medshield dental network - tariff file 2017 - final guides/2017/medshield dental network... · 8108...

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Trf Code TariffDescription Auth Indicator 54 95 113

8025 HANDLING FEE - DIRECT MATERIALS (26% OF MATERIAL COST TO A MAXIMUM OF R26.00)35.80R - -

8101 ORAL EXAMINATION 199.60R 103.90R 199.60R

8102 COMPREHENSIVE ORAL EXAMINATION 322.50R 167.70R -

8104 LIMITED ORAL EXAMINATION 96.80R 80.90R 96.80R

8106 SPECIAL REPORT 204.90R - -

8107 INTRAORAL RADIOGRAPH - PERIAPICAL 80.90R 77.90R 82.40R

8108 INTRAORAL RADIOGRAPHS - COMPLETE SERIES 625.50R 634.20R 634.20R

8109 INFECTION CONTROL/BARRIER TECHNIQUES 18.00R 18.00R 19.00R

8110 STERILIZED INSTRUMENTATION 46.40R 46.30R 49.00R

8112 INTRAORAL RADIOGRAPH - BITEWING 80.90R 77.90R 80.90R

8113 INTRAORAL RADIOGRAPH - OCCLUSAL 139.20R 133.90R 139.20R

8114 EXTRAORAL RADIOGRAPH - HAND-WRIST 323.10R - 323.10R

8115 EXTRAORAL RADIOGRAPH - PANORAMIC 323.10R 311.60R 256.30R

8116 EXTRAORAL RADIOGRAPH - CEPHALOMETRIC 323.10R 311.60R 323.10R

8117 DIAGNOSTIC MODELS 86.80R 88.40R 88.40R

8118 EXTRAORAL RADIOGRAPH - SKULL/FACIAL BONE 323.10R - -

8119 DIAGNOSTIC MODELS MOUNTED 218.40R - -

8120 TREATMENT PLAN COMPLETED * - -

8121 ORAL AND/OR FACIAL IMAGE (DIGITAL/CONVENTIONAL) 86.80R 83.50R 88.40R

8123 CARIES SUSCEPTIBILITY TESTS (BY ARRANGEMENT) 90.20R - -

8124 PULP TESTS 23.80R - -

Medshield Dental Network Tariff Files 2017

Where "YES" is indicated authorisation is required in order for the tariff amount to be paid

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

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

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

If the clinical code requires managed care intervention, all associated lab codes will be included in the authorisation process.

