - -

8281

PARTIAL DENTURE - CAST METAL

FRAMEWORK ONLY * 1 549.10R - - 1 549.10R - 1 549.10R - -8391 CAST CORE WITH SINGLE POST * 329.50R - - - - 329.50R - -

8397

CAST CORE WITH PINS (ANY

NUMBER OF PINS) * 525.70R - - - - 683.40R - -8401 CROWN - FULL CAST METAL * 1 640.00R - - - - 2 414.40R - -8403 CROWN - 3/4 CAST METAL * 1 640.00R - - - - 2 414.40R - -

8404

CROWN - 3/4

PORCELAIN/CERAMIC * 1 548.80R - - - - 2 325.20R - -8405 CROWN - RESIN LABORATORY * 1 548.80R - - - - 2 325.20R - -8407 CROWN - RESIN WITH METAL * 1 640.00R - - - - 2 414.40R - -8409 CROWN - PORCELAIN/CERAMIC * 1 640.00R - - - - 2 414.40R - -

8411

CROWN - PORCELAIN VENEERED

TO METAL * 1 640.00R - - - - 2 414.40R - -8415 PONTIC - CERAMIC * 1 338.70R - - - - 1 338.60R - -8416 PONTIC - CAST METAL * 1 063.50R - - - - 1 063.60R - -8417 PONTIC - RESIN WITH METAL * 1 338.70R - - - - 1 338.60R - -

8418

PONTIC - PORCELAIN VENEERED TO

METAL * 1 338.70R - - - - 1 338.60R - -

8432

INLAY/ONLAY RETAINER - METAL -

TWO SURFACES * 637.80R - - - - 1 247.50R - -

8433


THREE SURFACES * 1 063.50R - - - - 1 934.40R - -

8434


FOUR OR MORE SURFACES * 1 286.10R - - - - 1 934.40R - -

8436

INLAY/ONLAY RETAINER -

PORCELAIN - TWO SURFACES * 776.20R - - - - 1 496.50R - -

8437


PORCELAIN - THREE SURFACES * 1 279.10R - - - - 2 325.20R - -

8438


PORCELAIN - FOUR OR MORE

SURFACES * 1 549.10R - - - - 2 325.20R - -

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)

8441

CROWN RETAINER - FULL CAST

METAL * 1 640.00R - - - - 2 414.40R - -

8442

CROWN RETAINER - 3/4 CAST

METAL * 1 640.00R - - - - 2 414.40R - -8443 CROWN RETAINER - CERAMIC * 1 640.00R - - - - 2 414.40R - -

8444 CROWN RETAINER - 3/4 CERAMIC * 1 640.00R - - - - 2 414.40R - -

8445

CROWN RETAINER - PORCELAIN

VENEERED TO METAL * 1 640.00R - - - - 2 414.40R - -

8446

CROWN RETAINER - RESIN WITH

METAL * 1 640.00R - - - - 2 414.40R - -

8533

IMPLANT SUPPORTED REMOVABLE

COMPLETE OVERDENTURE * 2 574.50R - - - - 3 861.80R - -

8534

IMPLANT SUPPORTED REMOVABLE

PARTIAL OVERDENTURE * 2 059.50R - - - - 3 089.40R - -

8536

CROWN-IMPLANT/ABUTMENT

SUPPORTED CROWN -

PORCELAIN/CERAMIC * 2 128.80R - - - - 2 815.70R - -

8537


SUPPORTED CROWN - PORCELAIN

WITH METAL * 2 128.80R - - - - 2 815.70R - -

8538


SUPPORTED CROWN - CAST METAL * 2 128.80R - - - - 2 815.70R - -

8546

IMPLANT SUPPORTED CROWN

RETAINER - CERAMIC * 2 128.80R - - - - 2 815.70R - -

8547

IMPLANT SUPPORTED CROWN

RETAINER - PORCELAIN VENEERED

TO METAL * 2 128.80R - - - - 2 815.70R - -

8548

CROWN RETAINER -

IMPLANT/ABUTMENT SUPPORTED -

CAST METAL * 2 128.80R - - - - 2 815.70R - -8560 COST OF CERAMIC BLOCK * 644.10R - - - - 644.10R - -

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)

8570

FABRICATION OF COMPUTER

GENERATED CERAMIC

RESTORATION * 1 562.70R - - - - 1 562.70R - -8581 CAST CORE WITH SINGLE POST * - - - - - - - -8582 CAST CORE WITH DOUBLE POST * - - - - - - - -8583 CAST CORE WITH TRIPLE POST * - - - - - - - -

8584

CONNECTOR BAR - IMPLANT

SUPPORTED * - - - - - - - -

8592

CROWN - IMPLANT/ABUTMENT

SUPPORTED * 2 128.40R - - - - 2 815.70R - -

8600 COST OF IMPLANT COMPONENTS * - - - - - - - -8611 PONTIC - SANITARY * - - - - - 1 459.60R - -8613 PONTIC - POSTERIOR * - - - - - 1 785.60R - -8615 PONTIC - ANTERIOR/PREMOLAR * - - - - - 1 929.20R - -

8617

RETAINER CAST METAL

(MARYLAND TYPE RETAINER) * 637.80R - - - - 1 247.50R - -

8643


AND MANDIBULAR. ONLY FOR

PROSTHODONTISTS * - - - - - 6 276.30R - -

8645


OR MANDIBULAR. ONLY FOR

PROSTHODONTISTS * - - - - - 7 720.10R - -

8649

IMMEDIATE DENTURE -

MAXILLARY. ONLY FOR

PROSTHODONTIST * - - - - - 3 861.80R - -

8651

IMMEDIATE DENTURE -

MANDIBULAR. ONLY FOR

PROSTHODONTIST * - - - - - 4 343.60R - -8652 OVERDENTURE - COMPLETE * 2 574.50R - - - - 3 861.80R - -8653 OVERDENTURE - PARTIAL * 2 059.50R - - - - 3 089.40R - -

8654

IMPLANT SUPPORTED FIXED-

DETACHABLE COMPLETE

OVERDENTURE * 2 895.70R - - - - 4 343.60R - -

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)

8655

IMPLANT SUPPORTED FIXED-

DETACHABLE PARTIAL

OVERDENTURE * 2 316.50R - - - - 2 976.50R - -

8671

PARTIAL DENTURE - CAST METAL

FRAMEWORK WITH RESIN

DENTURE BASE * - - - - - 3 861.80R - -

8737

ROOT PLANING - FOUR OR MORE

TEETH PER QUADRANT * 574.80R - - 779.60R - 574.90R - 372.30R

8739

ROOT PLANING - ONE TO THREE

TEETH PER QUADRANT * 457.40R - - 622.10R - 457.20R - 343.00R

8841

ORTHO TX - FIXED LINGUAL

APPLIANCE - ONE ARCH * - - - - - - - -

8842


APPLIANCE - ONE ARCH, MODEATE * - - - - - - - -

8843


APPLIANCE - ONE ARCH, SEVERE * - - - - - - - -

8858

ORTHO TX - FUNCTIONAL

APPLIANCE * - - - - - - - -

8861

ORTHO TX - PARTIAL FIXED

APPLIANCE - MINOR * - - - - - - - -

8865


APPLIANCE - ONE ARCH * - - - - - - - -

8866


APPLIANCE - BOTH ARCHES * - - - - - - - -

8867

ORTHO TX - FIXED APPLIANCE -

ONE ARCH * - - - - - - - -

8868


ONE ARCH, MODEATE * - - - - - - - -

8869


ONE ARCH, SEVERE * - - - - - - - -

8873


BOTH ARCHES, CLASS 1 MILD * - - - - - - - -

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)

8874


APPLIANCE - BOTH ARCHES, CLASS

1 MILD * - - - - - - - -

8875


BOTH ARCHES, CLASS 1 MODERATE * - - - - - - - -

8876



1 MODERATE * - - - - - - - -

8877


BOTH ARCHES, CLASS 1 SEVERE * - - - - - - - -

8878



1 SEVERE * - - - - - - - -

8879


BOTH ARCHES, CLASS 1 SEVERE W/

COMPLICATIONS * - - - - - - - -

8880



1 SEVERE W/ COMPLICATIONS * - - - - - - - -

8881


BOTH ARCHES, CLASS 2/3 MILD * - - - - - - - -

8882



2/3 MILD * - - - - - - - -

8883


BOTH ARCHES, CLASS 2/3

MODERATE * - - - - - - - -

8884



2/3 MODERATE * - - - - - - - -

8885


BOTH ARCHES, CLASS 2/3 SEVERE * - - - - - - - -

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)

8886



2/3 SEVERE * - - - - - - - -

8887


BOTH ARCHES, CLASS 2/3 SEVERE

W/ COMPLICATIONS * - - - - - - - -

8888



2/3 SEVERE W/ COMPLICATIONS * - - - - - - - -

8890 MONTHLY INSTALMENT ORTHO TX * - - - - - - - -8958 EMERGENCY TRACHEOTOMY * - - - - - - - -8959 PHARYNGOSTOMY * - - - - - - - -

