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Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8025
HANDLING FEE - DIRECT MATERIALS (26% OF MATERIAL
COST TO A MAXIMUM OF R26.00) 42.01R 42.01R 42.01R - 42.01R
8101 ORAL EXAMINATION 233.77R 233.77R 233.77R - 233.77R
8102 COMPREHENSIVE ORAL EXAMINATION 377.66R 377.66R 377.66R - 377.66R
8104 LIMITED ORAL EXAMINATION 113.38R 113.38R 113.38R - 113.38R
8106 SPECIAL REPORT 240.04R 240.04R 240.04R - 240.04R
8107 INTRAORAL RADIOGRAPH - PERIAPICAL 94.68R 94.68R 94.68R - 94.68R
8108 INTRAORAL RADIOGRAPHS - COMPLETE SERIES 732.55R 732.55R 732.55R - 732.55R
8109 INFECTION CONTROL/BARRIER TECHNIQUES 21.00R 21.00R 21.00R - 21.00R
8110 STERILIZED INSTRUMENTATION 54.34R 54.34R 54.34R - 54.34R
8112 INTRAORAL RADIOGRAPH - BITEWING 94.68R 94.68R 94.68R - 94.68R
8113 INTRAORAL RADIOGRAPH - OCCLUSAL 163.02R 163.02R 163.02R - 163.02R
8114 EXTRAORAL RADIOGRAPH - HAND-WRIST 378.29R 378.29R 378.29R - 378.29R
8115 EXTRAORAL RADIOGRAPH - PANORAMIC 378.29R 378.29R 378.29R - 378.29R
8116 EXTRAORAL RADIOGRAPH - CEPHALOMETRIC 378.29R 378.29R 378.29R - 378.29R
8117 DIAGNOSTIC MODELS 101.68R 101.68R 101.68R - 101.68R
8118 EXTRAORAL RADIOGRAPH - SKULL/FACIAL BONE 378.29R 378.29R 378.29R - 378.29R
8119 DIAGNOSTIC MODELS MOUNTED 255.71R 255.71R 255.71R - 255.71R
8120 TREATMENT PLAN COMPLETED - - - - -
8121 ORAL AND/OR FACIAL IMAGE (DIGITAL/CONVENTIONAL) 101.68R 101.68R 101.68R - 101.68R
8123 CARIES SUSCEPTIBILITY TESTS (BY ARRANGEMENT) - - - - -
8124 PULP TESTS - - - - -
Pre-authorisation is required for the dental code to attract benefit
Tariff amount not applicable
MEDSHIELD 2020 DENTAL TARIFFS - SPECIALISTS & DENTAL TECHNICIANS
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.
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8129
OFFICE/HOSPITAL VISIT – AFTER REGULARLY SCHEDULED
HOURS 352.17R - 352.17R - 352.17R
8131 EMERGENCY DENTAL TREATMENT 143.58R 143.58R 143.58R - 292.60R
8132 PULP REMOVAL (PULPECTOMY) 234.81R - - - 312.25R
8133 RECEMENT INLAY, ONLAY, CROWN OR VENEER 143.58R - - - 182.14R
8135 REMOVE INLAY, ONLAY OR CROWN 285.60R - - - 285.60R
8136
ACCESS THROUGH A PROSTHETIC CROWN OR INLAY TO
FACILITATE ROOT CANAL TREATMENT 127.80R - 127.80R - 127.80R
8137 EMERGENCY CROWN (CHAIR-SIDE) 492.30R - - - 492.30R
8138 REMOVE RETENTION POST (PREFABRICATED OR CAST) 187.47R - - - 187.47R
8139 APPOINTMENT NOT KEPT /30MIN - - - - -
8140 HOUSE/EXTENDED CARE FACILITY/HOSPITAL CALL * 233.04R - 233.04R - 233.04R
8141
INHALATION SEDATION - FIRST 15 MINUTES OR PART
THEREOF 105.23R - 105.23R - 105.23R
8143 INHALATION SEDATION - EACH ADDNL 15 MINUTES 54.34R - 54.34R - 54.34R
8144 INTRAVENOUS SEDATION * 63.01R - 63.01R - 63.01R
8145 LOCAL ANAESTHETIC - PER VISIT 91.23R 91.23R 91.23R - 91.23R
8146 RESIN BONDING FOR RESTORATIONS - - - - -
8147 MONITORING EQUIPMENT FOR INTRAVENOUS SEDATION 224.36R - 224.36R - 224.36R
8151 ORAL HYGIENE INSTRUCTION - - 287.38R - 287.38R
8153 ORAL HYGIENE INSTRUCTION - EACH ADDITIONAL VISIT - - 138.36R - 138.36R
8154 ORAL EXAMINATION - ORAL HYGIENIST - - - - -
8155 POLISHING - COMPLETE DENTITION 143.58R - 197.92R - 143.58R
8157
RE-BURNISHING AND POLISHING OF RESTORATIONS -
COMPLETE DENTITION - - - - -
8158 ENAMEL MICROABRASION - - - - -
8159 PROPHYLAXIS - COMPLETE DENTITION 282.15R - 397.83R - 282.15R
8160 REMOVAL OF GROSS CALCULUS - - - - -
8161 TOPICAL APPLICATION OF FLUORIDE - CHILD 143.58R - 143.58R - 143.58R
8162 TOPICAL APPLICATION OF FLUORIDE - ADULT - - 143.58R - 143.58R
8163 DENTAL SEALANT 94.68R - 94.68R - 94.68R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8164 LIMITED ORAL EXAMINATION - ORAL HYGIENIST - - - - -
8165 SEDATIVE FILLING 143.58R - 143.58R - 143.58R
8166 APPLICATION OF DESENSITISING RESIN, PER TOOTH 94.68R - 94.68R - 94.68R
8167 APPLICATION OF DESENSITISING MEDICAMENT, PER VISIT 110.46R - 110.46R - 110.46R
8169 OCCLUSAL GUARD 551.86R 551.86R 551.86R - 551.86R
8171 MOUTH PROTECTOR 166.99R 166.99R 166.99R - 166.99R
8172 COST OF ORTHOTIC APPLIANCE * * * * - *
8173 SPACE MAINTAINER - FIXED, PER ABUTMENT 266.48R 266.48R 266.48R - 266.48R
8175 SPACE MAINTAINER - REMOVABLE 343.49R 343.49R 343.49R - 343.49R
8176 PERIODONTAL SCREENING 185.80R - 196.98R - 196.98R
8177
ORAL HYGIENE INSTRUCTION (PERIODONTALLY
COMPROMISED PATIENT) - - - - -
8178
ORAL HYGIENE INSTRUCTION - EACH ADDITIONAL VISIT
(PERIODONTALLY COMPROMISED PATIENT) - - - - -
8179
POLISHING - COMPLETE DENTITION (PERIODONTALLY
COMPROMISED PATIENT) 164.80R - 164.80R - 164.80R
8180
PROPHYLAXIS - COMPLETE DENTITION (PERIODONTALLY
COMPROMISED PATIENT) * 306.60R - 306.60R - -
8183 THERAPEUTIC DRUG INJECTION - - - - -
8189 RE-EXAMINATION - EXISTING CONDITION - - - - -
8190 CONSULTATION - SECOND OPINION OR ADVICE 233.77R 233.77R 233.77R - 233.77R
8192 SUTURE - MINOR 707.88R - 707.88R - 707.88R
8194
CBCT CAPTURE AND INTERPRETATION WITH LIMITED FIELD
OF VIEW - LESS THAN ONE WHOLE JAW 378.39R 378.39R 378.39R 378.39R
8195
CBCT CAPTURE AND INTERPRETATION WITH LIMITED FIELD
OF VIEW OF ONE FULL ARCH - MANDIBLE 378.39R 378.39R 378.39R 378.39R
8196
CBCT CAPTURE AND INTERPRETATION WITH LIMITED FIELD
OF VIEW OF ONE FULL ARCH - MAXILLA WITHOUT ORBITS
AND/OR CRANIUM 378.39R 378.39R 378.39R 378.39R
8197
CBCT CAPTURE AND INTERPRETATION WITH LIMITED FIELD
OF VIEW OF BOTH DENTAL ARCHES - WITHOUT ORBITS
AND/OR CRANIUM 378.39R 378.39R 378.39R 378.39R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8198
CBCT CAPTURE AND INTERPRETATION FOR TMJ SERIES
INCLUDING TWO OR MORE EXPOSURES 378.39R 378.39R 378.39R 378.39R
8199
CBCT CAPTURE AND INTERPRETATION WITH LIMITED FIELD
OF VIEW OF ONE FULL ARCH - MAXILLA WITH ORBITS
AND/OR CRANIUM 378.39R 378.39R 378.39R 378.39R
8200
CBCT CAPTURE AND INTERPRETATION WITH FIELD OF VIEW
OF BOTH DENTAL ARCHES - WITH ORBITS AND/OR