Pre-authorisation is required for the dental code to attract benefit

Tariff amount not applicable


8129 OFFICE/HOSPITAL VISIT – AFTER REGULARLY SCHEDULED HOURS 300.70R 249.30R -

8131 EMERGENCY DENTAL TREATMENT 122.60R 103.90R 109.90R

8132 PULP REMOVAL (PULPECTOMY) 200.50R - -

8133 RECEMENT INLAY, ONLAY, CROWN OR VENEER 122.60R - -

8135 REMOVE INLAY, ONLAY OR CROWN 243.90R - -

8136 ACCESS THROUGH A PROSTHETIC CROWN OR INLAY TO FACILITATE ROOT CANAL TREATMENT109.20R - -

8137 EMERGENCY CROWN (CHAIR-SIDE) 420.30R - -

8138 REMOVE RETENTION POST (PREFABRICATED OR CAST) 160.00R - -

8139 APPOINTMENT NOT KEPT /30MIN * - -

8140 HOUSE/EXTENDED CARE FACILITY/HOSPITAL CALL Yes 199.00R 164.90R -

8141 INHALATION SEDATION - FIRST 15 MINUTES OR PART THEREOF 89.80R - -

8143 INHALATION SEDATION - EACH ADDNL 15 MINUTES 46.40R - -

8144 INTRAVENOUS SEDATION Yes 53.80R - -

8145 LOCAL ANAESTHETIC - PER VISIT 77.90R 17.70R 18.70R

8146 RESIN BONDING FOR RESTORATIONS 1.38R 1.39R -

8147 MONITORING EQUIPMENT FOR INTRAVENOUS SEDATION 191.50R - -

8151 ORAL HYGIENE INSTRUCTION 122.60R 81.50R 86.30R

8153 ORAL HYGIENE INSTRUCTION - EACH ADDITIONAL VISIT 89.80R 59.70R 63.20R

8154 ORAL EXAMINATION - ORAL HYGIENIST - - 109.90R

8155 POLISHING - COMPLETE DENTITION 122.60R 99.70R 105.50R

8157 RE-BURNISHING AND POLISHING OF RESTORATIONS - COMPLETE DENTITION 122.60R - -

8158 ENAMEL MICROABRASION 112.10R - -

8159 PROPHYLAXIS - COMPLETE DENTITION 240.90R 181.70R 192.20R

8160 REMOVAL OF GROSS CALCULUS * - -

8161 TOPICAL APPLICATION OF FLUORIDE - CHILD 122.60R 99.70R 105.50R

8162 TOPICAL APPLICATION OF FLUORIDE - ADULT 122.60R 99.70R 78.10R

8163 DENTAL SEALANT 80.90R 73.80R 85.60R

8164 LIMITED ORAL EXAMINATION - ORAL HYGIENIST - - 109.90R

8165 SEDATIVE FILLING 122.60R 103.90R 72.50R

8166 APPLICATION OF DESENSITISING RESIN, PER TOOTH 80.90R 68.60R 84.60R

8167 APPLICATION OF DESENSITISING MEDICAMENT, PER VISIT 94.30R 79.90R 113.10R


8169 OCCLUSAL GUARD 471.20R - -

8171 MOUTH PROTECTOR 142.60R - 133.30R

8172 COST OF ORTHOTIC APPLIANCE Yes * - -

8173 SPACE MAINTAINER - FIXED, PER ABUTMENT 227.50R - -

8175 SPACE MAINTAINER - REMOVABLE 293.30R - -

8176 PERIODONTAL SCREENING 168.20R - 111.60R

8177 ORAL HYGIENE INSTRUCTION (PERIODONTALLY COMPROMISED PATIENT) 185.60R - -

8178

ORAL HYGIENE INSTRUCTION - EACH ADDITIONAL VISIT (PERIODONTALLY COMPROMISED

PATIENT)100.20R - -

8179 POLISHING - COMPLETE DENTITION (PERIODONTALLY COMPROMISED PATIENT) 140.70R - 111.60R

8180 PROPHYLAXIS - COMPLETE DENTITION (PERIODONTALLY COMPROMISED PATIENT) Yes 261.80R - 153.80R

8183 THERAPEUTIC DRUG INJECTION 53.80R - -