8966

REPAIR OF ORONASAL FISTULA

(LOCAL FLAPS) * - - - - - - - -

8975

HEMIRESECTION OF JAW

EXCLUDING CONDYL * - - - - - - - -

8977

SURGICAL REPAIR OF MAXILLA OR

MANDIBLE - MAJOR * 2 916.90R 4 375.30R - - - - - -

9013

INCISION & DRAINAGE OF ABSCESS

- EXTRA-ORAL (PYOGENIC) * - - - - - - - -

9017

DECORTICATION, SAUCERISATION

AND SEQUESTRECTOMY * - - - - - - - -

9025

MANDIBLE FRACTURE - CLOSED

REDUCTION * - - - - - - - -

9027

MANDIBLE FRACTURE -

COMPOUND, WITH EYELET WIRING * - - - - - - - -9029 MANDIBLE FRACTURE - SPLINTS * - - - - - - - -

9031

MANDIBLE FRACTURE - OPEN

REDUCTION * - - - - - - - -

Trf


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General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9032

REDUCTION OF MASSETER MUSCLE

AND BONE - EXTRA-ORAL

APPROACH * - - - - - - - -

9033

OPEN TREATMENT OF CONDYLAR

FRACTURE * - - - - - - - -

9035

MAXILLA FRACTURE - LE FORT I OR

GUERIN * - - - - - - - -8257 BAR - LINGUAL OR PALATAL 163.00R - - - - - - -

8259

REBASE COMPLETE OR PARTIAL

DENTURE (LABORATORY) 541.40R - - 541.40R - 781.40R - -

8261

REMODEL COMPLETE OR PARTIAL

DENTURE 869.10R - - 869.10R - 869.10R - -

8263

RELINE COMPLETE OR PARTIAL

DENTURE (CHAIR-SIDE) 343.50R - - 343.50R - 429.20R - -

8265

TISSUES CONDITIONING PER ARCH

(INCLUDING SOFT SELF-CURE

RELINE) 224.30R 224.30R - 224.30R - 287.40R - 168.20R

8267

RELINE COMPLETE OR PARTIAL

DENTURE (LABORATORY) 790.40R - - 790.40R - 790.40R - -

8269

REPAIR DENTURE OR OTHER INTRA-

ORAL APPLIANCE 182.20R - - - - 196.20R - -

8270

ADD CLASP TO EXISTING PARTIAL

DENTURE 131.30R - - - - - - -

8271

ADD TOOTH TO EXISTING PARTIAL

DENTURE 131.30R - - - - - - -

8273

IMPRESSION TO REPAIR OR

MODIFY A DENTURE OR OTHER

INTRA-ORAL APPLIANCE 105.20R - - 105.20R - 105.20R - -

8275

ADJUST COMPLETE OR PARTIAL

DENTURE 105.20R - - 105.20R - 105.20R - -8277 INLAY IN DENTURE 436.20R - - - - 860.20R - -8301 PULP CAP - DIRECT 190.90R - - - - - - -8303 PULP CAP - INDIRECT 190.90R - - - - - 172.70R -8304 RUBBER DAM PER ARCH 112.20R 112.20R - 112.20R - 112.20R - -8306 COST OF MTA - - - - - - - -

Trf


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General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8307 PULP AMPUTATION (PULPOTOMY) 187.40R 187.40R - 187.40R - 187.40R - -

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

8325

INTERNAL BLEACHING - PER

TOOTH 340.00R - - - - 510.00R - -

8327

INTERNAL BLEACHING - EACH

ADDITIONAL VISIT 163.00R - - - - 244.50R - -

8328

ROOT CANAL OBTURATION -

ANTERIORS AND PREMOLARS -

EACH ADDITIONAL CANAL 266.40R 266.40R - - - 354.40R - -

8329

ROOT CANAL THERAPY -


EACH ADDITIONAL CANAL 333.00R 333.00R - - - 442.80R - -

8330

REMOVAL OF ROOT CANAL

OBSTRUCTION 187.40R 187.40R - 187.40R - 187.40R - -

8332

ROOT CANAL PREPARATORY VISIT -

SINGLE CANAL TOOTH 143.60R 143.60R - - - 190.80R - -

8333

ROOT CANAL PREPARATORY VISIT -

MULTI CANAL TOOTH 201.40R 201.40R - - - 201.40R - -

8334

RE-TREATMENT OF PREVIOUSLY

COMPLETED ROOT CANAL

THERAPY, PER CANAL 212.10R 212.10R - 212.10R - 255.70R - -

8335



FIRST CANAL 651.80R 651.80R - - - 866.70R - -

8336


POSTERIORS - FIRST CANAL 897.00R 897.00R - - - 1 193.00R - -

8337


POSTERIORS - EACH ADDITIONAL

CANAL 266.40R 266.40R - - - 354.40R - -

8338



FIRST CANAL 997.00R 997.00R - - - 1 325.90R - -

Trf


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General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8339


POSTERIORS - FIRST CANAL 1 370.10R 1 370.10R - - - 1 822.10R - -

8340


POSTERIORS - EACH ADDITIONAL

CANAL 333.00R 333.00R - - - 442.80R - -8341 AMALGAM - ONE SURFACE 285.60R 285.60R - 285.60R - 285.60R 249.20R -8342 AMALGAM - TWO SURFACES 352.20R 352.20R - 352.20R - 352.20R 307.20R -8343 AMALGAM - THREE SURFACES 429.20R 429.20R - 429.20R - 429.20R 374.50R -

8344

AMALGAM - FOUR OR MORE

SURFACES 478.30R 478.30R - 478.30R - 478.30R 417.20R -

8345

PREFABRICATED POST RETENTION,

PER POST (IN ADDITION TO

RESTORATION) 282.10R 282.10R - 282.10R - 282.10R - -

8347

PIN RETENTION - FIRST PIN (IN

ADDITION TO RESTORATION) 141.80R 141.80R - 141.80R - 141.80R - -

8348

PIN RETENTION - EACH

ADDITIONAL PIN (IN ADDITION TO

RESTORATION) 131.30R 131.30R - 131.30R - 131.30R - -

8349

CARVE RESTORATION TO

ACCOMMODATE EXISTING

REMOVABLE PROSTHESIS 57.80R - - - - - - -

8350

RESIN CROWN - ANTERIOR

PRIMARY TOOTH (DIRECT) 623.10R 623.10R - 623.10R - 623.10R 543.40R -

8351 RESIN - ONE SURFACE, ANTERIOR 313.60R 313.60R - 313.60R - 313.60R 301.60R -

8352 RESIN - TWO SURFACES, ANTERIOR 394.30R 394.30R - 394.30R - 394.30R 379.00R -

8353

RESIN - THREE SURFACES,

ANTERIOR 471.30R 471.30R - 471.30R - 471.30R 452.90R -

8354

RESIN - FOUR OR MORE SURFACES,

ANTERIOR 525.70R 525.70R - 525.70R - 525.70R 505.50R -8355 VENEER - RESIN (CHAIR-SIDE) 497.70R 497.70R - 497.70R - 497.70R - -8357 PREFABRICATED METAL CROWN 292.60R 292.60R - 292.60R - 292.60R - -8361 INLAY - METAL - ONE SURFACE 436.20R - - - - 860.40R - -

Trf


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General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8362

INLAY/ONLAY - METAL - TWO

SURFACES 637.80R - - - - 1 247.50R - -

8363

INLAY/ONLAY - METAL - THREE

SURFACES 1 063.50R - - - - 1 934.40R - -

8364

INLAY/ONLAY - METAL - FOUR OR

MORE SURFACES 1 286.10R - - - - 1 934.40R - -

8366

PIN RETENTION AS PART OF CAST

RESTORATION (ANY NUMBER OF

PINS) 212.10R - - - - 287.40R - -

8367 RESIN - ONE SURFACE, POSTERIOR 340.00R 340.00R - 340.00R - 340.00R 326.90R -

8368

RESIN - TWO SURFACES,

POSTERIOR 420.50R 420.50R - 420.50R - 420.50R 404.40R -

8369

RESIN - THREE SURFACES,

POSTERIOR 508.20R 508.20R - 508.20R - 508.20R 488.50R -

8370

RESIN - FOUR OR MORE SURFACES,

POSTERIOR 546.60R 546.60R - 546.60R - 546.60R 525.40R -

8371 INLAY - PORCELAIN - ONE SURFACE 525.70R - - - - 1 039.10R - -

8372

INLAY/ONLAY - PORCELAIN - TWO

SURFACES 776.20R - - - - 1 496.50R - -

8373

INLAY/ONLAY - PORCELAIN - THREE

SURFACES 1 279.10R - - - - 2 325.20R - -

8374

INLAY/ONLAY - PORCELAIN - FOUR

OR MORE SURFACES 1 549.10R - - - - 2 325.20R - -8375 PREFABRICATED RESIN CROWN 292.60R 292.60R - 292.60R - 292.60R - -

8376

CORE BUILD-UP WITH

PREFABRICATED POSTS 781.40R - - - - 781.40R - -8379 COST OF PREFABRICATED POSTS 108.80R - - - - 108.80R - -8381 INLAY - RESIN - ONE SURFACE 525.70R - - - - 1 039.10R - -

8382

INLAY/ONLAY - RESIN - TWO

SURFACES 776.20R - - - - 1 496.50R - -

8383

INLAY/ONLAY - RESIN - THREE

SURFACES 1 279.10R - - - - 2 325.20R - -

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)