CRANIUM 378.39R 378.39R 378.39R 378.39R
8201
EXTRACTION - TOOTH OR EXPOSED TOOTH ROOTS (FIRST
PER QUADRANT) 215.37R 143.58R 143.58R - 143.58R
8202
EXTRACTION - EACH ADDITIONAL TOOTH OR EXPOSED
TOOTH ROOTS 86.74R 57.79R 57.79R - 57.79R
8213
SURGICAL REMOVAL OF RESIDUAL ROOTS, FIRST TOOTH
PER QUADRANT 620.31R - 620.31R - 620.31R
8214
SURGICAL REMOVAL OF RESIDUAL ROOTS, SECOND AND
SUBSEQUENT TEETH''S ROOTS 478.30R - 478.30R - 478.30R
8220 COST OF SUTURE MATERIAL 224.99R - 224.99R - 224.99R
8228 ART RESTORATIONS - - - - -
8231 COMPLETE DENTURES - MAXILLARY AND MANDIBULAR * - - 2 316.35R - 4 835.95R
8232 COMPLETE DENTURE - MAXILLARY OR MANDIBULAR * - - 1 427.99R - 3 383.40R
8233 PARTIAL DENTURE - RESIN BASE - ONE TOOTH * - - 663.99R - 663.99R
8234 PARTIAL DENTURE - RESIN BASE - TWO TEETH * - - 663.99R - 663.99R
8235 PARTIAL DENTURE - RESIN BASE - THREE TEETH * - - 993.48R - 993.48R
8236 PARTIAL DENTURE - RESIN BASE - FOUR TEETH * - - 993.48R - 993.48R
8237 PARTIAL DENTURE - RESIN BASE - FIVE TEETH * - - 993.48R - 993.48R
8238 PARTIAL DENTURE - RESIN BASE - SIX TEETH * - - 1 317.75R - 1 317.75R
8239 PARTIAL DENTURE - RESIN BASE - SEVEN TEETH * - - 1 317.75R - 1 317.75R
8240 PARTIAL DENTURE - RESIN BASE - EIGHT TEETH * - - 1 317.75R - 1 317.75R
8241 PARTIAL DENTURE - RESIN BASE - NINE OR MORE TEETH * - - 1 317.75R - 1 317.75R
8244 IMMEDIATE DENTURE - MAXILLARY * - - 1 427.99R - 2 142.04R
8245 IMMEDIATE DENTURE - MANDIBULAR * - - 1 427.99R - 2 142.04R
8251 CLASP OR REST - CAST GOLD - - - - -
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8253 CLASP OR REST - WROUGHT GOLD - - - - -
8255 CLASP OR REST - STAINLESS STEEL - - - - -
8257 BAR - LINGUAL OR PALATAL - - - - -
8259 REBASE COMPLETE OR PARTIAL DENTURE (LABORATORY) - - 541.31R - 781.35R
8261 REMODEL COMPLETE OR PARTIAL DENTURE - - 869.13R - 869.13R
8263 RELINE COMPLETE OR PARTIAL DENTURE (CHAIR-SIDE) - - 343.49R - 429.18R
8265
TISSUES CONDITIONING PER ARCH (INCLUDING SOFT SELF-
CURE RELINE) 224.36R - 224.36R - 287.38R
8267 RELINE COMPLETE OR PARTIAL DENTURE (LABORATORY) - - 790.33R - 790.33R
8269 REPAIR DENTURE OR OTHER INTRA-ORAL APPLIANCE - - - - 196.15R
8270 ADD CLASP TO EXISTING PARTIAL DENTURE - - - - -
8271 ADD TOOTH TO EXISTING PARTIAL DENTURE - - - - -
8273
IMPRESSION TO REPAIR OR MODIFY A DENTURE OR OTHER
INTRA-ORAL APPLIANCE - - 105.23R - 105.23R
8275 ADJUST COMPLETE OR PARTIAL DENTURE - - 105.23R - 105.23R
8277 INLAY IN DENTURE - - - - 860.24R
8281 PARTIAL DENTURE - CAST METAL FRAMEWORK ONLY * - - 1 549.00R - 1 549.00R
8301 PULP CAP - DIRECT - - - - -
8303 PULP CAP - INDIRECT - - - - -
8304 RUBBER DAM PER ARCH 112.13R - 112.13R - 112.13R
8306 COST OF MTA - - - - -
8307 PULP AMPUTATION (PULPOTOMY) 187.47R - 187.47R - 187.47R
8310 SUPPLY OF BLEACHING MATERIALS - - - - -
8325 INTERNAL BLEACHING - PER TOOTH - - - - 509.96R
8327 INTERNAL BLEACHING - EACH ADDITIONAL VISIT - - - - 244.53R
8328
ROOT CANAL OBTURATION - ANTERIORS AND PREMOLARS -
EACH ADDITIONAL CANAL 266.48R - - - 354.36R
8329
ROOT CANAL THERAPY - ANTERIORS AND PREMOLARS -
EACH ADDITIONAL CANAL 332.94R - - - 442.77R
8330 REMOVAL OF ROOT CANAL OBSTRUCTION 187.47R - 187.47R - 187.47R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8332 ROOT CANAL PREPARATORY VISIT - SINGLE CANAL TOOTH 143.58R - - - 190.82R
8333 ROOT CANAL PREPARATORY VISIT - MULTI CANAL TOOTH 201.37R - - - 201.37R
8334
RE-TREATMENT OF PREVIOUSLY COMPLETED ROOT CANAL
THERAPY, PER CANAL 212.14R - 212.14R - 255.71R
8335
ROOT CANAL OBTURATION - ANTERIORS AND PREMOLARS -
FIRST CANAL 651.77R - - - -
8336 ROOT CANAL OBTURATION - POSTERIORS - FIRST CANAL 897.03R - - - -
8337
ROOT CANAL OBTURATION - POSTERIORS - EACH
ADDITIONAL CANAL 266.48R - - - -
8338
ROOT CANAL THERAPY - ANTERIORS AND PREMOLARS -
FIRST CANAL 996.93R - - - -
8339 ROOT CANAL THERAPY - POSTERIORS - FIRST CANAL 1 370.10R - - - -
8340
ROOT CANAL THERAPY - POSTERIORS - EACH ADDITIONAL
CANAL 332.94R - - - -
8341 AMALGAM - ONE SURFACE 285.60R - 285.60R - 285.60R
8342 AMALGAM - TWO SURFACES 352.17R - 352.17R - 352.17R
8343 AMALGAM - THREE SURFACES 429.18R - 429.18R - 429.18R
8344 AMALGAM - FOUR OR MORE SURFACES 478.30R - 478.30R - 478.30R
8345
PREFABRICATED POST RETENTION, PER POST (IN ADDITION
TO RESTORATION) 282.15R - 282.15R - 282.15R
8347
PIN RETENTION - FIRST PIN (IN ADDITION TO
RESTORATION) 141.81R - 141.81R - 141.81R
8348
PIN RETENTION - EACH ADDITIONAL PIN (IN ADDITION TO
RESTORATION) 131.36R - 131.36R - 131.36R
8349
CARVE RESTORATION TO ACCOMMODATE EXISTING
REMOVABLE PROSTHESIS - - - - -
8350 RESIN CROWN - ANTERIOR PRIMARY TOOTH (DIRECT) 623.13R - 623.13R - 623.13R
8351 RESIN - ONE SURFACE, ANTERIOR 313.50R - 313.50R - 313.50R
8352 RESIN - TWO SURFACES, ANTERIOR 394.28R - 394.28R - 394.28R
8353 RESIN - THREE SURFACES, ANTERIOR 471.30R - 471.30R - 471.30R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8354 RESIN - FOUR OR MORE SURFACES, ANTERIOR 525.64R - 525.64R - 525.64R
8355 VENEER - RESIN (CHAIR-SIDE) 497.73R - 497.73R - 497.73R
8357 PREFABRICATED METAL CROWN 292.60R - 292.60R - 292.60R
8361 INLAY - METAL - ONE SURFACE - - - - 860.35R
8362 INLAY/ONLAY - METAL - TWO SURFACES - - - - 1 247.42R
8363 INLAY/ONLAY - METAL - THREE SURFACES - - - - 1 934.30R
8364 INLAY/ONLAY - METAL - FOUR OR MORE SURFACES - - - - 1 934.30R
8366
PIN RETENTION AS PART OF CAST RESTORATION (ANY
NUMBER OF PINS) - - - - 287.38R
8367 RESIN - ONE SURFACE, POSTERIOR 339.94R - 339.94R - 339.94R
8368 RESIN - TWO SURFACES, POSTERIOR 420.51R - 420.51R - 420.51R
8369 RESIN - THREE SURFACES, POSTERIOR 508.18R - 508.18R - 508.18R
8370 RESIN - FOUR OR MORE SURFACES, POSTERIOR 546.54R - 546.54R - 546.54R
8371 INLAY - PORCELAIN - ONE SURFACE - - - - 1 039.04R
8372 INLAY/ONLAY - PORCELAIN - TWO SURFACES - - - - 1 496.44R