8189 RE-EXAMINATION - EXISTING CONDITION 96.80R 80.90R 85.60R

8190 CONSULTATION - SECOND OPINION OR ADVICE 199.60R - -

8192 SUTURE - MINOR 604.40R - -

8201 EXTRACTION - TOOTH OR EXPOSED TOOTH ROOTS (FIRST PER QUADRANT) 122.60R 116.30R -

8202 EXTRACTION - EACH ADDITIONAL TOOTH OR EXPOSED TOOTH ROOTS 49.40R 44.90R -

8213 SURGICAL REMOVAL OF RESIDUAL ROOTS, FIRST TOOTH PER QUADRANT 529.70R - -

8214 SURGICAL REMOVAL OF RESIDUAL ROOTS, SECOND AND SUBSEQUENT TEETH''S ROOTS 408.40R - -

8220 COST OF SUTURE MATERIAL 192.20R 192.20R -

8228 ART RESTORATIONS - - 225.10R

8231 COMPLETE DENTURES - MAXILLARY AND MANDIBULAR 1 977.80R - -

8232 COMPLETE DENTURE - MAXILLARY OR MANDIBULAR 1 219.30R - -

8233 PARTIAL DENTURE - RESIN BASE - ONE TOOTH 566.90R - -

8234 PARTIAL DENTURE - RESIN BASE - TWO TEETH 566.90R - -

8235 PARTIAL DENTURE - RESIN BASE - THREE TEETH 848.30R - -

8236 PARTIAL DENTURE - RESIN BASE - FOUR TEETH 848.30R - -

8237 PARTIAL DENTURE - RESIN BASE - FIVE TEETH 848.30R - -

8238 PARTIAL DENTURE - RESIN BASE - SIX TEETH 1 125.20R - -

8239 PARTIAL DENTURE - RESIN BASE - SEVEN TEETH 1 125.20R - -

8240 PARTIAL DENTURE - RESIN BASE - EIGHT TEETH 1 125.20R - -

8241 PARTIAL DENTURE - RESIN BASE - NINE OR MORE TEETH 1 125.20R - -


8244 IMMEDIATE DENTURE - MAXILLARY 1 219.30R - -

8245 IMMEDIATE DENTURE - MANDIBULAR 1 219.30R - -

8251 CLASP OR REST - CAST GOLD 112.10R - -

8253 CLASP OR REST - WROUGHT GOLD 112.10R - -

8255 CLASP OR REST - STAINLESS STEEL 118.10R - -

8257 BAR - LINGUAL OR PALATAL 139.20R - -

8259 REBASE COMPLETE OR PARTIAL DENTURE (LABORATORY) 462.20R - -

8261 REMODEL COMPLETE OR PARTIAL DENTURE 742.10R - -

8263 RELINE COMPLETE OR PARTIAL DENTURE (CHAIR-SIDE) 293.30R - -

8265 TISSUES CONDITIONING PER ARCH (INCLUDING SOFT SELF-CURE RELINE) 191.50R - 152.00R

8267 RELINE COMPLETE OR PARTIAL DENTURE (LABORATORY) 674.80R - -

8269 REPAIR DENTURE OR OTHER INTRA-ORAL APPLIANCE 155.60R - -

8270 ADD CLASP TO EXISTING PARTIAL DENTURE 112.10R - -

8271 ADD TOOTH TO EXISTING PARTIAL DENTURE 112.10R - -

8273 IMPRESSION TO REPAIR OR MODIFY A DENTURE OR OTHER INTRA-ORAL APPLIANCE 89.80R - -

8275 ADJUST COMPLETE OR PARTIAL DENTURE 89.80R - -

8277 INLAY IN DENTURE 372.50R - -

8281 PARTIAL DENTURE - CAST METAL FRAMEWORK ONLY 1 322.70R - -

8301 PULP CAP - DIRECT 163.00R - -

8303 PULP CAP - INDIRECT 163.00R 147.50R -

8304 RUBBER DAM PER ARCH 95.80R - -

8306 COST OF MTA * - -

8307 PULP AMPUTATION (PULPOTOMY) 160.00R - -

8310 SUPPLY OF BLEACHING MATERIALS * - -

8325 INTERNAL BLEACHING - PER TOOTH 290.30R - -

8327 INTERNAL BLEACHING - EACH ADDITIONAL VISIT 139.20R - -