8384

INLAY/ONLAY - RESIN - FOUR OR

MORE SURFACES 1 549.10R - - - - 2 325.20R - -8392 CAST POST (EACH ADDITIONAL) 196.20R - - - - 196.20R - -8398 CORE BUILD-UP WITH PINS 637.80R - - - - 637.80R - -8410 PROVISIONAL CROWN * 318.80R - - 318.80R - 478.30R - -

8413

REPAIR CROWN (PERMANENT OR

PROVISIONAL) * 318.80R 318.80R - - - 318.80R - -

8414

ADDITIONAL FEE FOR PROVISION

OF CROWN WITHIN AN EXISTING

CLASP OR REST * 94.70R - - - - 94.70R - -8419 PROVISIONAL PONTIC * 318.80R - - - - 478.30R - -

8447 PROVISIONAL CROWN RETAINER * 318.80R - - - - 478.30R - -8499 GENERAL ANAESTHETIC * - - - - - - - -

8501 CONSULTATION - PROSTHODONTIS - - - - - 297.90R - -

8503 OCCLUSION ANALYSIS MOUNTED 318.80R - - - - 478.30R - -8505 PANTOGRAPHIC RECORDING 462.60R - - - - 693.90R - -

8506

DETAILED CONSULTATION -

PROSTHODONTIST - - - - - 779.60R - -

8507

COMPREHENSIVE CONSULTATION -


8508

ELECTROGNATHOGRAPHIC

RECORDING 495.30R - - - - 743.00R - -

8509

ELECTROGNATHOGRAPHIC

RECORDING WITH COMPUTER

ANALYSIS 822.30R - - - - 1 233.50R - -8514 RECEMENT BRIDGE 143.60R 143.60R - - - 182.20R - -8516 REMOVE BRIDGE 285.60R 285.60R - - - 285.60R - -

8517

REIMPLANTATION OF AVULSED

TOOTH (INCLUDE STABILISATION) 331.70R 331.70R - 331.70R - 497.70R - -8518 REPAIR BRIDGE 318.80R 318.80R - - - 318.80R - -

Trf


*Pre-

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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)

8551 OCCLUSAL ADJUSTMENT - MAJOR 908.70R - 1 363.10R - - 1 363.10R - -

8552

VENEER - PORCELAIN

(LABORATORY) 1 101.40R - - - - 1 652.30R - -

8553 OCCLUSAL ADJUSTMENT - MINOR 317.00R 434.40R 434.40R 434.40R - 434.40R - -8554 VENEER - RESIN (LABORATORY) 1 101.40R - - - - 1 652.30R - -8561 GOLD FOIL CLASS I OR IV 831.70R - - - - 1 247.50R - -8563 GOLD FOIL CLASS V 973.00R - - - - 1 459.60R - -8565 GOLD FOIL CLASS III 1 224.10R - - - - 1 836.20R - -8578 PREFABRICATED ABUTMENT 266.40R - - - - 399.50R - -8579 CUSTOM ABUTMENT 1 214.80R - - - - 1 822.20R - -

8580

CUSTOMISED PREFABRICATED

ABUTMENT * 496.60R 496.60R - - - 496.60R - -8585 CONNECTOR BAR - - - - - - - -8586 STRESS BREAKER - - - - - - - -8587 COPING METAL 213.90R - - - - 399.50R - -

8590

IMPLANT MAINTENANCE

PROCEDURES - PER IMPLANT 117.90R - - - - 177.00R - -

8594

REPAIR OF IMPLANT SUPPORTED

PROSTHESIS 130.90R - - - - 196.20R - -8595 REPAIR OF IMPLANT ABUTMENT 130.90R - - - - 196.20R - -8597 LOCKS AND MILLED RESTS 130.90R - - - - 196.20R - -

8599

PRECISION ATTACHMENT

(REMOVABLE DENTURE) 318.80R - - - - 478.30R - -

8631

ROOT CANAL THERAPY - FIRST

CANAL SPECIALIST

PROSTHODONTIST - - - - - 1 692.60R - -

8633

ROOT CANAL THERAPY - EACH

ADDITIONAL CANAL SPECIALIST


8635

APEXIFICATION/APEXOGENESIS/RE

CALCIFICATION – PER VISIT 190.90R 190.90R - 190.90R - 375.20R - -

8640

REMOVAL OF FRACTURED ROOT

CANAL INSTRUMENT 497.70R - - - - 497.70R - -

Trf


*Pre-

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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)

8657

REPLACEMENT OF PRECISION

ATTACHMENT 182.20R - - - - 196.20R - -8658 INTERIM COMPLETE DENTURE 1 427.90R - - - - 2 142.00R - -8659 INTERIM PARTIAL DENTURE 1 142.30R - - - - 1 713.60R - -

8660

ADDITIONAL FEE TO IMPLANT

SUPPORTED FIXED-DETACHABLE

DENTURE - PER IMPLANT 399.50R - - - - 399.50R - -

8661

DIAGNOSTIC DENTURES

(INCLUDING TISSUE

CONDITIONING) - - - - - - - -

8662

ADJUST COMPLETE OR PARTIAL

DENTURES (REMOUNTING) 371.60R - - - - 557.30R - -

8663

METAL BASE TO COMPLETE

DENTURE 775.60R - - - - 1 163.50R - -

8664

REMOUNT CROWN OR BRIDGE FOR

ADJUSTMENT 371.60R - - - - 582.20R - -

8667

SOFT BASE TO DENTURE (HEAT

CURED) 775.60R - - - - 1 163.50R - -

8672

ALTERED CAST TECHNIQUE (IN

ADDITION TO PARTIAL DENTURE) 99.50R - - 99.50R - 149.00R - -8674 ADDITIVE PARTIAL DENTURE 1 168.20R - - - - 1 752.20R - -

8701 CONSULTATION - PERIODONTIST - - - 297.90R - - - -

8703

CONSULTATION - PERIODONTIST

(DETAILED) - - - 779.60R - - - -

8705 RE-EXAMINATION - PERIODONTIST - - - 233.00R - - - -

8707

PERIODONTAL SCREENING -

PERIODONTIST - - - 233.00R - - - -

8723

PROVISIONAL SPLINTING -

EXTRACORONAL (WIRE) - PER

SEXTANT 266.40R 266.40R - 399.50R - 399.50R - 266.40R

Trf


*Pre-

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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)

8725


EXTRACORONAL (WIRE PLUS

RESIN) - PER SEXTANT 386.60R 386.60R - 580.00R - 580.00R - 386.60R

8727


INTRACORONAL - PER TOOTH 121.40R 121.40R - 182.20R - 182.20R - -

8731


- INTRA-ORAL 229.10R 229.10R - 343.50R - - - -

8741

GINGIVECTOMY/GINGIVOPLASTY -

FOUR OR MORE TEETH PER

QUADRANT 750.00R - - 1 028.60R - - - -

8743

GINGIVECTOMY OR

GINGIVOPLASTY - ONE TO THREE

TEETH PER QUADRANT 599.20R - - 816.50R - - - -

8749

FLAP PROCEDURE, ROOT PLANING

AND ONE TO THREE SURGICAL

SERVICES - PER QUADRANT 1 557.00R - - 2 335.70R - - - -

8751


AND ONE TO THREE SURGICAL

SERVICES - PER SEXTANT 1 289.60R - - 1 934.40R - - - -

8753


AND FOUR OR MORE SURGICAL

SERVICES - PER QUADRANT 1 929.90R - - 2 894.70R - - - -

8755


AND FOUR OR MORE SURGICAL

SERVICES - PER SEXTANT 1 564.00R - - 2 346.20R - - - -

8756

CLINICAL CROWN LENGTHENING

(ISOLATED PROCEDURE) * 948.40R - - 1 422.70R - - - -

8759

PEDICLE FLAPPED GRAFT

(ISOLATED PROCEDURE) 712.60R - - 1 068.80R - - - -

Trf


*Pre-

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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)

8761

MASTICATORY MUCOSAL

AUTOGRAFT - ONE TO FOUR TEETH

(ISOLATED PROCEDURE) 774.40R 1 161.70R - 1 161.70R - - - -

8762

MASTICATORY MUCOSAL

AUTOGRAFT - FOUR OR MORE

TEETH (ISOLATED PROCEDURE) 1 163.50R 1 745.20R - 1 745.20R - - - -

8763

WEDGE RESECTION (ISOLATED

PROCEDURE) * 455.60R 455.60R - 683.40R - - - -

8765

HEMISECTION OF A TOOTH,

RESECTION OF A ROOT OR TUNNEL

PREPARATION (ISOLATED

PROCEDURE) 626.10R - - 939.20R - 939.20R - -

8766

BONE REGENERATION/REPAIR

PROCEDURE - AS PART OF A FLAP

OPERATION 372.60R - - 559.10R - - - -

8767

BONE REGENERATION/REPAIR

PROCEDURE - AT A SINGLE SITE 966.10R 1 449.10R - 1 449.10R - - - -

8768

UNLISTED PERIODONTAL

PROCEDURE 455.60R - - 683.40R - - - -

8769

MEMBRANE REMOVAL (USED FOR

GUIDED TISSUE REGENERATION) 455.60R 683.40R - 683.40R - - - -

8770

COST OF BONE

REGENERATIVE/REPAIR MATERIAL - - - - - - - -

8772

SUBMUCOSAL CONNECTIVE TISSUE

AUTOGRAFT (ISOLATED

PROCEDURE) 782.60R 1 174.00R - 1 174.00R - - - -

8773

COST OF INTRAPOCKET

CHEMOTHERAPEUTIC AGENT - - - - - - - -

8781

CONSULTATION - ORAL MEDICINE

(SIMPLE) - - - - - - - -

8782


(COMPLEX) - - - - - - - -

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)

