medshield 2020 dental tariffs - specialists & dental ...€¦ · 8162 topical application of...

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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.


*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


*Pre-

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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


OF VIEW OF ONE FULL ARCH - MANDIBLE 378.39R 378.39R 378.39R 378.39R

8196


OF VIEW OF ONE FULL ARCH - MAXILLA WITHOUT ORBITS

AND/OR CRANIUM 378.39R 378.39R 378.39R 378.39R

8197


OF VIEW OF BOTH DENTAL ARCHES - WITHOUT ORBITS



*Pre-

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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


OF VIEW OF ONE FULL ARCH - MAXILLA WITH ORBITS


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 - - - - -


*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


*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


*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


*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 - - - - -


*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


*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 - - - - -


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Surgery (62)

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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


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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 - -


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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 - - -


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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


MODERATE * - * - - -

8876


CLASS 1 MODERATE * - * - - -

8877


SEVERE * - * - - -

8878


CLASS 1 SEVERE * - * - - -


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8879


SEVERE W/ COMPLICATIONS * - * - - -

8880


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

8881

ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 2/3

MILD * - * - - -

8882


CLASS 2/3 MILD * - * - - -

8883


MODERATE * - * - - -

8884


CLASS 2/3 MODERATE * - * - - -

8885


SEVERE * - * - - -

8886


CLASS 2/3 SEVERE * - * - - -

8887


SEVERE W/ COMPLICATIONS * - * - - -

8888


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 - - - -


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Surgery (62)

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Technician

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(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 - -


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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


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Technician

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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 * * - - - -


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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 * * - - - -


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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 * - - - - *


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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 * - - - - *


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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) * - - - - *


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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 * * - - - -


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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


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


9252

REPAIR CLEFT LIP - UNILATERAL W/ MUSCLE


9254

REPAIR CLEFT LIP - BILATERAL W/O MUSCLE


9256

REPAIR CLEFT LIP - BILATERAL W/ MUSCLE


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 * * - - - -


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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


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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


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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


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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


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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


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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


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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 - - - - -


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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


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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 -


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Surgery (62)

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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


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Surgery (62)

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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 -


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Maxillo-Facial

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Surgery (62)

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Technician

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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

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