8373 INLAY/ONLAY - PORCELAIN - THREE SURFACES - - - - 2 325.13R
8374 INLAY/ONLAY - PORCELAIN - FOUR OR MORE SURFACES - - - - 2 325.13R
8375 PREFABRICATED RESIN CROWN 292.60R - 292.60R - 292.60R
8376 CORE BUILD-UP WITH PREFABRICATED POSTS - - - - 781.35R
8379 COST OF PREFABRICATED POSTS - - - - 108.78R
8381 INLAY - RESIN - ONE SURFACE - - - - 1 039.04R
8382 INLAY/ONLAY - RESIN - TWO SURFACES - - - - 1 496.44R
8383 INLAY/ONLAY - RESIN - THREE SURFACES - - - - 2 325.13R
8384 INLAY/ONLAY - RESIN - FOUR OR MORE SURFACES - - - - 2 325.13R
8391 CAST CORE WITH SINGLE POST * - - - - 329.49R
8392 CAST POST (EACH ADDITIONAL) - - - - 196.15R
8397 CAST CORE WITH PINS (ANY NUMBER OF PINS) * - - - - 683.43R
8398 CORE BUILD-UP WITH PINS - - - - 637.76R
8401 CROWN - FULL CAST METAL * - - - - 2 414.37R
8403 CROWN - 3/4 CAST METAL * - - - - 2 414.37R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8404 CROWN - 3/4 PORCELAIN/CERAMIC * - - - - 2 325.13R
8405 CROWN - RESIN LABORATORY * - - - - 2 325.13R
8407 CROWN - RESIN WITH METAL * - - - - 2 414.37R
8409 CROWN - PORCELAIN/CERAMIC * - - - - 2 414.37R
8410 PROVISIONAL CROWN - - 318.73R - 478.30R
8411 CROWN - PORCELAIN VENEERED TO METAL * - - - - 2 414.37R
8413 REPAIR CROWN (PERMANENT OR PROVISIONAL) 318.73R - - - 318.73R
8414
ADDITIONAL FEE FOR PROVISION OF CROWN WITHIN AN
EXISTING CLASP OR REST - - - - 94.68R
8415 PONTIC - CERAMIC * - - - - 1 338.54R
8416 PONTIC - CAST METAL * - - - - 1 063.60R
8417 PONTIC - RESIN WITH METAL * - - - - 1 338.54R
8418 PONTIC - PORCELAIN VENEERED TO METAL * - - - - 1 338.54R
8419 PROVISIONAL PONTIC - - - - 478.30R
8432 INLAY/ONLAY RETAINER - METAL - TWO SURFACES * - - - - 1 247.42R
8433 INLAY/ONLAY RETAINER - METAL - THREE SURFACES * - - - - 1 934.30R
8434
INLAY/ONLAY RETAINER - METAL - FOUR OR MORE
SURFACES * - - - - 1 934.30R
8436 INLAY/ONLAY RETAINER - PORCELAIN - TWO SURFACES * - - - - 1 496.44R
8437 INLAY/ONLAY RETAINER - PORCELAIN - THREE SURFACES * - - - - 2 325.13R
8438
INLAY/ONLAY RETAINER - PORCELAIN - FOUR OR MORE
SURFACES * - - - - 2 325.13R
8441 CROWN RETAINER - FULL CAST METAL * - - - - 2 414.37R
8442 CROWN RETAINER - 3/4 CAST METAL * - - - - 2 414.37R
8443 CROWN RETAINER - CERAMIC * - - - - 2 414.37R
8444 CROWN RETAINER - 3/4 CERAMIC * - - - - 2 414.37R
8445 CROWN RETAINER - PORCELAIN VENEERED TO METAL * - - - - 2 414.37R
8446 CROWN RETAINER - RESIN WITH METAL * - - - - 2 414.37R
8447 PROVISIONAL CROWN RETAINER - - - - 478.30R
8499 GENERAL ANAESTHETIC - - - - -
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8501 CONSULTATION - PROSTHODONTIS - - - - -
8503 OCCLUSION ANALYSIS MOUNTED - - - - 478.30R
8505 PANTOGRAPHIC RECORDING - - - - 693.88R
8506 DETAILED CONSULTATION - PROSTHODONTIST - - - - -
8507 COMPREHENSIVE CONSULTATION - PROSTHODONTIST - - - - -
8508 ELECTROGNATHOGRAPHIC RECORDING - - - - 743.00R
8509
ELECTROGNATHOGRAPHIC RECORDING WITH COMPUTER
ANALYSIS - - - - 1 233.52R
8514 RECEMENT BRIDGE 143.58R - - - 182.14R
8516 REMOVE BRIDGE 285.60R - - - 285.60R
8517
REIMPLANTATION OF AVULSED TOOTH (INCLUDE
STABILISATION) 331.68R - 331.68R - 497.73R
8518 REPAIR BRIDGE 318.73R - - - 318.73R
8533
IMPLANT SUPPORTED REMOVABLE COMPLETE
OVERDENTURE * - - - - 3 861.69R
8534 IMPLANT SUPPORTED REMOVABLE PARTIAL OVERDENTURE * - - - - 3 089.33R
8536
CROWN-IMPLANT/ABUTMENT SUPPORTED CROWN -
PORCELAIN/CERAMIC * - - - - 2 815.65R
8537
CROWN-IMPLANT/ABUTMENT SUPPORTED CROWN -
PORCELAIN WITH METAL * - - - - 2 815.65R
8538
CROWN-IMPLANT/ABUTMENT SUPPORTED CROWN - CAST
METAL * - - - - 2 815.65R
8546 IMPLANT SUPPORTED CROWN RETAINER - CERAMIC * - - - - 2 815.65R
8547
IMPLANT SUPPORTED CROWN RETAINER - PORCELAIN
VENEERED TO METAL * - - - - 2 815.65R
8548
CROWN RETAINER - IMPLANT/ABUTMENT SUPPORTED -
CAST METAL * - - - - 2 815.65R
8551 OCCLUSAL ADJUSTMENT - MAJOR - 1 363.10R - - 1 363.10R
8552 VENEER - PORCELAIN (LABORATORY) - - - - 1 652.25R
8553 OCCLUSAL ADJUSTMENT - MINOR 434.41R 434.41R 434.41R - 434.41R
8554 VENEER - RESIN (LABORATORY) - - - - 1 652.25R
8560 COST OF CERAMIC BLOCK * - - - - 644.14R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8561 GOLD FOIL CLASS I OR IV - - - - 1 247.42R
8563 GOLD FOIL CLASS V - - - - 1 459.55R
8565 GOLD FOIL CLASS III - - - - 1 836.17R
8570
FABRICATION OF COMPUTER GENERATED CERAMIC
RESTORATION * - - - - 1 562.69R
8578 PREFABRICATED ABUTMENT - - - - 399.50R
8579 CUSTOM ABUTMENT - - - - 1 822.17R
8580 CUSTOMISED PREFABRICATED ABUTMENT * - - - - *
8581 CAST CORE WITH SINGLE POST * - - - - -
8582 CAST CORE WITH DOUBLE POST * - - - - -
8583 CAST CORE WITH TRIPLE POST * - - - - -
8584 CONNECTOR BAR - IMPLANT SUPPORTED * - - - - -
8585 CONNECTOR BAR - - - - -
8586 STRESS BREAKER - - - - -
8587 COPING METAL - - - - 399.50R
8590 IMPLANT MAINTENANCE PROCEDURES - PER IMPLANT - - - - 176.92R
8592 CROWN - IMPLANT/ABUTMENT SUPPORTED * - - - - 2 815.65R
8594 REPAIR OF IMPLANT SUPPORTED PROSTHESIS - - - - 196.15R
8595 REPAIR OF IMPLANT ABUTMENT - - - - 196.15R
8597 LOCKS AND MILLED RESTS - - - - 196.15R
8599 PRECISION ATTACHMENT (REMOVABLE DENTURE) - - - - 478.30R
8600 COST OF IMPLANT COMPONENTS * * - * * *
8611 PONTIC - SANITARY * - - - - -
8613 PONTIC - POSTERIOR * - - - - -
8615 PONTIC - ANTERIOR/PREMOLAR * - - - - -
8617 RETAINER CAST METAL (MARYLAND TYPE RETAINER) * - - - - 1 247.42R
8631
ROOT CANAL THERAPY - FIRST CANAL SPECIALIST
PROSTHODONTIST - - - - -
8633
ROOT CANAL THERAPY - EACH ADDITIONAL CANAL
SPECIALIST PROSTHODONTIST - - - - -
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8635
APEXIFICATION/APEXOGENESIS/RECALCIFICATION – PER
VISIT 190.92R - 190.92R - 375.16R
8640 REMOVAL OF FRACTURED ROOT CANAL INSTRUMENT - - - - 497.73R
8643
COMPLETE DENTURES - MAXILLARY AND MANDIBULAR.
ONLY FOR PROSTHODONTISTS * - - - - -
8645
COMPLETE DENTURES - MAXILLARY OR MANDIBULAR.