8783


(SUBSEQUENT) - - - - - - - -

8787

UNLISTED ORAL MEDICINE

PROCEDURE 163.50R - - 245.30R - - - -

8801 CONSULTATION - ORTHODONTIST - - 297.90R - - - - -

8803

CONSULTATION - ORTHODONTIS

(SUBSEQUENT, RETENTION AND

POST TREATMENT) - - 173.50R - - - - -

8811

TRACING AND ANALYSIS OF EXTRA-

ORAL FILM 43.90R 43.90R 43.90R 43.90R - 43.90R - -

8837

DIAGNOSIS AND TREATMENT

PLANNING - ORTHODONTIST - - 138.30R - - - - -8839 DIAGNOSTIC SETUP 195.20R 195.20R 292.60R - - - - -

8840

TREATMENT PLANNING FOR

ORTHOGNATHIC SURGERY - ALL 672.70R 1 009.20R 1 009.20R - - - - -

8846

REPAIR ORTHODONTIC APPLIANCE -

REMOVABLE 131.90R - 197.90R - - - - -

8847

REPLACE ORTHODONTIC

APPLIANCE - REMOVABLE 455.60R - 683.40R - - - - -

8848

REPAIR ORTHODONTIC APPLIANCE -

FIXED 195.20R - 292.60R - - - - -8849 RETAINER (ORTHODONTIC) 455.60R - 683.40R - - - - -

8850 TREATMENT OF MPDS - FIRST VISIT 219.60R 219.60R 329.50R 219.60R - 329.50R - -

8851

TREATMENT OF MPDS -

SUBSEQUENT VISIT 115.60R 115.60R 173.50R 115.60R - 173.50R - -

8852 OCCLUSAL ORTHOTIC APPLIANCE 551.80R 727.10R 727.10R 727.10R - 727.10R - -

8855

CONSULTATION - CLEFT PALATE

THERAPY (HOUSE OR HOSPITAL) 266.40R - 399.50R - - 399.50R - -

8856


(SUBSEQUENT) 130.90R - 196.20R - - 196.20R - -

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)

8857


(MAXIMUM) 910.00R - 1 364.90R - - 1 364.90R - -

8862

ORTHO TX - REMOVABLE

APPLIANCE * - - - - - - - -

8863

ORTHO TX - EACH ADDITIONAL

REMOVABLE APPLIANCE * - - - - - - - -8891 ORTHODONTIC TRANSFER * - - - - - - - -8892 ORTHODONTIC RE-TREATMENT * - - - - - - - -8935 TREATMENT OF SEPTIC SOCKET 105.20R 164.80R - 105.20R - 105.20R 88.80R -8901 CONSULTATION - MFOS - 297.90R - - - - - -

8902 CONSULTATION - MFOS (DETAILED) - 779.60R - - - - - -

8903

HOUSE/HOSP/NURSING HOME

CONSULTATION - MFOS - 261.00R - - - - - -

8904


CONSULTATION (SUBSEQUENT) -

MFOS - 173.50R - - - - - -

8905

AFTER REGULARLY HOURS

CONSULTATION - MFOS - 382.10R - - - - - -

8907


CONSULTATION (MAXIMUM PER

WEEK) - MFOS - 434.40R - - - - - -

8908

SURGICAL REMOVAL OF ROOTS

FROM MAXILLARY ANTRUM 1 897.00R 2 845.60R - - - - - -8909 ORAL ANTRAL FISTULA CLOSURE 1 454.30R 2 181.40R - - - - - -8911 CALDWELL-LUC PROCEDURE 569.00R 853.40R - - - - - -8917 BIOPSY OF ORAL TISSUE - SOFT 362.70R 483.50R - 483.50R - - - -8919 BIOPSY OF BONE - NEEDLE * 558.30R 837.50R - - - - - -

8921

BIOPSY – EXTRA-ORAL BONE/SOFT

TISSUE * 913.50R 1 370.10R - - - - - -

8931

TREATMENT OF POST-EXTRACTION

HAEMORRHAGE 105.20R 630.80R - 105.20R - 105.20R 88.80R -

8933

TREATMENT OF HAEMORRHAGE

(BLOOD DYSCRACIAS) 1 454.30R 2 181.40R - 1 454.30R - 1 454.30R - -8937 SURGICAL REMOVAL OF TOOTH 620.40R 837.50R - 620.40R - - - -

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Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8941

SURGICAL REMOVAL OF IMPACTED

TOOTH - FIRST TOOTH 1 028.60R 1 352.70R - 1 028.60R - - - -

8943


TOOTH - SECOND TOOTH 551.80R 728.80R - 551.80R - - - -

8945


TOOTH - THIRD AND SUBSEQUENT

TEETH 313.60R 413.50R - 313.60R - - - -

8953


ROOTS, FIRST TOOTH - PER TOOTH 620.40R 837.50R - 837.40R - - - -

8957

ALVEOLOTOMY OR

ALVEOLECTOMY (INCLUDING

EXTRACTIONS) 761.70R 1 142.50R - 761.70R - - - -8961 TOOTH TRANSPLANTATION 1 248.70R 1 873.10R - - - - - -8962 HARVEST ILIAC CREST GRAFT 460.40R 565.80R - - - - - -8963 HARVEST RIB GRAFT 528.10R 792.10R - - - - - -8964 HARVEST CRANIUM GRAFT 413.50R 620.40R - - - - - -8965 PERIPHERAL NEURECTOMY 1 248.70R 1 873.10R - - - - - -

8967

SURGICAL REMOVAL OF JAW CYST -

INTRA-ORAL APPROACH 1 734.70R 2 602.10R - - - - - -

8969

SURGICAL REMOVAL OF JAW CYST -

EXTRA-ORAL APPROACH 2 778.80R 4 168.40R - - - - - -

8971

EXCISION OF TUMOUR OF THE

SOFT TISSUE 558.30R 837.50R - 837.50R - - - -

8973

SURGICAL EXCISION OF TUMOURS

OF THE JAW 2 778.80R 4 168.40R - - - - - -

8979

HARVESTING OF AUTOGENOUS

GRAFTS (INTRA-ORAL) 240.50R 360.90R - 360.90R - - - -

8981

SURGICAL EXPOSURE OF

IMPACTED OR UNERUPTED TEETH

TO AID ERUPTION 1 146.00R 1 561.30R - 1 561.30R - - - -

9003

REPOSITION MENTAL FORAMEN

AND NERVE - PER SIDE 1 734.70R 2 602.10R - - - - - -

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Practice (54)

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(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

8983 CORTICOTOMY - FIRST TOOTH 829.20R 1 244.00R - - - - - -

8984

CORTICOTOMY - EACH ADDITIONAL

TOOTH 420.50R 630.80R - - - - - -8985 FRENULECTOMY/FRENULOTOMY 761.70R 1 142.50R - 1 142.50R - - - -

8987

REDUCTION OF MYLOHYOID

RIDGES - PER SIDE 1 248.70R 1 873.10R - - - - - -

8989 REMOVAL TORUS MANDIBULARIS 1 248.70R 1 873.10R - - - - - -8991 REMOVAL OF TORUS PALATINUS 1 248.70R 1 873.10R - - - - - -

8993

SURGICAL REDUCTION OF

OSSEOUS TUBEROSITY - PER SIDE 558.30R 837.50R - - - - - -8995 GINGIVECTOMY - PER JAW 1 110.90R 1 666.50R - - - - - -

8997 SULCOPLASTY / VESTIBULOPLASTY 2 863.10R 4 294.80R - 4 294.80R - - - -

9004

LATERALIZATION OF INFERIOR

DENTAL NERVE 2 795.30R 4 193.10R - - - - - -

9005

ALVEOLAR RIDGE AUGMENTATION -

TOTAL (BY BONE GRAFT) 2 919.20R 4 378.70R - 4 378.70R - - - -

9007


TOTAL (BY ALLOPLASTIC MATERIAL) 1 837.40R 2 756.20R - - - - - -

9008


ONE TO TWO TOOTH SITES 568.00R 1 039.10R - 1 039.10R - - - -

9009


THREE ACROSS 3 OR MORE TOOTH

SITES 1 262.70R 1 894.00R - 1 894.00R - - - -9010 SINUS LIFT PROCEDURE 1 897.00R 2 845.60R - 2 845.60R - - - -

9011


- INTRA-ORAL (PYOGENIC) 355.20R 532.60R - - - - 167.70R -

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(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9015