8328 ROOT CANAL OBTURATION - ANTERIORS AND PREMOLARS - EACH ADDITIONAL CANAL 227.50R - -

8329 ROOT CANAL THERAPY - ANTERIORS AND PREMOLARS - EACH ADDITIONAL CANAL 284.30R - -

8330 REMOVAL OF ROOT CANAL OBSTRUCTION 160.00R - -

8332 ROOT CANAL PREPARATORY VISIT - SINGLE CANAL TOOTH 122.60R - -

8333 ROOT CANAL PREPARATORY VISIT - MULTI CANAL TOOTH 172.00R - -


8334 RE-TREATMENT OF PREVIOUSLY COMPLETED ROOT CANAL THERAPY, PER CANAL 181.10R - -

8335 ROOT CANAL OBTURATION - ANTERIORS AND PREMOLARS - FIRST CANAL 556.50R - -

8336 ROOT CANAL OBTURATION - POSTERIORS - FIRST CANAL 765.90R - -

8337 ROOT CANAL OBTURATION - POSTERIORS - EACH ADDITIONAL CANAL 227.50R - -

8338 ROOT CANAL THERAPY - ANTERIORS AND PREMOLARS - FIRST CANAL 851.30R - -

8339 ROOT CANAL THERAPY - POSTERIORS - FIRST CANAL 1 169.80R - -

8340 ROOT CANAL THERAPY - POSTERIORS - EACH ADDITIONAL CANAL 284.30R - -

8341 AMALGAM - ONE SURFACE 243.90R 212.80R -

8342 AMALGAM - TWO SURFACES 300.70R 262.40R -

8343 AMALGAM - THREE SURFACES 366.50R 319.80R -

8344 AMALGAM - FOUR OR MORE SURFACES 408.40R 356.30R -

8345 PREFABRICATED POST RETENTION, PER POST (IN ADDITION TO RESTORATION) 240.90R - -

8347 PIN RETENTION - FIRST PIN (IN ADDITION TO RESTORATION) 121.10R - -

8348 PIN RETENTION - EACH ADDITIONAL PIN (IN ADDITION TO RESTORATION) 112.10R - -

8349 CARVE RESTORATION TO ACCOMMODATE EXISTING REMOVABLE PROSTHESIS 49.40R - -

8350 RESIN CROWN - ANTERIOR PRIMARY TOOTH (DIRECT) 532.00R 464.10R -

8351 RESIN - ONE SURFACE, ANTERIOR 267.70R 257.50R 267.70R

8352 RESIN - TWO SURFACES, ANTERIOR 336.70R 323.70R -

8353 RESIN - THREE SURFACES, ANTERIOR 402.40R 386.80R -

8354 RESIN - FOUR OR MORE SURFACES, ANTERIOR 448.80R 431.70R -

8355 VENEER - RESIN (CHAIR-SIDE) 425.00R - -

8357 PREFABRICATED METAL CROWN 249.80R - -

8361 INLAY - METAL - ONE SURFACE 372.40R - -

8362 INLAY/ONLAY - METAL - TWO SURFACES 544.60R - -

8363 INLAY/ONLAY - METAL - THREE SURFACES 908.10R - -

8364 INLAY/ONLAY - METAL - FOUR OR MORE SURFACES 1 098.10R - -

8366 PIN RETENTION AS PART OF CAST RESTORATION (ANY NUMBER OF PINS) 181.10R - -

8367 RESIN - ONE SURFACE, POSTERIOR 290.30R 279.20R 290.30R

8368 RESIN - TWO SURFACES, POSTERIOR 359.00R 345.30R -

8369 RESIN - THREE SURFACES, POSTERIOR 433.90R 417.10R -

8370 RESIN - FOUR OR MORE SURFACES, POSTERIOR 466.70R 448.70R -


8371 INLAY - PORCELAIN - ONE SURFACE 448.80R - -

8372 INLAY/ONLAY - PORCELAIN - TWO SURFACES 662.70R - -

8373 INLAY/ONLAY - PORCELAIN - THREE SURFACES 1 092.20R - -

8374 INLAY/ONLAY - PORCELAIN - FOUR OR MORE SURFACES 1 322.70R - -

8375 PREFABRICATED RESIN CROWN 249.80R - -

8376 CORE BUILD-UP WITH PREFABRICATED POSTS 667.20R - -