ONLY FOR PROSTHODONTISTS * - - - - -
8649
IMMEDIATE DENTURE - MAXILLARY. ONLY FOR
PROSTHODONTIST * - - - - -
8651
IMMEDIATE DENTURE - MANDIBULAR. ONLY FOR
PROSTHODONTIST * - - - - -
8652 OVERDENTURE - COMPLETE * - - - - 3 861.69R
8653 OVERDENTURE - PARTIAL * - - - - 3 089.33R
8654
IMPLANT SUPPORTED FIXED-DETACHABLE COMPLETE
OVERDENTURE * - - - - 4 343.54R
8655
IMPLANT SUPPORTED FIXED-DETACHABLE PARTIAL
OVERDENTURE * - - - - 2 976.37R
8657 REPLACEMENT OF PRECISION ATTACHMENT - - - - 196.15R
8658 INTERIM COMPLETE DENTURE - - - - 2 141.94R
8659 INTERIM PARTIAL DENTURE - - - - 1 713.49R
8660
ADDITIONAL FEE TO IMPLANT SUPPORTED FIXED-
DETACHABLE DENTURE - PER IMPLANT - - - - 399.50R
8661
DIAGNOSTIC DENTURES (INCLUDING TISSUE
CONDITIONING) - - - - -
8662 ADJUST COMPLETE OR PARTIAL DENTURES (REMOUNTING) - - - - 557.30R
8663 METAL BASE TO COMPLETE DENTURE - - - - 1 163.40R
8664 REMOUNT CROWN OR BRIDGE FOR ADJUSTMENT - - - - 582.27R
8667 SOFT BASE TO DENTURE (HEAT CURED) - - - - 1 163.40R
8671
PARTIAL DENTURE - CAST METAL FRAMEWORK WITH RESIN
DENTURE BASE * - - - - -
8672
ALTERED CAST TECHNIQUE (IN ADDITION TO PARTIAL
DENTURE) - - 99.48R - 149.02R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8674 ADDITIVE PARTIAL DENTURE - - - - 1 752.15R
8701 CONSULTATION - PERIODONTIST - - - - -
8703 CONSULTATION - PERIODONTIST (DETAILED) - - - - -
8705 RE-EXAMINATION - PERIODONTIST - - - - -
8707 PERIODONTAL SCREENING - PERIODONTIST - - - - -
8723
PROVISIONAL SPLINTING - EXTRACORONAL (WIRE) - PER
SEXTANT 266.48R - 399.50R - 399.50R
8725
PROVISIONAL SPLINTING - EXTRACORONAL (WIRE PLUS
RESIN) - PER SEXTANT 386.55R - 579.98R - 579.98R
8727 PROVISIONAL SPLINTING - INTRACORONAL - PER TOOTH 121.32R - 182.14R - 182.14R
8731 INCISION & DRAINAGE OF ABSCESS - INTRA-ORAL * 229.06R - 343.49R - *
8737 ROOT PLANING - FOUR OR MORE TEETH PER QUADRANT * - - 779.57R - 574.85R
8739 ROOT PLANING - ONE TO THREE TEETH PER QUADRANT * - - 622.09R - 457.19R
8741
GINGIVECTOMY/GINGIVOPLASTY - FOUR OR MORE TEETH
PER QUADRANT - - 1 028.59R - -
8743
GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE TEETH
PER QUADRANT - - 816.46R - -
8749
FLAP PROCEDURE, ROOT PLANING AND ONE TO THREE
SURGICAL SERVICES - PER QUADRANT - - 2 335.58R - -
8751
FLAP PROCEDURE, ROOT PLANING AND ONE TO THREE
SURGICAL SERVICES - PER SEXTANT - - 1 934.30R - -
8753
FLAP PROCEDURE, ROOT PLANING AND FOUR OR MORE
SURGICAL SERVICES - PER QUADRANT - - 2 894.65R - -
8755
FLAP PROCEDURE, ROOT PLANING AND FOUR OR MORE
SURGICAL SERVICES - PER SEXTANT - - 2 346.13R - -
8756 CLINICAL CROWN LENGTHENING (ISOLATED PROCEDURE) * - - 1 422.66R - *
8759 PEDICLE FLAPPED GRAFT (ISOLATED PROCEDURE) - - 1 068.72R - -
8761
MASTICATORY MUCOSAL AUTOGRAFT - ONE TO FOUR
TEETH (ISOLATED PROCEDURE) 1 161.73R - 1 161.73R - -
8762
MASTICATORY MUCOSAL AUTOGRAFT - FOUR OR MORE
TEETH (ISOLATED PROCEDURE) 1 745.15R - 1 745.15R - -
Trf Code TariffDescription
*Pre-
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required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8763 WEDGE RESECTION (ISOLATED PROCEDURE) * 455.62R - 683.43R - *
8765
HEMISECTION OF A TOOTH, RESECTION OF A ROOT OR
TUNNEL PREPARATION (ISOLATED PROCEDURE) - - 939.14R - 939.14R
8766
BONE REGENERATION/REPAIR PROCEDURE - AS PART OF A
FLAP OPERATION - - 559.08R - -
8767
BONE REGENERATION/REPAIR PROCEDURE - AT A SINGLE
SITE 1 449.10R - 1 449.10R - -
8768 UNLISTED PERIODONTAL PROCEDURE - - 683.43R - -
8769
MEMBRANE REMOVAL (USED FOR GUIDED TISSUE
REGENERATION) 683.43R - 683.43R - -
8770 COST OF BONE REGENERATIVE/REPAIR MATERIAL * - - - - -
8772
SUBMUCOSAL CONNECTIVE TISSUE AUTOGRAFT (ISOLATED
PROCEDURE) 1 173.95R - 1 173.95R - -
8773 COST OF INTRAPOCKET CHEMOTHERAPEUTIC AGENT - - - - -
8781 CONSULTATION - ORAL MEDICINE (SIMPLE) - - - - -
8782 CONSULTATION - ORAL MEDICINE (COMPLEX) - - - - -
8783 CONSULTATION - ORAL MEDICINE (SUBSEQUENT) - - - - -
8787 UNLISTED ORAL MEDICINE PROCEDURE - - 245.26R - -
8801 CONSULTATION - ORTHODONTIST - - - - -
8803
CONSULTATION - ORTHODONTIS (SUBSEQUENT,
RETENTION AND POST TREATMENT) - - - - -
8811 TRACING AND ANALYSIS OF EXTRA-ORAL FILM 43.89R 43.89R 43.89R - 43.89R
8837 DIAGNOSIS AND TREATMENT PLANNING - ORTHODONTIST - - - - -
8839 DIAGNOSTIC SETUP 195.21R 292.60R - - -
8840
TREATMENT PLANNING FOR ORTHOGNATHIC SURGERY -
ALL 1 009.16R 1 009.16R - - -
8841 ORTHO TX - FIXED LINGUAL APPLIANCE - ONE ARCH * - * - - -
8842
ORTHO TX - FIXED LINGUAL APPLIANCE - ONE ARCH,
MODEATE * - * - - -
8843
ORTHO TX - FIXED LINGUAL APPLIANCE - ONE ARCH,
SEVERE * - * - - -
8846 REPAIR ORTHODONTIC APPLIANCE - REMOVABLE - 197.92R - - -
Trf Code TariffDescription
*Pre-
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required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8847 REPLACE ORTHODONTIC APPLIANCE - REMOVABLE - 683.43R - - -
8848 REPAIR ORTHODONTIC APPLIANCE - FIXED - 292.60R - - -
8849 RETAINER (ORTHODONTIC) - 683.43R - - -
8850 TREATMENT OF MPDS - FIRST VISIT 219.55R 329.49R 219.55R - 329.49R
8851 TREATMENT OF MPDS - SUBSEQUENT VISIT 115.68R 173.47R 115.68R - 173.47R
8852 OCCLUSAL ORTHOTIC APPLIANCE 727.01R 727.01R 727.01R - 727.01R
8855
CONSULTATION - CLEFT PALATE THERAPY (HOUSE OR
HOSPITAL) - 399.50R - - 399.50R
8856 CONSULTATION - CLEFT PALATE (SUBSEQUENT) - 196.15R - - 196.15R
8857 CONSULTATION - CLEFT PALATE (MAXIMUM) - 1 364.87R - - 1 364.87R
8858 ORTHO TX - FUNCTIONAL APPLIANCE * - * - - -
8861 ORTHO TX - PARTIAL FIXED APPLIANCE - MINOR * - * - - -
8862 ORTHO TX - REMOVABLE APPLIANCE * - * - - -
8863 ORTHO TX - EACH ADDITIONAL REMOVABLE APPLIANCE * - * - - -
8865 ORTHO TX - PARTIAL FIXED APPLIANCE - ONE ARCH * - * - - -
8866 ORTHO TX - PARTIAL FIXED APPLIANCE - BOTH ARCHES * - * - - -
8867 ORTHO TX - FIXED APPLIANCE - ONE ARCH * - * - - -
8868 ORTHO TX - FIXED APPLIANCE - ONE ARCH, MODEATE * - * - - -
8869 ORTHO TX - FIXED APPLIANCE - ONE ARCH, SEVERE * - * - - -
8873
ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 1
MILD * - * - - -
8874
ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES,
CLASS 1 MILD * - * - - -
8875
ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 1
MODERATE * - * - - -
8876
ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES,
CLASS 1 MODERATE * - * - - -
8877
ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 1
SEVERE * - * - - -
8878
ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES,
CLASS 1 SEVERE * - * - - -
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8879
ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 1
SEVERE W/ COMPLICATIONS * - * - - -