APICECTOMY/PERIRADICULAR

SURGERY - ANTERIORS (INCLUDING

RETROGRADE FILLING) 707.90R 939.20R - 939.20R - 939.20R - -

9016

APICECTOMY/PERIRADICULAR

SURGERY - MOLARS (INCLUDING

RETROGRADE FILLING) 1 248.70R 1 873.10R - 1 873.10R - 1 873.10R - -

9019

SEQUESTRECTOMY - INTRA ORAL

PER SEXTANT AND OR RAMUS 558.30R 837.50R - - - - - -

9021

SUTURE - RECONSTRUCTION,

MINOR (EXCLUDES CLOSURE OF

SURGICAL INCISIONS) 707.90R 939.20R - - - - - -

9023

SUTURE - RECONSTRUCTION,

MAJOR (EXCLUDES CLOSURE OF

SURGICAL INCISIONS) 1 317.80R 1 976.50R - - - - - -

9024

DENTO-ALVEOLAR FRACTURE - PER

SEXTANT 626.10R 939.20R - - - - - -

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 * - - - - - - - -

9043


OPEN REDUCTION * - - - - - - - -

9045


OPEN REDUCTION (REQUIRING

OSTEOSYNTHESIS AND/OR

GRAFTING) * - - - - - - - -

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Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9046

PLACEMENT OF ZYGOMATICUS

FIXTURE, PER FIXTURE * - - - - - - - -

9047

OSTEOTOMY - OPEN WITH

STABILISATION * - - - - - - - -

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


OSTEOTOMY W/ REPOSITIONING

AND GRAFT * - - - - - - - -9061 PALATAL OSTEOTOMY * - - - - - - - -

9062


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) * - - - - - - - -

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Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9066

SURGICAL EXPANSION -

MAXILLIARY OR MANDIBULAR * - - - - - - - -

9067

DISTRACTION OSTEOGENESIS -

ACROSS ONE TO TWO TOOTH SITES - - - 13 071.50R - - - -

9068


ACROSS THREE TO FIVE TOOTH

SITES - - - 13 071.50R - - - -9069 GLOSSECTOMY - PARTIAL * - - - - - - - -

9070


FULL ARCH - - - 13 071.50R - - - -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 * - - - - - - - -

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General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9091

REDUCTION OF TMJ DISLOCATION -

OPEN REDUCTION * - - - - - - - -9092 JOINT RECONSTRUCTION * - - - - - - - -

9093

REMOVAL OF SALIVARY STONE

(SIALOLITHOTOMY) 626.10R 939.20R - - - - - -

9095

EXCISION OF SUBLINGLUAL

SALIVARY GLAND * - - - - - - - -

9096

EXCISION OF SALIVARY GLAND -

EXTRA ORAL APPROACH * - - - - - - - -

9099

UNLISTED DENTAL PROCEDURE OR

SERVICE (BY REPORT) * - - - - - - - -

9101

OBTURATOR PROSTHESIS,

SURGICAL - MODIFIED DENTURE * - - - - - - - -

9102


SURGICAL - CONTINUOUS BASE * - - - - - - - -

9103


SURGICAL - SPLIT BASE * - - - - - - - -

9104

OBTURATOR PROSTHESIS, INTERIM

- ON EXISTING DENTURE * - - - - - - - -

9105

OBTURATOR PROSTHESIS, INTERIM

- ON NEW DENTURE * - - - - - - - -

9106


DEFINITIVE - OPEN/HOLLOW BOX * - - - - - - - -

9107


DEFINITIVE - SILICONE GLOVE * - - - - - - - -

9108

MANDIBULAR RESECTION

PROSTHESIS W/ GUIDE FLANGE * - - - - - - - -

9109


PROSTHESIS W/O GUIDE FLANGE * - - - - - - - -

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Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9110


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 * - - - - - - - -9116 RADIATION SHIELD - COMPLEX * - - - - - - - -9117 RADIATION CONE LOCATOR * - - - - - - - -

9118

CHEMOTHERAPEUTIC AGENT

CARRIER * - - - - - - - -

9119

FEEDING AID PROSTHESIS,

NEONATAL * - - - - - - - -

9120

ORTHOPAEDIC APPLIANCE, ACTIVE

PRESURGICAL - MINOR * - - - - - - - -

9121


PRESURGICAL - MODERATE * - - - - - - - -

9122


PRESURGICAL - SEVERE * - - - - - - - -

9123


PRESURGICAL - MODIFICATION * - - - - - - - -

9125

SPEECH AID/OBTURATOR

PROSTHESIS - PALATAL

ALTERATION * - - - - - - - -

9126


PROSTHESIS - VELAR ALTERATION * - - - - - - - -

9127


PROSTHESIS - PHARYNGEAL

ALTERATION * - - - - - - - -

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General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9128


PROSTHESIS - MODIFICATION * - - - - - - - -

9129


PROSTHESIS - SURGICAL * - - - - - - - -

9130

SPEECH AID APPLIANCE - PALATAL

LIFT * - - - - - - - -

9131

SPEECH AID APPLIANCE - PALATAL

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

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 * - - - - - - - -

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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)

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 * - - - - - - - -

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 * 1 890.00R 1 889.90R - - - - - -

9181

SURGICAL PLACEMENT OF SUB-

PERIOSTEAL IMPLANT -

PLACEMENT STAGE * 1 890.00R 1 889.90R - - - - - -

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Dental

Practice (54)

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Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9182

SURGICAL PLACEMENT OF

ENDOSTEAL IMPLANT PLATE * 946.10R 1 419.20R - 1 419.20R - - - -

9183


ENDOSSEUS IMPLANT - FIRST PER

QUADRANT * 1 331.70R 1 810.00R - 1 810.00R - 1 809.70R - -

9184


ENDOSSEUS IMPLANT - SECOND

PER QUADRANT * 997.00R 1 357.90R - 1 357.90R - 1 357.40R - -

9185


ENDOSSEUS IMPLANT - THIRD AND

SUBSEQUENT PER QUADRANT * 667.50R 909.50R - 909.50R - - - -

9187

COST OF ENDOSTEAL IMPLANT

BODY * - - - - - - - -

9188

COST OF PREFABRICATED

ABUTMENT * - - - - - - - -

9189

COST OF OTHER IMPLANT

COMPNTS * - - - - - - - -

9190


ENDOSSEUS IMPLANT - FIRST PER

QUADRANT * 494.00R 669.20R - 669.20R - 669.20R - -

9191


ENDOSSEUS IMPLANT - SECOND

PER QUADRANT * 371.40R 503.00R - 503.00R - 503.00R - -

9192


ENDOSSEUS IMPLANT - THIRD AND

SUBSEQUENT PER QUADRANT * 248.70R 338.20R - 338.20R - 338.20R - -

9198 SURGICAL REMOVAL OF IMPLANT * 615.60R 923.50R - 923.50R - 615.70R - -

9201

CONSULTATION - ORAL

PATHOLOGIST - - - - - - - -

9203


CONSULTATION - ORAL


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Practice (54)

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Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9205

CONSULTATION - ORAL

PATHOLOGIST (SUBSEQUENT) - - - - - - - -

9207

AFTER HOURS VISIT - ORAL


9220

REPAIR CLEFT HARD PALATE -

UNILATERAL * - - - - - - - -

9222


BILATERAL (ONE PROCEDURE) * - - - - - - - -

9224


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/


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/


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Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

9254

REPAIR CLEFT LIP - BILATERAL W/O


9256

REPAIR CLEFT LIP - BILATERAL W/

MUSCLE RECONSTRUCTION * - - - - - - - -9258 REPAIR ANTERIOR NASAL FLOOR * - - - - - - - -

9260

REVISION OF SECONDARY CLEFT

LIP DEFORMITY - PARTIAL * - - - - - - - -

9262

REVISION OF SECONDARY CLEFT

LIP DEFORMITY - TOTAL W/

MUSCLE RECONSTRUCTION * - - - - - - - -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 - - - - - - - -

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General

Dental

Practice (54)

Maxillo-Facial &

Oral Surgery

(62)

Orthodontics

(64)

Periodontics

(92)

Dental

Technicians

(93)

Prostodontics

(94)

Dental

Therapists

(95)

Oral

Hygiene

(113)

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 - - - - - - - -

9294

MAXILLECTOMY - ALVEOLUS,

SINUS, NASAL FLOOR AND

ZYGOMA EXCLUDING ORBITAL RIM

LEVEL III - - - - - - - -

9296


SINUS, NASAL FLOOR AND

ZYGOMA INCLUDING ORBITAL RIM

LEVEL IV - - - - - - - -

9298


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 40.90R 40.90R 40.90R 40.90R 40.90R 40.90R - -

9303


MODEL IN SUPER-HARD STONE

(DIE-STONE) PER MODEL 58.10R 58.10R 58.10R 58.10R 58.10R 58.10R - -

9305


STUDY MODEL, PER MODEL 107.60R 107.60R 107.60R 107.60R 107.60R 107.60R - -

9307


GNATHOSTATIC MODEL, PER

MODEL. 139.90R 139.90R 139.90R 139.90R 139.90R 139.90R - -

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)

9309

NEW TRIMMED BASE TO SUPPLIED

MODEL, PER MODEL 49.50R 49.50R 49.50R 49.50R 49.50R 49.50R - -

9311

TRIMMING OF SUPPLIED MODEL,

PER MODEL 30.10R 30.10R 30.10R 30.10R 30.10R 30.10R - -

9312

GINGIVAL TISSUE MASK PER

IMPLANT 232.50R 232.50R 232.50R 232.50R 232.50R 232.50R - -

9313 DUPLICATING MODEL, PER MODEL 124.90R 124.90R 124.90R 124.90R 124.90R 124.90R - -9314 REFRACTORY MODEL, PER UNIT 122.70R 122.70R 122.70R 122.70R 122.70R 122.70R - -

