| 1 |
ADMINISTRATION |
|
| 2 |
New Patient |
25.000 |
| 3 |
Old Patients |
10.000 |
| 4 |
|
|
| 5 |
DRUG, GENERAL MAINTENANCE, ADDITIONAL CARE & OTHER |
|
| 6 |
Consultation (No Inspection) |
0 / Free |
| 21 |
Drug Costs |
50.000 |
| 22 |
Minosep Mouthwash 0,1% 60 ml (Green) |
40.000 |
| 23 |
Consultation, Dental Checkup + Intra Oral Camera |
115.000 |
| 24 |
Intra Oral Camera |
50.000 |
| 25 |
Teeth Scaling |
350.000 |
| 26 |
Fluoride |
60.000 |
| 27 |
Dental Curettage |
275.000 |
| 30 |
Root Planing |
250.000 |
| 31 |
Occlusal Adjustment |
165.000 |
| 32 |
Ties App (Metronidazole) |
165.000 |
| 33 |
Apliasi Tooth Mousse |
115.000 |
| 34 |
NaOCl irrigation, H2O2 |
115.000 |
| 35 |
Dental Fissure Sealant |
280.000 |
| 39 |
Topical Fluoride |
250.000 |
| 40 |
Fiber pegs |
290.000 |
| 43 |
Mouth Guard |
775.000 |
| 44 |
Plate TMJ |
775.000 |
| 45 |
Gummy Smile |
525.000 |
| 46 |
Temporary Crown |
265.000 |
| 47 |
Addition of Standard Loose Dentures (1 GIGI) |
260.000 |
| 51 |
Addition of Ortholux Removable Dentures (1 GIGI) |
360.000 |
| 52 |
Alginate Print (1 Jaw) |
110.000 |
| 53 |
Alginate Print (2 Jaw) |
200.000 |
| 54 |
Orthokit |
50.000 |
| 58 |
|
|
| 59 |
TOOTH ROOT CANAL TREATMENT & DENTAL FILLINGS |
|
| 65 |
Temporary Dental Fillings |
225.000 |
| 67 |
Single Root Canal Sterilization |
250.000 |
| 68 |
Double Root Canal Sterilization |
300.000 |
| 77 |
Anesthesia |
150.000 |
| 78 |
Open Bur |
225.000 |
| 87 |
Root Canal Filling |
285.000 |
| 88 |
Small GIC Dental Fillings |
280.000 |
| 89 |
Large GIC Dental Fillings |
330.000 |
| 90 |
Small Composite Dental Fillings |
305.000 |
| 91 |
Medium Composite Dental Fillings |
325.000 |
| 92 |
Large Composite Dental Fillings |
360.000 |
| 93 |
Sandwich Method Tooth Filling |
475.000 |
| 94 |
Front Teeth Fillings |
770.000 |
| 95 |
Root Canal Filling & Dental Fillings |
740.000 |
| 96 |
|
|
| 97 |
TOOTH EXtraction |
|
| 98 |
Milk Tooth Extraction Without Injections |
200.000 |
| 99 |
Extraction of Milk Teeth by Injection |
225.000 |
| 100 |
Adult Tooth Extraction 1 Will (Including Medicine) |
300.000 |
| 101 |
Adult Tooth Extraction more 1 Will (Including Medicine) |
350.000 |
| 102 |
Extraction of adult teeth with complicating factors |
530.000 |
| 103 |
Cancel tooth extraction after anesthesia |
175.000 |
| 104 |
Cancel Tooth Extraction without Anesthesia |
150.000 |
| 105 |
|
|
| 106 |
CHILDREN'S DENTAL CARE |
|
| 107 |
Fissure Sealant |
|
| 108 |
Fissure Sealant for Children's Milk Teeth |
280.000 |
| 109 |
Fissure Sealant for Adolescent Permanent Teeth |
325.000 |
| 110 |
Remineralising Agents |
300.000 |
| 125 |
Children's Mouth Guard |
775.000 |
| 143 |
Space Maintainer |
775.000 |
| 144 |
Stainless Steel Crown |
25.000 |
| 145 |
Celluloid Crown |
25.000 |
| 146 |
|
|
| 147 |
VENEER GIGI |
|
| 148 |
Veneer Gigi Composite Direct |
770.000 |
| 149 |
Veneer Gigi All Porcelain Emax |
3.225.000 |
| 150 |
Veneer Gigi All Porcelain Zirconia |
3.525.000 |
| 151 |
Opaquer |
250.000 |
| 152 |
Lepas Veneer Composite Direct |