8880
ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES,
CLASS 1 SEVERE W/ COMPLICATIONS * - * - - -
8881
ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 2/3
MILD * - * - - -
8882
ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES,
CLASS 2/3 MILD * - * - - -
8883
ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 2/3
MODERATE * - * - - -
8884
ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES,
CLASS 2/3 MODERATE * - * - - -
8885
ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 2/3
SEVERE * - * - - -
8886
ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES,
CLASS 2/3 SEVERE * - * - - -
8887
ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 2/3
SEVERE W/ COMPLICATIONS * - * - - -
8888
ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES,
CLASS 2/3 SEVERE W/ COMPLICATIONS * - * - - -
8890 MONTHLY INSTALMENT ORTHO TX * - * - - -
8891 ORTHODONTIC TRANSFER * - * - - -
8892 ORTHODONTIC RE-TREATMENT * - * - - -
8901 CONSULTATION - MFOS 297.93R - - - -
8902 CONSULTATION - MFOS (DETAILED) 779.57R - - - -
8903 HOUSE/HOSP/NURSING HOME CONSULTATION - MFOS 260.94R - - - -
8904
HOUSE/HOSP/NURSING HOME CONSULTATION
(SUBSEQUENT) - MFOS 173.47R - - - -
8905 AFTER REGULARLY HOURS CONSULTATION - MFOS 382.05R - - - -
8907
HOUSE/HOSP/NURSING HOME CONSULTATION
(MAXIMUM PER WEEK) - MFOS 434.41R - - - -
8908
SURGICAL REMOVAL OF ROOTS FROM MAXILLARY
ANTRUM 2 845.54R - - - -
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8909 ORAL ANTRAL FISTULA CLOSURE 2 181.33R - - - -
8911 CALDWELL-LUC PROCEDURE 853.45R - - - -
8917 BIOPSY OF ORAL TISSUE - SOFT 483.52R - 483.52R - -
8919 BIOPSY OF BONE - NEEDLE * 837.46R - * - -
8921 BIOPSY – EXTRA-ORAL BONE/SOFT TISSUE * 1 370.10R - * - -
8931 TREATMENT OF POST-EXTRACTION HAEMORRHAGE 630.87R - 105.23R - 105.23R
8933 TREATMENT OF HAEMORRHAGE (BLOOD DYSCRACIAS) 2 181.33R - 1 454.33R - 1 454.33R
8935 TREATMENT OF SEPTIC SOCKET 164.80R - 105.23R - 105.23R
8937 SURGICAL REMOVAL OF TOOTH 837.46R - 620.31R - -
8941 SURGICAL REMOVAL OF IMPACTED TOOTH - FIRST TOOTH 1 352.65R - 1 028.59R - -
8943
SURGICAL REMOVAL OF IMPACTED TOOTH - SECOND
TOOTH 728.78R - 551.86R - -
8945
SURGICAL REMOVAL OF IMPACTED TOOTH - THIRD AND
SUBSEQUENT TEETH 413.51R - 313.50R - -
8953
SURGICAL REMOVAL OF RESIDUAL ROOTS, FIRST TOOTH -
PER TOOTH 837.46R - 837.36R - -
8957
ALVEOLOTOMY OR ALVEOLECTOMY (INCLUDING
EXTRACTIONS) 1 142.50R - 761.70R - -
8958 EMERGENCY TRACHEOTOMY * * - - - -
8959 PHARYNGOSTOMY * * - - - -
8961 TOOTH TRANSPLANTATION 1 873.06R - - - -
8962 HARVEST ILIAC CREST GRAFT 565.76R - - - -
8963 HARVEST RIB GRAFT 792.11R - - - -
8964 HARVEST CRANIUM GRAFT 620.31R - - - -
8965 PERIPHERAL NEURECTOMY 1 873.06R - - - -
8966 REPAIR OF ORONASAL FISTULA (LOCAL FLAPS) * * - - - -
8967
SURGICAL REMOVAL OF JAW CYST - INTRA-ORAL
APPROACH 2 602.05R - - - -
8969
SURGICAL REMOVAL OF JAW CYST - EXTRA-ORAL
APPROACH 4 168.30R - - - -
8971 EXCISION OF TUMOUR OF THE SOFT TISSUE 837.46R - 837.46R - -
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
8973 SURGICAL EXCISION OF TUMOURS OF THE JAW 4 168.30R - - - -
8975 HEMIRESECTION OF JAW EXCLUDING CONDYL * * - - - -
8977 SURGICAL REPAIR OF MAXILLA OR MANDIBLE - MAJOR * 4 375.10R - - - -
8979 HARVESTING OF AUTOGENOUS GRAFTS (INTRA-ORAL) 360.84R - 360.84R - -
8981
SURGICAL EXPOSURE OF IMPACTED OR UNERUPTED TEETH
TO AID ERUPTION 1 561.23R - 1 561.23R - -
8983 CORTICOTOMY - FIRST TOOTH 1 243.97R - - - -
8984 CORTICOTOMY - EACH ADDITIONAL TOOTH 630.87R - - - -
8985 FRENULECTOMY/FRENULOTOMY 1 142.50R - 1 142.50R - -
8987 REDUCTION OF MYLOHYOID RIDGES - PER SIDE 1 873.06R - - - -
8989 REMOVAL TORUS MANDIBULARIS 1 873.06R - - - -
8991 REMOVAL OF TORUS PALATINUS 1 873.06R - - - -
8993 SURGICAL REDUCTION OF OSSEOUS TUBEROSITY - PER SIDE 837.46R - - - -
8995 GINGIVECTOMY - PER JAW 1 666.46R - - - -
8997 SULCOPLASTY / VESTIBULOPLASTY 4 294.64R - 4 294.64R - -
9003 REPOSITION MENTAL FORAMEN AND NERVE - PER SIDE 2 602.05R - - - -
9004 LATERALIZATION OF INFERIOR DENTAL NERVE 4 192.96R - - - -
9005
ALVEOLAR RIDGE AUGMENTATION - TOTAL (BY BONE
GRAFT) 4 378.65R - 4 378.65R - -
9007
ALVEOLAR RIDGE AUGMENTATION - TOTAL (BY
ALLOPLASTIC MATERIAL) 2 756.08R - - - -
9008
ALVEOLAR RIDGE AUGMENTATION - ONE TO TWO TOOTH
SITES 1 039.04R - 1 039.04R - -
9009
ALVEOLAR RIDGE AUGMENTATION - THREE ACROSS 3 OR
MORE TOOTH SITES 1 893.96R - 1 893.96R - -
9010 SINUS LIFT PROCEDURE 2 845.54R - 2 845.54R - -
9011
INCISION & DRAINAGE OF ABSCESS - INTRA-ORAL
(PYOGENIC) 532.64R - - - -
9013
INCISION & DRAINAGE OF ABSCESS - EXTRA-ORAL
(PYOGENIC) * * - * - -
9015
APICECTOMY/PERIRADICULAR SURGERY - ANTERIORS
(INCLUDING RETROGRADE FILLING) 939.14R - 939.14R - 939.14R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9016
APICECTOMY/PERIRADICULAR SURGERY - MOLARS
(INCLUDING RETROGRADE FILLING) 1 873.06R - 1 873.06R - 1 873.06R
9017 DECORTICATION, SAUCERISATION AND SEQUESTRECTOMY * * - - - -
9019
SEQUESTRECTOMY - INTRA ORAL PER SEXTANT AND OR
RAMUS 837.46R - - - -
9021
SUTURE - RECONSTRUCTION, MINOR (EXCLUDES CLOSURE
OF SURGICAL INCISIONS) 939.14R - - - -
9023
SUTURE - RECONSTRUCTION, MAJOR (EXCLUDES CLOSURE
OF SURGICAL INCISIONS) 1 976.51R - - - -
9024 DENTO-ALVEOLAR FRACTURE - PER SEXTANT 939.14R - - - -
9025 MANDIBLE FRACTURE - CLOSED REDUCTION * * - - - -
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 * * - - - -
9043 ZYGOMATIC ARCH FRACTURE - OPEN REDUCTION * * - - - -
9045
ZYGOMATIC ARCH FRACTURE - OPEN REDUCTION
(REQUIRING OSTEOSYNTHESIS AND/OR GRAFTING) * * - - - -
9046 PLACEMENT OF ZYGOMATICUS FIXTURE, PER FIXTURE * * - - - -
Trf Code TariffDescription
*Pre-
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required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
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
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 * - - - - -
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 * * - - - -
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
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) 939.14R - - - -
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 OBTURATOR PROSTHESIS, SURGICAL - CONTINUOUS BASE * - - - - *
9103 OBTURATOR PROSTHESIS, SURGICAL - SPLIT BASE * - - - - *
9104
OBTURATOR PROSTHESIS, INTERIM - ON EXISTING
DENTURE * - - - - *
9105 OBTURATOR PROSTHESIS, INTERIM - ON NEW DENTURE * - - - - *
9106
OBTURATOR PROSTHESIS, DEFINITIVE - OPEN/HOLLOW
BOX * - - - - *
9107 OBTURATOR PROSTHESIS, DEFINITIVE - SILICONE GLOVE * - - - - *
9108 MANDIBULAR RESECTION PROSTHESIS W/ GUIDE FLANGE * - - - - *