9315

MODELS AND DUPLICATE MODELS

(VIRGIN MODEL) FOR CROWN AND

BRIDGE, WORK INCLUSIVE OF ONE

REMOVABLE DIE 170.10R - - 170.10R 170.10R 170.10R - -

9317

SECTIONAL MODELS FOR CROWN

AND BRIDGE, WORK INCLUSIVE OF

ONE REMOVABLE DIE 150.70R - - - 150.70R 150.70R - -

9319

EACH ADDITIONAL REMOVABLE

DIE FOR ITEMS 9315 AND 9317 PER

DIE 38.70R - - 38.70R 38.70R 38.70R - -

9320

INDEXED OR MODEL TRAY PER DIE

(NOT MORE THAN 9319) 38.70R - - - 38.70R 38.70R - -9321 OCCLUSION BLOCK, PER BLOCK 148.50R 148.50R - - 148.50R 148.50R - -

9323

OCCLUSION BLOCK ON BASEPLATE,

PER BLOCK 187.30R - - - 187.30R 187.30R - -

9327

INFECTION CONTROL PER

IMPRESSION, DENTURE (WAX OR

ACRYLIC) OR ANY ITEM IN

CONTACT WITH BODY FLUIDS 28.00R 28.00R 28.00R 28.00R 28.00R 28.00R - -

9329

FIT AND SUPPLY OF DISPOSABLE

ARTICULATOR 73.20R - 73.20R - 73.20R 73.20R - -

9330

DELIVERY / COLLECTION FEE PER

COMPLETED PROCEDURE

(MAXIMUM 4) - - - - - - - -

Trf


*Pre-

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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)

9331

FULL UPPER AND LOWER

DENTURES 1 997.70R 1 997.70R - - 1 997.70R 1 997.70R - -

9333 FULL UPPER OR LOWER DENTURE 1 168.90R - - - 1 168.90R 1 168.90R - -

9335

SET-UP AND WAXING OF FULL

UPPER AND LOWER DENTURES 688.90R - - - 688.90R 688.90R - -

9337

SET-UP AND WAXING OF FULL

UPPER OR LOWER DENTURE 460.70R - - - 460.70R 460.70R - -

9339

WAXING AND FINISHING OF FULL

UPPER AND LOWER DENTURES 1 224.90R - - - 1 224.90R 1 224.90R - -

9341

WAXING AND FINISHING OF FULL

UPPER OR LOWER DENTURE 684.60R - - - 684.60R 684.60R - -

9343

ADDITIONAL FEE FOR DENTURES

ON FULLY ADJUSTABLE

ARTICULATOR AT REQUEST OF

DENTIST 1 950.40R - - - 1 950.40R 1 950.40R - -

9345

ADDITIONAL FEE FOR IMMEDIATE

DENTURES, OR TOOTH SOCKETED 28.00R - - - 28.00R 28.00R - -

9346

ADDITIONAL FEE FOR IMMEDIATE

DENTURES, PER TOOTH NOT

SOCKETED. 15.10R - - 15.10R 15.10R 15.10R - -

9347

ADDITIONAL FEE FOR EACH RETRY

FROM THE THIRD AND UPWARDS

AT AN AGREED QUANTUM OF

TIME TO BE CALCULATED AT

HOURLY RATE 443.50R - - - 443.50R 443.50R - -

9351

SET-UP AND FINISH OF ONE-

TOOTH DENTURE 536.00R - - 536.00R 536.00R 536.00R - -

9352

SET-UP AND FINISH OF TWO-


9353

SET-UP AND FINISH OF THREE-


Trf


*Pre-

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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)

9354

SET-UP AND FINISH OF FOUR-


9355

SET-UP AND FINISH OF FIVE-TOOTH

DENTURE 697.50R - - 697.50R 697.50R 697.50R - -

9356

SET-UP AND FINISH OF SIX-TOOTH

DENTURE 833.10R - - 833.10R 833.10R 833.10R - -

9357

SET-UP AND FINISH OF SEVEN-


9358

SET-UP AND FINISH OF EIGHT-

TOOTH DENTURE 1 050.50R - - 1 050.50R 1 050.50R 1 050.50R - -

9359

SET-UP AND FINISH NINE OR MORE

TOOTH DENTURE 1 076.40R - - 1 076.40R 1 076.40R 1 076.40R - -

9361

SET-UP AND WAXING OF ONE-


9362

SET-UP AND WAXING OF TWO-


9363

SET-UP AND WAXING OF THREE-


9364

SET-UP AND WAXING OF FOUR-


9365

SET-UP AND WAXING OF FIVE-


9366

SET-UP AND WAXING OF SIX-


9367

SET-UP AND WAXING OF SEVEN-


9368

SET-UP AND WAXING OF EIGHT-


9369

SET-UP AND WAXING OF NINE OR

MORE TOOTH DENTURE 404.70R - - 404.70R 404.70R 404.70R - -

9371

WAXING AND FINISHING OF ONE-


9372

WAXING AND FINISHING OF TWO-


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)

9373

WAXING AND FINISHING OF THREE-


9374

WAXING AND FINISHING OF FOUR-


9375

WAXING AND FINISHING OF FIVE-


9376

WAXING AND FINISHING OF SIX-


9377

WAXING AND FINISHING OF SEVEN-


9378

WAXING AND FINISHING OF

EIGHTH-TOOTH DENTURE 620.00R - - 620.00R 620.00R 620.00R - -

9379

WAXING AND FINISHING OF NINE

OR MORE TOOTH DENTURE 654.40R - - 654.40R 654.40R 654.40R - -

9383

ADDITIONAL FEE FOR FINISHING

DENTURE IN TOOTH COLOUR

MATERIAL, PER TOOTH 103.30R - - 103.30R 103.30R 103.30R - -

9385

ADDITIONAL FEE FOR SUPPLYING

FINISHED DENTURE ON DUPLICATE

MODEL 195.90R - - 195.90R 195.90R 195.90R - -

9391

BASIC CHARGE WHICH INCLUDES

REPAIR OF ONE FRACTURE, OR

ADDITION OF ONE TOOTH, OR

ADDITION OF ONE CLASP 340.10R - 340.10R 340.10R 340.10R 340.10R - -

9393

ADDITIONAL CHARGE FOR EACH

ADDITIONAL FRACTURE, OR

TOOTH, OR CLASP 105.50R - 105.50R 105.50R 105.50R 105.50R - -

9395

ADDITIONAL FEE FOR USING WIRE

STRENGTHENER 120.60R - 120.60R 120.60R 120.60R 120.60R - -

9397

ADDITIONAL FEE FOR USING PRE-

FORMED STRENGTHENER 129.20R - 129.20R 129.20R 129.20R 129.20R - -

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)

9398

ADDITIONAL FEE FOR USING MESH

STRENGTHENER IN REPAIR

PROCEDURE 204.50R - - 204.50R 204.50R 204.50R - -9401 CLEAR BASE - - - - - - - -

9403

DOX GRINDING OF UPPER AND

LOWER DENTURES 191.60R - - 191.60R 191.60R 191.60R - -

9405

INLAY TO ARTIFICIAL TOOTH, ONE

SURFACE ONLY, PER INLAY - - - - - - - -

9406

INLAY TO ARTIFICIAL TOOTH,

MULTI-SURFACES E.G. HORSESHOE

OR L-TYPE INLAY, PER INLAY - - - - - - - -

9407

HEKA BASE TECHNIQUE PER UPPER

OR LOWER DENTURE 452.10R - - 452.10R 452.10R 452.10R - -9409 FREGO FRAME 195.90R - - 195.90R 195.90R 195.90R - -9410 BLEACHING TRAY - - - - - - - -

9411

TEMPLATE PER UPPER OR LOWER

DENTURE 540.30R - - 540.30R 540.30R 540.30R - -

9413

RELINE/REBASE OF SINGLE

DENTURE 680.30R - - 680.30R 680.30R 680.30R - -9415 REMODEL OF SINGLE DENTURE 1 046.20R - - 1 046.20R 1 046.20R 1 046.20R - -9417 SOFT BASE RELINE PER DENTURE 1 717.90R - - 1 717.90R 1 717.90R 1 717.90R - -

9419

SOFT BASE TO NEW DENTURE, PER

DENTURE 1 717.90R - - 1 717.90R 1 717.90R 1 717.90R - -9421 GUM TINTING PER DENTURE - - - - - - - -9423 LINGUAL OR PALATAL BAR 256.20R - 256.20R 256.20R 256.20R 256.20R - -

9425

CLEANING AND POLISHING OF

EXISTING DENTURE, PER DENTURE 208.80R - - 208.80R 208.80R 208.80R - -9427 MESH STRENGTHENER 178.70R - - 178.70R 178.70R 178.70R - -