165.000 |
| 153 |
Remove Porcelain Veneers |
275.000 |
| 154 |
|
|
| 156 |
MOUTH SURGERY |
|
| 157 |
(WITH THE AGREEMENT OF THE DENTIST SP. BM) |
|
| 158 |
Adult Tooth Extraction |
1.000.000 - 1.500.000 |
| 159 |
Odontectomy / Wisdom Teeth Surgery |
2.000.000 - 3.500.000 |
| 160 |
(Includes sewing and sponge) |
- |
| 161 |
Wisdom Teeth Frenectomy |
1.500.000 - 2.000.000 |
| 162 |
Gingivectomy |
200.000 |
| 164 |
Single Root Apex Resection Surgery |
1.550.000 |
| 165 |
Dental Implants |
20.000.000 |
| 166 |
Frenectomy |
1.550.000 |
| 167 |
Operculectomy |
800.000 |
| 168 |
Mucocel |
800.000 |
| 169 |
|
|
| 170 |
FULL DENTURE or FULL FALSE TEETH 4 - 10 DAY |
|
| 171 |
Full Denture Acrylic Material 1 Jaw |
3.550.000 |
| 172 |
Full Denture Acrylic Material 2 Jaw |
6.550.000 |
| 173 |
Full Denture Bahan Thermosens 1 Jaw |
4.550.000 |
| 174 |
Full Denture Bahan Thermosens 2 Jaw |
8.550.000 |
| 175 |
|
|
| 176 |
EXPRESS FALSE TEETH or MISSING DISHES 1 - 3 DAY |
|
| 177 |
Acrylic Dentures & 1 Gigi |
1.400.000 |
| 178 |
Valplast Material Dentures / Flexy & 1 Gigi |
1.900.000 |
| 179 |
Thermosens Material Dentures & 1 Gigi |
2.360.000 |
| 180 |
|
|
| 181 |
FALSE TEETH or MISSING DISHES 3 - 6 DAY |
|
| 182 |
Acrylic Dentures & 1 Gigi |
1.160.000 |
| 183 |
Valplast Material Dentures / Flexy & 1 Gigi |
1.400.000 |
| 184 |
Thermosens Material Dentures & 1 Gigi |
1.860.000 |
| 185 |
|
|
| 186 |
PERMANENT FALSE TEETH, CROWN, BRIDGE or PORCELAIN VENEER 4 - 7 DAY |
|
| 187 |
Metal Porcelain Permanent Dentures (PFM) |
2.500.000 |
| 188 |
Permanent Dentures / Veneer All Porcelain Emax |
3.500.000 |
| 189 |
Permanent Dentures / Veneer All Porcelain Zirconia |
4.000.000 |
| 190 |
|
|
| 191 |
DENTAL WIRE, ORTHODONTICS or DENTAL BRACES |
|
| 192 |
Metal Braces USA (1 Jaw) |
3.000.000 |
| 193 |
Metal Braces USA (2 Jaw) |
6.000.000 |
| 194 |
Behel Ceramic USA (1 Jaw) |
4.500.000 |
| 195 |
Behel Ceramic USA (2 Jaw) |
9.000.000 |
| 196 |
USA Mini Metal Braces (1 Jaw) |
3.750.000 |
| 197 |
USA Mini Metal Braces (2 Jaw) |
7.500.000 |
| 198 |
USA Mini Ceramic Braces (1 Jaw) |
4.750.000 |
| 199 |
USA Mini Ceramic Braces (2 Jaw) |
9.500.000 |
| 200 |
AO Metal Braces |
8.000.000 |
| 201 |
Self Ligating Braces |
10.000.000 |
| 202 |
Behel Self Ligating Clear |
15.000.000 |
| 203 |
Behel Self Ligating Damon 3M |
22.000.000 |
| 204 |
Behel Self Ligating Clear AO |
22.000.000 |
| 205 |
|
|
| 206 |
DENTAL BRACE CONTROL |
|
| 207 |
Metal Braces Control / Ceramic (2 Jaw) |
210.000 |
| 208 |
Metal Braces Control / Ceramic (1 Jaw) |
160.000 |
| 209 |
Lem Bracket (1 Bracket) |
65.000 |
| 210 |
Ganti Bracket Metal / Ceramic (1 Bracket) |
60.000 |
| 211 |
Self Lighting Stirrup Control / Damon + Teeth Scaling |
385.000 |
| 212 |
Lem Bracket Self Lighting / Damon (1 Bracket) |
110.000 |
| 213 |
Ganti Bracket Self Lighting / Damon (1 Bracket) |
360.000 |
| 214 |
Post Bite Composite |
305.000 |
| 215 |
Post Bite GIC |
280.000 |
| 216 |
Lem Gic Ortho |
100.000 |
| 217 |
Elastic Rubber |
25.000 |
| 218 |
Ortho Toothbrush |