Trf Code TariffDescription
*Pre-
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Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9109 MANDIBULAR RESECTION PROSTHESIS W/O GUIDE FLANGE * - - - - *
9110
MANDIBULAR RESECTION 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
ORTHOPAEDIC APPLIANCE, ACTIVE PRESURGICAL -
MODERATE * - * - - *
9122 ORTHOPAEDIC APPLIANCE, ACTIVE PRESURGICAL - SEVERE * - * - - *
9123
ORTHOPAEDIC APPLIANCE, ACTIVE PRESURGICAL -
MODIFICATION * - * - - *
9125
SPEECH AID/OBTURATOR PROSTHESIS - PALATAL
ALTERATION * - - - - *
9126 SPEECH AID/OBTURATOR PROSTHESIS - VELAR ALTERATION * - - - - *
9127
SPEECH AID/OBTURATOR PROSTHESIS - PHARYNGEAL
ALTERATION * - - - - *
9128 SPEECH AID/OBTURATOR PROSTHESIS - MODIFICATION * - - - - *
9129 SPEECH AID/OBTURATOR PROSTHESIS - SURGICAL * - - - - *
9130 SPEECH AID APPLIANCE - PALATAL LIFT * - - - - *
9131 SPEECH AID APPLIANCE - PALATAL STIMULATING * - - - - *
9132 SPEECH AID APPLIANCE - BULB * - - - - *
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
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 * - - - - *
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) * - - - - *
Trf Code TariffDescription
*Pre-
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required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
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 * 1 889.88R - - - -
9181
SURGICAL PLACEMENT OF SUB-PERIOSTEAL IMPLANT -
PLACEMENT STAGE * 1 889.88R - - - -
9182 SURGICAL PLACEMENT OF ENDOSTEAL IMPLANT PLATE * 1 419.21R - 1 419.21R - -
9183
SURGICAL PLACEMENT OF ENDOSSEUS IMPLANT - FIRST
PER QUADRANT * 1 809.94R - 1 809.94R - 1 809.73R
9184
SURGICAL PLACEMENT OF ENDOSSEUS IMPLANT - SECOND
PER QUADRANT * 1 357.87R - 1 357.87R - 1 357.35R
9185
SURGICAL PLACEMENT OF ENDOSSEUS IMPLANT - THIRD
AND SUBSEQUENT PER QUADRANT * 909.46R - 909.46R - *
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 * 669.22R - 669.22R - 669.22R
9191
SURGICAL EXPOSURE OF ENDOSSEUS IMPLANT - SECOND
PER QUADRANT * 502.96R - 502.96R - 502.96R
9192
SURGICAL EXPOSURE OF ENDOSSEUS IMPLANT - THIRD
AND SUBSEQUENT PER QUADRANT * 338.27R - 338.27R - 338.27R
9198 SURGICAL REMOVAL OF IMPLANT * 923.47R - 923.47R - 615.71R
9201 CONSULTATION - ORAL PATHOLOGIST - - - - -
9203
HOUSE/HOSP/NURSING HOME CONSULTATION - ORAL
PATHOLOGIST - - - - -
9205 CONSULTATION - ORAL PATHOLOGIST (SUBSEQUENT) - - - - -
9207 AFTER HOURS VISIT - ORAL PATHOLOGIST - - - - -
9220 REPAIR CLEFT HARD PALATE - UNILATERAL * * - - - -
Trf Code TariffDescription
*Pre-
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required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9222
REPAIR CLEFT HARD PALATE - BILATERAL (ONE
PROCEDURE) * * - - - -
9224
REPAIR CLEFT HARD PALATE - BILATERAL (TWO
PROCEDURES) * * - - - -
9226
REPAIR CLEFT SOFT PALATE - W/O MUSCLE
RECONSTRUCTION * * - - - -
9228
REPAIR CLEFT SOFT PALATE - W/ MUSCLE
RECONSTRUCTION * * - - - -
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/ MUSCLE
RECONSTRUCTION * * - - - -
9254
REPAIR CLEFT LIP - BILATERAL W/O MUSCLE
RECONSTRUCTION * * - - - -
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 * * - - - -
Trf Code TariffDescription
*Pre-
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required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
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 * - - - - -
9294
MAXILLECTOMY - ALVEOLUS, SINUS, NASAL FLOOR AND
ZYGOMA EXCLUDING ORBITAL RIM LEVEL III * - - - - -
9296
MAXILLECTOMY - ALVEOLUS, SINUS, NASAL FLOOR AND
ZYGOMA INCLUDING ORBITAL RIM LEVEL IV * - - - - -
9298
MAXILLECTOMY - ALVEOLUS, 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
9303
CASTING AND TRIMMING OF MODEL IN SUPER-HARD
STONE (DIE-STONE) PER MODEL 58.10R 58.10R 58.10R 58.10R 58.10R
Trf Code TariffDescription
*Pre-
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Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9305 CASTING AND TRIMMING OF STUDY MODEL, PER MODEL 107.60R 107.60R 107.60R 107.60R 107.60R
9307
CASTING AND TRIMMING OF GNATHOSTATIC MODEL, PER
MODEL. 139.90R 139.90R 139.90R 139.90R 139.90R
9309 NEW TRIMMED BASE TO SUPPLIED MODEL, PER MODEL 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
9312 GINGIVAL TISSUE MASK PER IMPLANT 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
9314 REFRACTORY MODEL, PER UNIT 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 - - 170.00R 170.00R 170.00R
9317
SECTIONAL MODELS FOR CROWN AND BRIDGE, WORK
INCLUSIVE OF ONE REMOVABLE DIE - - - 150.70R 150.70R
9319
EACH ADDITIONAL REMOVABLE DIE FOR ITEMS 9315 AND
9317 PER DIE - - 38.80R 38.80R 38.80R
9320 INDEXED OR MODEL TRAY PER DIE (NOT MORE THAN 9319) - - - 38.80R 38.80R
9321 OCCLUSION BLOCK, PER BLOCK 148.50R - - 148.50R 148.50R
9323 OCCLUSION BLOCK ON BASEPLATE, PER BLOCK - - - 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
9329 FIT AND SUPPLY OF DISPOSABLE ARTICULATOR - 73.20R - 73.20R 73.20R
9330
DELIVERY / COLLECTION FEE PER COMPLETED PROCEDURE
(MAXIMUM 4) - - - - -
9331 FULL UPPER AND LOWER DENTURES * 1 997.70R - - 1 997.70R 1 997.70R
9333 FULL UPPER OR LOWER DENTURE * - - - 1 168.90R 1 168.90R
9335
SET-UP AND WAXING OF FULL UPPER AND LOWER
DENTURES - - - 688.90R 688.90R
9337 SET-UP AND WAXING OF FULL UPPER OR LOWER DENTURE * - - - 460.60R 460.60R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9339
WAXING AND FINISHING OF FULL UPPER AND LOWER
DENTURES - - - 1 224.80R 1 224.80R
9341
WAXING AND FINISHING OF FULL UPPER OR LOWER
DENTURE * - - - 684.60R 684.60R
9343
ADDITIONAL FEE FOR DENTURES ON FULLY ADJUSTABLE
ARTICULATOR AT REQUEST OF DENTIST - - - 1 950.40R 1 950.40R
9345
ADDITIONAL FEE FOR IMMEDIATE DENTURES, OR TOOTH
SOCKETED - - - 28.00R 28.00R
9346
ADDITIONAL FEE FOR IMMEDIATE DENTURES, PER TOOTH
NOT SOCKETED. - - 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
9351 SET-UP AND FINISH OF ONE-TOOTH DENTURE * - - 536.00R 536.00R 536.00R
9352 SET-UP AND FINISH OF TWO-TOOTH DENTURE * - - 570.50R 570.50R 570.50R
9353 SET-UP AND FINISH OF THREE-TOOTH DENTURE * - - 611.30R 611.30R 611.30R
9354 SET-UP AND FINISH OF FOUR-TOOTH DENTURE * - - 645.80R 645.80R 645.80R
9355 SET-UP AND FINISH OF FIVE-TOOTH DENTURE * - - 697.40R 697.40R 697.40R
9356 SET-UP AND FINISH OF SIX-TOOTH DENTURE * - - 833.10R 833.10R 833.10R
9357 SET-UP AND FINISH OF SEVEN-TOOTH DENTURE * - - 990.20R 990.20R 990.20R
9358 SET-UP AND FINISH OF EIGHT-TOOTH DENTURE * - - 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
9361 SET-UP AND WAXING OF ONE-TOOTH DENTURE * - - 152.90R 152.90R 152.90R