9429

THEATRE/ CONSULTATION OUT OF

LABORATORY PER HOUR OR PART

THEREOF 443.50R 443.50R - 443.50R 443.50R 443.50R - -9431 SPECIAL TRAY, ACRYLIC, EACH 167.90R - - 167.90R 167.90R 167.90R - -9432 SPECIAL TRAY LIGHT CURE, EACH 183.00R - - 183.00R 183.00R 183.00R - -

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)

9433

SPECIAL TRAY IN BASE PLATE

MATERIAL, EACH 172.20R - - 172.20R 172.20R 172.20R - -

9435

PROVISION OF SINGLE ARM CLASP,

TO PARTIAL DENTURE 88.30R - - 88.30R 88.30R 88.30R - -

9437

PROVISION OF DOUBLE ARM

CLASP, TO PARTIAL DENTURE 152.80R - - 152.80R 152.80R 152.80R - -

9439

PROVISION OF SINGLE ARM CLASP

WITH REST, TO PARTIAL DENTURE 198.10R - - 198.10R 198.10R 198.10R - -

9441

PROVISION OF DOUBLE ARM CLASP

WITH REST, TO PARTIAL DENTURE 266.90R - - 266.90R 266.90R 266.90R - -

9443

PROVISION OF PREFORMED

ROACH CLASP, TO PARTIAL

DENTURE 114.10R - - 114.10R 114.10R 114.10R - -

9445

PROVISION OF REST ONLY TO

PARTIAL DENTURE 114.10R - - 114.10R 114.10R 114.10R - -9447 CAST CLASP 400.40R - - 400.40R 400.40R 400.40R - -

9448


MODEL FROM IMPRESSION INSIDE

OCCLUSION BLOCK OR WAX TRY IN 73.20R - - 73.20R 73.20R 73.20R - -

9450

FINISHING OF ACRYLIC WORK ON

ANY CHROME COBALT OR GOLD

PROSTHESIS 152.80R 152.80R 152.80R 152.80R 152.80R 152.80R - -

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 1 199.10R - - - 1 199.10R 1 199.10R - -

9455


ONE ARM CLASP 49.50R - - - 49.50R 49.50R - -

Trf


*Pre-

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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)

9457


ROACH CLASP 83.90R - - - 83.90R 83.90R - -

9459


REST 45.20R - - - 45.20R 45.20R - -

9461

ADDITIONAL CHARGE FOR

CONTINUOUS CLASP, PER TOOTH 49.50R - - - 49.50R 49.50R - -

9463

ADDITIONAL CHARGE FOR LINGUAL

BAR, PER TOOTH PASSED 116.20R - - - 116.20R 116.20R - -

9465

ADDITIONAL CHARGE FOR PALATAL

BAR 185.10R - - - 185.10R 185.10R - -

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

9469

ADDITIONAL CHARGE FOR SADDLE

WITH FINISHING LINE, PER TOOTH 81.80R - - - 81.80R 81.80R - -

9471

ADDITIONAL CHARGE FOR SADDLE

WITHOUT FINISHING LINE, PER

TOOTH 47.40R - - - 47.40R 47.40R - -

9473


HORSESHOE SADDLE, PER TOOTH 81.80R - - - 81.80R 81.80R - -

9475

ADDITIONAL CHARGE FOR FITTING

OF TOOTH TO METAL BACKING,

PER TOOTH 56.00R - - - 56.00R 56.00R - -

9479


ONE DISTAL-EXTENSION HINGE 165.80R - - - 165.80R 165.80R - -

9480

ADDITIONAL CHARGE PER MILLED

EDGE PER TOOTH 144.20R - - - 144.20R 144.20R - -

9481


SOLDERING JOINT 202.40R - - - 202.40R 202.40R - -

9483


SOLDERING RETENTION 245.40R - - - 245.40R 245.40R - -

Trf


*Pre-

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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)

9485


ADDITIONAL RETENTION

SOLDERING JOINT 75.30R - - - 75.30R 75.30R - -

9487


WELDING JOINT 247.60R - - - 247.60R 247.60R - -

9489


SWING LOCK 202.40R - - - 202.40R 202.40R - -

9491


BACKING CAST 198.10R - - - 198.10R 198.10R - -

9493


STEELS BACKING OR PONTIC CAST

(PLASTIC WORK TO BE CHARGED IN

ADDITION) 215.30R - - - 215.30R 215.30R - -

9495

BASIC FEE FOR THE REPAIRING OF

OR ADDITION TO ANY APPLIANCE

NECESSITATING THE CASTING OF A

MODEL (9301) 312.10R - - - 312.10R 312.10R - -

9497

BASIC FEE IF A NEW SECTION IS TO

BE FABRICATED AND WHERE ITEM

9495 DOES NOT APPLY (9301) 355.20R - - - 355.20R 355.20R - -

9501

CERAMIC JACKET

CROWN/CEROMER CROWN OR

PONTIC * 1 362.70R - - - 1 362.70R 1 362.70R - -

9502

CERAMIC METAL SUBSTITUTE

COPING * 1 100.00R - - - 1 100.00R 1 100.00R - -

9505

CERAMIC BONDED CROWN OR

PONTIC * 1 799.70R - - 1 697.90R 1 799.70R 1 799.70R - -

9507

POST-SOLDER INVESTED JOINT,

PER JOINT 368.10R - - - 368.10R 368.10R - -

9511

INLAY IN PORCELAIN VENEER

CROWN - - - - - - - -

9512

CERAMIC, INLAY/ONLAY, BRIDGE

RETAINER * 1 397.10R - - - 1 397.10R 1 397.10R - -9513 CERAMIC POST * - - - - - - - -

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)

9515

PORCELAIN SHOULDER PER UNIT

(NOT APPLICABLE TO PONTICS) 120.60R - - 120.60R 120.60R 120.60R - -

9520

ADDITIONAL FEE FOR CROWN- &

BRIDGE WORK PERFORMED ON A

MOVABLE CONDYLE ARTICULATOR

PER UNIT 58.10R - - - 58.10R 58.10R - -

9521

FULL METAL CROWN, MOD, THREE-

QUARTER CROWN * 1 113.00R - - - 1 113.00R 1 113.00R - -

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

9525

CLASS IV, MO, DO,

CERVICAL/OCCLUSAL INLAY * 917.10R - - - 917.10R 917.10R - -

9526

ADDITIONAL FEE FOR ONE PIECE

CASTING OF CROWN OR INLAY ON

POST 279.80R - - - 279.80R 279.80R - -9531 PIN-LEDGE INLAY - - - - - - - -9533 FULL METAL PONTIC * 822.30R - - - 822.30R 822.30R - -9535 ABUTMENT THIMBLE CAST 770.70R - - - 770.70R 770.70R - -9537 PRECISION LOCK AND REST CAST - - - - - - - -9538 LOCK AND REST CAST - - - - - - - -9539 CASTING OF REST ONLY 312.10R - - - 312.10R 312.10R - -

9541

METAL INLAY OR POST, CAST

DIRECT - - - - - - - -

9543

GOLD/PRE-SOLDER INVESTED

JOINT - - - - - - - -

9545

CAST POST WITH THIMBLE,

INDIRECT * 548.90R - - - 548.90R 548.90R - -9546 MULTIPLE POST * 908.40R - - - 908.40R 908.40R - -

9547

MANUFACTURE CAST POST AND

CORE TO EXISTING CROWN * 716.80R - - - 716.80R 716.80R - -9549 C.S.P. ATTACHMENT (STEIGER) - - - - - - - -9550 MILLING MILLED EDGE PER UNIT 770.70R - - - 770.70R 770.70R - -9551 TELESCOPE CROWN - - - - - - - -

9553

COMPOSITE/ACRYLIC VENEER

CROWN/PONTIC, INDIRECT * 1 517.70R - - - 1 517.70R 1 517.70R - -

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)

9557

COMPOSITE/ACRYLIC JACKET

CROWN, INDIRECT * 1 072.10R - - - 1 072.10R 1 072.10R - -

9559

COMPOSITE/ACRYLIC VENEER POST

CROWN * 1 500.40R - - - 1 500.40R 1 500.40R - -

9560

INDIRECT COMPOSITE RESIN

VENEER - - - - - - - -

9561

COMPOSITE/ACRYLIC JACKET

CROWN, DIRECT * 731.90R - - - 731.90R 731.90R - -

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 609.20R - - - 609.20R 609.20R - -

9566

PORCELAIN/ CEROMER FACING

REPLACED 1 104.30R - - - 1 104.30R 1 104.30R - -

9569

WAXING OF CROWN TO EXISTING

DENTURE 430.50R - - - 430.50R 430.50R - -

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 544.60R 544.60R 544.60R 544.60R 544.60R 544.60R - -

9572 BASIC CHARGE NON ACRYLIC BASE 262.60R - 262.60R - 262.60R - - -

9573


FIRST EXPANSION SCREW 103.30R - 103.30R - 103.30R - - -

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)