30.000 |
| 219 |
Ortho Fir Toothbrush |
15.000 |
| 220 |
Wax Ortho |
15.000 |
| 221 |
|
|
| 222 |
EXPRESS RETAINER GIGI - 1 BIRTHDAY |
|
| 223 |
Clear Retainer (2 Jaw) |
1.700.000 |
| 224 |
Clear Retainer (1 Jaw) |
1.250.000 |
| 225 |
|
|
| 226 |
RETAINER GIGI |
|
| 227 |
Hawley Retainer (2 Jaw) |
1.800.000 |
| 228 |
Hawley Retainer (1 Jaw) |
900.000 |
| 229 |
Clear Retainer (2 Jaw) |
1.400.000 |
| 230 |
Clear Retainer (1 Jaw) |
950.000 |
| 231 |
Lingual Retainer (1 Jaw) |
2.000.000 |
| 232 |
|
|
| 233 |
ORTHODONTICS, DENTAL WIRE, or LOOSE TEETH RING |
|
| 234 |
Removable Ortho (1 Jaw) |
775.000 |
| 235 |
Removable Ortho (2 Jaw) |
1.525.000 |
| 236 |
Removable Ortho Control (1 Jaw) |
160.000 |
| 237 |
Removable Ortho Control (2 Jaw) |
210.000 |
| 238 |
|
|
| 239 |
BEHEL REMOVAL PACKAGE |
|
| 240 |
Take off the strap, Clean the Glue (1 Jaw) |
300.000 |
| 241 |
Take off the strap, Clean the Glue (2 Jaw) |
600.000 |
| 242 |
Take off the strap, Clean the Glue & Tartar (1 Jaw) |
500.000 |
| 243 |
Take off the strap, Clean the Glue & Tartar (2 Jaw) |
975.000 |
| 246 |
Take off the strap, Clean the Glue & Tartar, Retainer Clear (1 Jaw) |
1.560.000 |
| 247 |
Take off the strap, Clean the Glue & Tartar, Retainer Clear (2 Jaw) |
2.485.000 |
| 248 |
|
|
| 249 |
MOVING CONTROL BEHEL or PATIENT OUTSIDE |
|
| 250 |
Metal Braces Control (1 Jaw) |
210.000 |
| 251 |
Metal Braces Control (2 Jaw) |
260.000 |
| 252 |
Bracket Glue (1 Bracket) |
115.000 |
| 253 |
Replace Bracket (1 Fruit) |
110.000 |
| 254 |
Ceramic Braces Control, Sapphire, Damon or Empower Metal (1 Jaw) |
210.000 |
| 255 |
Ceramic Braces Control, Sapphire, Damon or Empower Metal (2 Jaw) |
260.000 |
| 256 |
Lem Bracket Ceramic, Sapphire, Damon or Empower Metal (1 Bracket) |
115.000 |
| 257 |
Replace Ceramic or Sapphire Bracket (1 Bracket) |
250.000 |
| 258 |
Replace Damon or Empower Metal Bracket & Clear (1 Bracket) |
350.000 |
| 259 |
Take off the strap, Clean the Glue (1 Jaw) |
300.000 |
| 260 |
Take off the strap, Clean the Glue (2 Jaw) |
600.000 |
| 261 |
Replace Orthodontic Wires (1 Fruit) |
30.000 |
| 262 |
Slicing Double Abrasif (1 Fruit) |
30.000 |
| 263 |
Open Coil Spring (1 Fruit) |
30.000 |
| 265 |
Lip Bumper Material (1 Fruit) |
30.000 |
| 266 |
Glue Ring or Mollar Band (1 Fruit) |
280.000 |
| 267 |
|
|
| 268 |
WHITENING TEETH or BLEACHING TEETH WITH LIGHTS |
|
| 269 |
Teeth Bleaching |
1.700.000 |
| 270 |
Teeth Bleaching Package, Teeth Scaling & Polising |
2.050.000 |
| 271 |
Teeth Bleaching Package, Teeth Scaling & Protection |
3.500.000 |
| 272 |
|
|
| 273 |
SPLINTING or OVERCOMING MOBILE TEETH |
|
| 274 |
Splinting with Dental Composite Resin |
280.000 |
| 275 |
Splinting with a Combination of Composite Resin and Dental Wire |
335.000 |
| 276 |
Splinting with a Combination of Composite Resin and Dental Fiber |
430.000 |
| 277 |
|
|
| 278 |
OBTURATOR |
|
| 279 |
Acrylic Obturator |
775.000 |
| 280 |
Metal Frame Obturator (Double Impression) |
2.225.000 |
| 281 |
Obturator Essix, Clear or Transparent |
775.000 |