9362 SET-UP AND WAXING OF TWO-TOOTH DENTURE * - - 185.20R 185.20R 185.20R
9363 SET-UP AND WAXING OF THREE-TOOTH DENTURE * - - 211.00R 211.00R 211.00R
9364 SET-UP AND WAXING OF FOUR-TOOTH DENTURE * - - 245.40R 245.40R 245.40R
9365 SET-UP AND WAXING OF FIVE-TOOTH DENTURE * - - 271.30R 271.30R 271.30R
9366 SET-UP AND WAXING OF SIX-TOOTH DENTURE * - - 320.70R 320.70R 320.70R
9367 SET-UP AND WAXING OF SEVEN-TOOTH DENTURE * - - 353.00R 353.00R 353.00R
9368 SET-UP AND WAXING OF EIGHT-TOOTH DENTURE * - - 378.90R 378.90R 378.90R
9369 SET-UP AND WAXING OF NINE OR MORE TOOTH DENTURE * - - 404.70R 404.70R 404.70R
Trf Code TariffDescription
*Pre-
authorisation
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Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9371 WAXING AND FINISHING OF ONE-TOOTH DENTURE * - - 419.80R 419.80R 419.80R
9372 WAXING AND FINISHING OF TWO-TOOTH DENTURE * - - 428.40R 428.40R 428.40R
9373 WAXING AND FINISHING OF THREE-TOOTH DENTURE * - - 434.80R 434.80R 434.80R
9374 WAXING AND FINISHING OF FOUR-TOOTH DENTURE * - - 443.50R 443.50R 443.50R
9375 WAXING AND FINISHING OF FIVE-TOOTH DENTURE * - - 460.60R 460.60R 460.60R
9376 WAXING AND FINISHING OF SIX-TOOTH DENTURE * - - 477.90R 477.90R 477.90R
9377 WAXING AND FINISHING OF SEVEN-TOOTH DENTURE * - - 596.30R 596.30R 596.30R
9378 WAXING AND FINISHING OF EIGHTH-TOOTH DENTURE * - - 620.00R 620.00R 620.00R
9379
WAXING AND FINISHING OF NINE OR MORE TOOTH
DENTURE * - - 654.40R 654.40R 654.40R
9383
ADDITIONAL FEE FOR FINISHING DENTURE IN TOOTH
COLOUR MATERIAL, PER TOOTH - - 103.40R 103.40R 103.40R
9385
ADDITIONAL FEE FOR SUPPLYING FINISHED DENTURE ON
DUPLICATE MODEL - - 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 - 340.20R 340.20R 340.20R 340.20R
9393
ADDITIONAL CHARGE FOR EACH ADDITIONAL FRACTURE,
OR TOOTH, OR CLASP - 105.40R 105.40R 105.40R 105.40R
9395 ADDITIONAL FEE FOR USING WIRE STRENGTHENER - 120.60R 120.60R 120.60R 120.60R
9397 ADDITIONAL FEE FOR USING PRE-FORMED STRENGTHENER - 129.20R 129.20R 129.20R 129.20R
9398
ADDITIONAL FEE FOR USING MESH STRENGTHENER IN
REPAIR PROCEDURE - - 204.50R 204.50R 204.50R
9401 CLEAR BASE - - - - -
9403 DOX GRINDING OF UPPER AND LOWER DENTURES - - 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
9409 FREGO FRAME - - 195.90R 195.90R 195.90R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9410 BLEACHING TRAY - - - - -
9411 TEMPLATE PER UPPER OR LOWER DENTURE - - 540.40R 540.40R 540.40R
9413 RELINE/REBASE OF SINGLE DENTURE - - 680.30R 680.30R 680.30R
9415 REMODEL OF SINGLE DENTURE - - 1 046.30R 1 046.30R 1 046.30R
9417 SOFT BASE RELINE PER DENTURE - - 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
9421 GUM TINTING PER DENTURE - - - - -
9423 LINGUAL OR PALATAL BAR - 256.10R 256.10R 256.10R 256.10R
9425
CLEANING AND POLISHING OF EXISTING DENTURE, PER
DENTURE - - 208.80R 208.80R 208.80R
9427 MESH STRENGTHENER - - 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
9431 SPECIAL TRAY, ACRYLIC, EACH - - 167.90R 167.90R 167.90R
9432 SPECIAL TRAY LIGHT CURE, EACH - - 183.00R 183.00R 183.00R
9433 SPECIAL TRAY IN BASE PLATE MATERIAL, EACH - - 172.20R 172.20R 172.20R
9435 PROVISION OF SINGLE ARM CLASP, TO PARTIAL DENTURE - - 88.30R 88.30R 88.30R
9437 PROVISION OF DOUBLE ARM CLASP, TO PARTIAL DENTURE - - 152.90R 152.90R 152.90R
9439
PROVISION OF SINGLE ARM CLASP WITH REST, TO PARTIAL
DENTURE - - 198.00R 198.00R 198.00R
9441
PROVISION OF DOUBLE ARM CLASP WITH REST, TO
PARTIAL DENTURE - - 266.90R 266.90R 266.90R
9443
PROVISION OF PREFORMED ROACH CLASP, TO PARTIAL
DENTURE - - 114.10R 114.10R 114.10R
9445 PROVISION OF REST ONLY TO PARTIAL DENTURE - - 114.10R 114.10R 114.10R
9447 CAST CLASP - - 400.40R 400.40R 400.40R
9448
CASTING AND TRIMMING OF MODEL FROM IMPRESSION
INSIDE OCCLUSION BLOCK OR WAX TRY IN - - 73.20R 73.20R 73.20R
9450
FINISHING OF ACRYLIC WORK ON ANY CHROME COBALT OR
GOLD PROSTHESIS 152.90R 152.90R 152.90R 152.90R 152.90R
Trf Code TariffDescription
*Pre-
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Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
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 * - - - 1 199.00R 1 199.00R
9455 ADDITIONAL CHARGE FOR EACH ONE ARM CLASP - - - 49.50R 49.50R
9457 ADDITIONAL CHARGE FOR EACH ROACH CLASP - - - 83.90R 83.90R
9459 ADDITIONAL CHARGE FOR EACH REST - - - 45.30R 45.30R
9461
ADDITIONAL CHARGE FOR CONTINUOUS CLASP, PER
TOOTH - - - 49.50R 49.50R
9463
ADDITIONAL CHARGE FOR LINGUAL BAR, PER TOOTH
PASSED - - - 116.20R 116.20R
9465 ADDITIONAL CHARGE FOR PALATAL BAR - - - 185.20R 185.20R
9467 ADDITIONAL CHARGE FOR ONLAY - - - - -
9469
ADDITIONAL CHARGE FOR SADDLE WITH FINISHING LINE,
PER TOOTH - - - 81.80R 81.80R
9471
ADDITIONAL CHARGE FOR SADDLE WITHOUT FINISHING
LINE, PER TOOTH - - - 47.30R 47.30R
9473
ADDITIONAL CHARGE FOR HORSESHOE SADDLE, PER
TOOTH - - - 81.80R 81.80R
9475
ADDITIONAL CHARGE FOR FITTING OF TOOTH TO METAL
BACKING, PER TOOTH - - - 56.00R 56.00R
9479
ADDITIONAL CHARGE FOR FITTING ONE DISTAL-EXTENSION
HINGE - - - 165.70R 165.70R
9480 ADDITIONAL CHARGE PER MILLED EDGE PER TOOTH - - - 144.20R 144.20R
9481 ADDITIONAL CHARGE FOR EACH SOLDERING JOINT - - - 202.30R 202.30R
9483 ADDITIONAL CHARGE FOR SOLDERING RETENTION - - - 245.40R 245.40R
9485
ADDITIONAL CHARGE FOR EACH ADDITIONAL RETENTION
SOLDERING JOINT - - - 75.30R 75.30R
9487 ADDITIONAL CHARGE FOR EACH WELDING JOINT - - - 247.60R 247.60R
9489 ADDITIONAL CHARGE FOR FITTING SWING LOCK - - - 202.30R 202.30R
9491 ADDITIONAL CHARGE FOR EACH BACKING CAST - - - 198.00R 198.00R
Trf Code TariffDescription
*Pre-
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Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9493
ADDITIONAL CHARGE FOR EACH STEELS BACKING OR
PONTIC CAST (PLASTIC WORK TO BE CHARGED IN
ADDITION) - - - 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
9497
BASIC FEE IF A NEW SECTION IS TO BE FABRICATED AND
WHERE ITEM 9495 DOES NOT APPLY (9301) - - - 355.20R 355.20R
9501 CERAMIC JACKET CROWN/CEROMER CROWN OR PONTIC * - - - 1 362.70R 1 362.70R
9502 CERAMIC METAL SUBSTITUTE COPING * - - - 1 100.10R 1 100.10R
9505 CERAMIC BONDED CROWN OR PONTIC * - - 1 697.90R 1 799.70R 1 799.70R
9507 POST-SOLDER INVESTED JOINT, PER JOINT - - - 368.20R 368.20R
9511 INLAY IN PORCELAIN VENEER CROWN - - - - -
9512 CERAMIC, INLAY/ONLAY, BRIDGE RETAINER * - - - * *
9513 CERAMIC POST * - - - * *
9515
PORCELAIN SHOULDER PER UNIT (NOT APPLICABLE TO
PONTICS) - - 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
9521 FULL METAL CROWN, MOD, THREE-QUARTER CROWN * - - - 1 112.90R 1 112.90R