9575

ADDITIONAL FEE FOR FITTING

SUBSEQUENT EXPANSION SCREWS 88.30R - 88.30R - 88.30R - - -

9576

ADDITIONAL FEE FOR FULL

ACLUSAL BITE PLATE 305.70R 305.70R 305.70R 305.70R 305.70R 305.70R - -

9577

ADDITIONAL FEE FOR BITE PLATE

ANTERIOR 103.30R 103.30R 103.30R - 103.30R 103.30R - -

9578

ADDITIONAL FEE FOR BITE PLATE

POSTERIOR 103.30R 103.30R 103.30R - 103.30R 103.30R - -

9579


TONGUE GUARD 129.20R - 129.20R - 129.20R - - -

9581

ADDITIONAL FEE FOR FLAT OR

INCLINED PLANE 79.70R - 79.70R - 79.70R - - -

9583 ADDITIONAL FEE FOR ADAMS CRIB 94.70R - 94.70R - 94.70R - - -

9585

ADDITIONAL FEE FOR JACKSON

CRIB 99.00R - 99.00R - 99.00R - - -

9587 ADDITIONAL FEE FOR BALL CLASP 111.90R 111.90R 111.90R 111.90R 111.90R - - -

9589

ADDITIONAL FEE FOR SINGLE ARM

CLASP 86.10R - 86.10R - 86.10R - - -

9591

ADDITIONAL FEE FOR DOUBLE

ARM CLASP 150.70R - 150.70R - 150.70R - - -

9593


SINGLE LOOP FINGER SPRING 71.00R - 71.00R - 71.00R - - -

9595


DOUBLE LOOP FINGER SPRING 83.90R - 83.90R - 83.90R - - -

9597


BUCCAL RETRACTION SPRING 62.40R - 62.40R - 62.40R - - -

9599


APRON SPRING 161.40R - 161.40R - 161.40R - - -

9603


COFFIN SPRING 155.00R - 155.00R - 155.00R - - -

9605


QUAD HELIX 172.20R - 172.20R - 172.20R - - -

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*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)

9607


FLAPPER OR “T”-SPRING 129.20R - 129.20R - 129.20R - - -

9609

ADDITIONAL FEE FOR FITTING ALL

SPRINGS WITH TUBING, EACH 144.20R - 144.20R - 144.20R - - -

9611


LABIAL ARCH 81.80R - 81.80R - 81.80R - - -

9613


BUCCAL ARCH 96.90R - 96.90R - 96.90R - - -

9615


ROBERTS RETRACTOR 180.80R - 180.80R - 180.80R - - -9617 INVISIBLE RETAINER - - - - - - - -

9619


TWIN WIRE ARCH EXTRA-ORAL

ARCH 226.00R - 226.00R - 226.00R - - -9620 ADDITIONAL FEE LIP BUMPER 94.70R - 94.70R - 94.70R - - -

9621


EXTRA-ORAL ARCH 215.30R - 215.30R - 215.30R - - -

9622


SPACE MAINTAINER ARCH 94.70R - 94.70R - 94.70R - - -

9623

ADDITIONAL FEE FOR EACH SPOT-

WELDING JOINT 43.10R - 43.10R - 43.10R - - -

9625


SOLDERING JOINT 68.90R - 68.90R - 68.90R - - -

9627


INVESTED SOLDERING JOINT 191.60R - 191.60R - 191.60R - - -

9629

ADDITIONAL FEE FOR EACH HOOK

FOR ELASTIC TRACTION 62.40R - 62.40R - 62.40R - - -

9631

MOUTH PROTECTOR (GUM

GUARD) - - - - - - - -9633 ORAL SCREEN 497.30R 497.30R 497.30R 497.30R 497.30R 497.30R - -

9635

ANDRESEN OR NORWEGIAN

APPLIANCE 889.10R 889.10R 889.10R 889.10R 889.10R 889.10R - -9637 TOOTH POSITIONER 1 024.70R - 1 024.70R 1 024.70R 1 024.70R 1 024.70R - -9639 GUNNING SPLINT 1 364.80R 1 364.80R 1 364.80R 1 364.80R 1 364.80R 1 364.80R - -

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*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)

9641 FRANKEL APPLIANCE 1 317.50R - 1 317.50R - 1 317.50R - - -9643 CHIN CAP 437.00R - 437.00R - 437.00R - - -9645 BIONATOR 891.20R - 891.20R - 891.20R - - -9646 DIAGNOSTIC SET-UP - - - - - - - -9647 SNORING APPLIANCE - - - - - - - -

9651

PINCHED OR SWAGED BAND WITH

WELDED ATTACHMENT

(EXCLUDING COST OF

ATTACHMENT) 262.60R - 262.60R - 262.60R - - -

9653

PINCHED OR SWAGED BAND WITH

SOLDERED ATTACHMENT 344.40R - 344.40R - 344.40R - - -

9662


REMAKE AT AN AGREED

QUANTUM OF TIME TO BE

CALCULATED AT AN HOURLY RATE - - - - - - - -9700 DIATORICS 1 X 6/8 215.50R 215.50R - 215.50R 215.50R 215.50R - -9702 DIATORICS, ODDS, ANTERIOR 73.30R - - 73.30R 73.30R 73.30R - -9704 DIATORICS, ODDS, POSTERIOR 73.30R - - 73.30R 73.30R 73.30R - -

9706

COST OF BLEACHING TRAY

MATERIAL - - - - - - - -

9720

SOFT BASE MATERIAL PER

DENTURE 779.30R - - 779.30R 779.30R 779.30R - -9722 ACRYLIC PER DENTURE 88.20R 88.20R 88.20R 88.20R 88.20R 88.20R - -

9724

COST OF PRECISION ATTACHMENT,

PER ATTACHMENT - - - - - - - -

9726

PREFORMED BALL OR ROACH

CLASP 15.20R 15.20R 15.20R 15.20R 15.20R 15.20R - -

9728 COST OF LINGUAL / PALATAL BAR 176.40R - - - 176.40R 176.40R - -9729 COST OF MESH STRENGTHENER 92.60R - - - 92.60R 92.60R - -

9730

COST OF PRE-FABRICATED BURN-

OUT COMPONENT, PER

COMPONENT 91.60R - - - 91.60R 91.60R - -

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)

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 * - - - - - - - -

9738

COST OF PREFORMED

STRENGTHENER 92.60R - - - 92.60R 92.60R - -

9739

ADDITIONAL CHARGE GOLD

PLATING - - - - - - - -

9740 COST OF GOLD WIRE, PER GRAM - - - - - - - -

9741

COST OF COBALT CHROME

CASTING ALLOY 146.30R - - - 146.30R 146.30R - -

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 * 165.70R - - 165.70R - 165.70R - -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 54.00R - - - 54.00R 54.00R - -9757 CEROMER MATERIAL - PER UNIT 1 100.10R - - - 1 100.00R 1 100.10R - -

9758

FIBER RE-ENFORCED MATERIAL

PER UNIT 362.40R - 362.40R 362.40R 362.40R 362.40R - -9759 FIBRE POST * - - - - - - - -

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)

9760

COMPOSITE RESTORATION

MATERIAL - - - - - - - -9761 CERAMIC MATERIAL - - - - - - - -

9762

COST OF ANTERIOR ORTHODONTIC

ATTACHMENT, PER ATTACHMENT 32.10R - 32.10R - 32.10R - - -9763 ORTHODONTIC MATERIAL 32.10R 32.10R 32.10R - 32.10R - - -

9764

COST OF POSTERIOR

ORTHODONTIC ATTACHMENT, PER

ATTACHMENT 32.10R - 32.10R - 32.10R - - -9765 PREFORMED COMPONENTS 17.20R - 17.20R - 17.20R 17.20R - -

9766

COST OF EXPANSION SCREW, PER

SCREW 36.60R - 36.60R - 36.60R - - -9767 SOLDERING MATERIAL 8.59R - 8.59R - 8.59R 8.59R - -

9768

COST OF BUCCAL TUBE/TRANSFER

TUBE, PER TUBE - - - - - - - -9770 COST OF J-HOOK, PER HOOK 34.40R - 34.40R - 34.40R - - -

9772

COST OF LINGUAL BUTTONS, PER

BUTTON 34.40R - 34.40R - 34.40R 34.40R - -

9774

COST OF INVISIBLE RETAINER

MATERIAL - - - - - - - -9775 R/A CASE - - - - - - - -

9776

COST OF MOUTH PROTECTOR

MATERIAL - - - - - - - -9778 COST OF ARCH WIRE 8.59R - 8.59R - 8.59R - - -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 - - - - - - - -

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)

9784

ALIGNMENT OF DOLDER BAR AND

CLIPS * - - - - - - - -

9786

TRIMMING, WAXING AND

FINISHING OF IMPLANT

ABUTMENT - CROWN AND BRIDGE

WORK ONLY, PER ABUTMENT 307.80R - - 307.80R 307.80R 307.80R - -

9787

WAXING, MILLING AND FINISHING

OF A CUSTOM ABUTMENT 600.60R - - - 600.60R 600.60R - -

9788

IMPLANT SUPERSTRUCTURE

(EDENTULOUS CASES) INCLUDING

PLACING OF PREFORMED PARTS,

PER SECTION CAST - - - - - - - -

9789

FINISHING OF PROSTHESIS ON

IMPLANT STRUCTURE PER ARCH 1 199.10R - - - 1 199.10R 1 199.10R - -

Documents

DENIS 2020 Rates · Dental Practice (54) Maxillo-Facial & Oral Surgery (62) Orthodontics (64) Periodontics (92) Dental Technicians (93) Prostodontics (94) Dental Therapists (95) Oral