9524 INDIRECT COMPOSITE RESIN INLAY - - - - -
9525 CLASS IV, MO, DO, CERVICAL/OCCLUSAL INLAY * - - - 917.10R 917.10R
9526
ADDITIONAL FEE FOR ONE PIECE CASTING OF CROWN OR
INLAY ON POST - - - 279.90R 279.90R
9531 PIN-LEDGE INLAY - - - - -
9533 FULL METAL PONTIC * - - - 822.30R 822.30R
9535 ABUTMENT THIMBLE CAST - - - 770.70R 770.70R
9537 PRECISION LOCK AND REST CAST - - - - -
9538 LOCK AND REST CAST - - - - -
9539 CASTING OF REST ONLY - - - 312.10R 312.10R
9541 METAL INLAY OR POST, CAST DIRECT - - - - -
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9543 GOLD/PRE-SOLDER INVESTED JOINT - - - - -
9545 CAST POST WITH THIMBLE, INDIRECT * - - - 548.90R 548.90R
9546 MULTIPLE POST * - - - 908.40R 908.40R
9547
MANUFACTURE CAST POST AND CORE TO EXISTING
CROWN * - - - 716.90R 716.90R
9549 C.S.P. ATTACHMENT (STEIGER) - - - - -
9550 MILLING MILLED EDGE PER UNIT - - - 770.70R 770.70R
9551 TELESCOPE CROWN - - - - -
9553 COMPOSITE/ACRYLIC VENEER CROWN/PONTIC, INDIRECT * - - - 1 517.70R 1 517.70R
9557 COMPOSITE/ACRYLIC JACKET CROWN, INDIRECT * - - - 1 072.10R 1 072.10R
9559 COMPOSITE/ACRYLIC VENEER POST CROWN * - - - 1 500.40R 1 500.40R
9560 INDIRECT COMPOSITE RESIN VENEER - - - - -
9561 COMPOSITE/ACRYLIC JACKET CROWN, DIRECT * - - - 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
9566 PORCELAIN/ CEROMER FACING REPLACED - - - 1 104.40R 1 104.40R
9569 WAXING OF CROWN TO EXISTING DENTURE - - - 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 544.70R 544.70R 544.70R 544.70R 544.70R
9572 BASIC CHARGE NON ACRYLIC BASE - 262.60R - 262.60R -
9573
ADDITIONAL CHARGE FOR FITTING FIRST EXPANSION
SCREW - 103.40R - 103.40R -
9575
ADDITIONAL FEE FOR FITTING SUBSEQUENT EXPANSION
SCREWS - 88.30R - 88.30R -
9576 ADDITIONAL FEE FOR FULL ACLUSAL BITE PLATE 305.70R 305.70R 305.70R 305.70R 305.70R
9577 ADDITIONAL FEE FOR BITE PLATE ANTERIOR 103.40R 103.40R - 103.40R 103.40R
9578 ADDITIONAL FEE FOR BITE PLATE POSTERIOR 103.40R 103.40R - 103.40R 103.40R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9579 ADDITIONAL FEE FOR FITTING TONGUE GUARD - 129.20R - 129.20R -
9581 ADDITIONAL FEE FOR FLAT OR INCLINED PLANE - 79.60R - 79.60R -
9583 ADDITIONAL FEE FOR ADAMS CRIB - 94.70R - 94.70R -
9585 ADDITIONAL FEE FOR JACKSON CRIB - 99.10R - 99.10R -
9587 ADDITIONAL FEE FOR BALL CLASP 111.90R 111.90R 111.90R 111.90R -
9589 ADDITIONAL FEE FOR SINGLE ARM CLASP - 86.10R - 86.10R -
9591 ADDITIONAL FEE FOR DOUBLE ARM CLASP - 150.70R - 150.70R -
9593 ADDITIONAL FEE FOR FITTING SINGLE LOOP FINGER SPRING - 71.10R - 71.10R -
9595
ADDITIONAL FEE FOR FITTING DOUBLE LOOP FINGER
SPRING - 83.90R - 83.90R -
9597 ADDITIONAL FEE FOR FITTING BUCCAL RETRACTION SPRING - 62.40R - 62.40R -
9599 ADDITIONAL FEE FOR FITTING APRON SPRING - 161.50R - 161.50R -
9603 ADDITIONAL FEE FOR FITTING COFFIN SPRING - 155.00R - 155.00R -
9605 ADDITIONAL FEE FOR FITTING QUAD HELIX - 172.20R - 172.20R -
9607 ADDITIONAL FEE FOR FITTING FLAPPER OR “T”-SPRING - 129.20R - 129.20R -
9609
ADDITIONAL FEE FOR FITTING ALL SPRINGS WITH TUBING,
EACH - 144.20R - 144.20R -
9611 ADDITIONAL FEE FOR FITTING LABIAL ARCH - 81.80R - 81.80R -
9613 ADDITIONAL FEE FOR FITTING BUCCAL ARCH - 96.90R - 96.90R -
9615 ADDITIONAL FEE FOR FITTING ROBERTS RETRACTOR - 180.80R - 180.80R -
9617 INVISIBLE RETAINER - - - - -
9619
ADDITIONAL FEE FOR FITTING TWIN WIRE ARCH EXTRA-
ORAL ARCH - 226.00R - 226.00R -
9620 ADDITIONAL FEE LIP BUMPER - 94.70R - 94.70R -
9621 ADDITIONAL FEE FOR FITTING EXTRA-ORAL ARCH - 215.30R - 215.30R -
9622 ADDITIONAL FEE FOR FITTING SPACE MAINTAINER ARCH - 94.70R - 94.70R -
9623 ADDITIONAL FEE FOR EACH SPOT-WELDING JOINT - 43.10R - 43.10R -
9625 ADDITIONAL FEE FOR EACH SOLDERING JOINT - 68.90R - 68.90R -
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9627 ADDITIONAL FEE FOR EACH INVESTED SOLDERING JOINT - 191.60R - 191.60R -
9629 ADDITIONAL FEE FOR EACH HOOK FOR ELASTIC TRACTION - 62.40R - 62.40R -
9631 MOUTH PROTECTOR (GUM GUARD) - - - - -
9633 ORAL SCREEN 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
9637 TOOTH POSITIONER - 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
9641 FRANKEL APPLIANCE - 1 317.40R - 1 317.40R -
9643 CHIN CAP - 437.00R - 437.00R -
9645 BIONATOR - 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 -
9653
PINCHED OR SWAGED BAND WITH SOLDERED
ATTACHMENT - 344.40R - 344.40R -
9662
ADDITIONAL FEE FOR EACH 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
9702 DIATORICS, ODDS, ANTERIOR - - 73.30R 73.30R 73.30R
9704 DIATORICS, ODDS, POSTERIOR - - 73.30R 73.30R 73.30R
9706 COST OF BLEACHING TRAY MATERIAL - - - - -
9720 SOFT BASE MATERIAL PER DENTURE - - 779.30R 779.30R 779.30R
9722 ACRYLIC PER DENTURE 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
9728 COST OF LINGUAL / PALATAL BAR - - - 176.40R 176.40R
9729 COST OF MESH STRENGTHENER - - - 92.60R 92.60R
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9730
COST OF PRE-FABRICATED BURN-OUT COMPONENT, PER
COMPONENT - - - 91.70R 91.70R
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
9739 ADDITIONAL CHARGE GOLD PLATING - - - - -
9740 COST OF GOLD WIRE, PER GRAM - - - - -
9741 COST OF COBALT CHROME CASTING ALLOY - - - 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 * - - * * *
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
9757 CEROMER MATERIAL - PER UNIT * - - - 1 100.00R 1 100.10R
9758 FIBER RE-ENFORCED MATERIAL PER UNIT - 362.40R 362.40R 362.40R 362.40R
9759 FIBRE POST * - - - * *
9760 COMPOSITE RESTORATION MATERIAL - - - - -
9761 CERAMIC MATERIAL - - - - -
9762
COST OF ANTERIOR ORTHODONTIC ATTACHMENT, PER
ATTACHMENT - 32.10R - 32.10R -
9763 ORTHODONTIC MATERIAL 32.10R 32.10R - 32.10R -
9764
COST OF POSTERIOR ORTHODONTIC ATTACHMENT, PER
ATTACHMENT - 32.10R - 32.10R -
9765 PREFORMED COMPONENTS - 17.20R - 17.20R 17.20R
9766 COST OF EXPANSION SCREW, PER SCREW - 36.60R - 36.60R -
Trf Code TariffDescription
*Pre-
authorisation
required
Maxillo-Facial
& Oral
Surgery (62)
Orthodontic
(64)
Periodontic
(92)
Dental
Technician
(93)
Prostondontic
(94)
9767 SOLDERING MATERIAL - 8.60R - 8.60R 8.60R
9768 COST OF BUCCAL TUBE/TRANSFER TUBE, PER TUBE - - - - -
9770 COST OF J-HOOK, PER HOOK - 34.40R - 34.40R -
9772 COST OF LINGUAL BUTTONS, PER BUTTON - 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 - 8.60R - 8.60R -
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 - - 307.90R 307.90R 307.90R
9787
WAXING, MILLING AND FINISHING OF A CUSTOM
ABUTMENT - - - 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 - - - 1 199.00R 1 199.00R