8379 COST OF PREFABRICATED POSTS 93.00R - -

8381 INLAY - RESIN - ONE SURFACE 448.80R - -

8382 INLAY/ONLAY - RESIN - TWO SURFACES 662.70R - -

8383 INLAY/ONLAY - RESIN - THREE SURFACES 1 092.20R - -

8384 INLAY/ONLAY - RESIN - FOUR OR MORE SURFACES 1 322.70R - -

8391 CAST CORE WITH SINGLE POST Yes 281.30R - -

8392 CAST POST (EACH ADDITIONAL) 167.50R - -

8397 CAST CORE WITH PINS (ANY NUMBER OF PINS) Yes 448.80R - -

8398 CORE BUILD-UP WITH PINS 544.60R - -

8401 CROWN - FULL CAST METAL Yes 1 400.30R - -

8403 CROWN - 3/4 CAST METAL Yes 1 400.30R - -

8404 CROWN - 3/4 PORCELAIN/CERAMIC Yes 1 322.40R - -

8405 CROWN - RESIN LABORATORY Yes 1 322.40R - -

8407 CROWN - RESIN WITH METAL Yes 1 400.30R - -

8409 CROWN - PORCELAIN/CERAMIC Yes 1 400.30R - -

8410 PROVISIONAL CROWN 272.20R - -

8411 CROWN - PORCELAIN VENEERED TO METAL Yes 1 400.30R - -

8413 REPAIR CROWN (PERMANENT OR PROVISIONAL) 272.20R - -

8414 ADDITIONAL FEE FOR PROVISION OF CROWN WITHIN AN EXISTING CLASP OR REST 80.90R - -

8415 PONTIC - CERAMIC Yes 1 143.00R - -

8416 PONTIC - CAST METAL Yes 908.10R - -

8417 PONTIC - RESIN WITH METAL Yes 1 143.00R - -

8418 PONTIC - PORCELAIN VENEERED TO METAL Yes 1 143.00R - -

8419 PROVISIONAL PONTIC 272.20R - -

8432 INLAY/ONLAY RETAINER - METAL - TWO SURFACES Yes 544.60R - -


8433 INLAY/ONLAY RETAINER - METAL - THREE SURFACES Yes 908.10R - -

8434 INLAY/ONLAY RETAINER - METAL - FOUR OR MORE SURFACES Yes 1 098.10R - -

8436 INLAY/ONLAY RETAINER - PORCELAIN - TWO SURFACES Yes 662.70R - -

8437 INLAY/ONLAY RETAINER - PORCELAIN - THREE SURFACES Yes 1 092.20R - -

8438 INLAY/ONLAY RETAINER - PORCELAIN - FOUR OR MORE SURFACES Yes 1 322.70R - -

8441 CROWN RETAINER - FULL CAST METAL Yes 1 400.30R - -

8442 CROWN RETAINER - 3/4 CAST METAL Yes 1 400.30R - -

8443 CROWN RETAINER - CERAMIC Yes 1 400.30R - -

8444 CROWN RETAINER - 3/4 CERAMIC Yes 1 400.30R - -

8445 CROWN RETAINER - PORCELAIN VENEERED TO METAL Yes 1 400.30R - -

8446 CROWN RETAINER - RESIN WITH METAL Yes 1 400.30R - -

8447 PROVISIONAL CROWN RETAINER 272.20R - -

8499 GENERAL ANAESTHETIC * - -

8503 OCCLUSION ANALYSIS MOUNTED 272.20R - -

8505 PANTOGRAPHIC RECORDING 395.00R - -

8508 ELECTROGNATHOGRAPHIC RECORDING 422.90R - -

8509 ELECTROGNATHOGRAPHIC RECORDING WITH COMPUTER ANALYSIS 702.10R - -

8514 RECEMENT BRIDGE 122.60R - -

8516 REMOVE BRIDGE 243.90R - -

8517 REIMPLANTATION OF AVULSED TOOTH (INCLUDE STABILISATION) 283.30R - -

8518 REPAIR BRIDGE 272.20R - -

8533 IMPLANT SUPPORTED REMOVABLE COMPLETE OVERDENTURE 2 198.20R - -

8534 IMPLANT SUPPORTED REMOVABLE PARTIAL OVERDENTURE 1 758.50R - -

8536 CROWN-IMPLANT/ABUTMENT SUPPORTED CROWN - PORCELAIN/CERAMIC Yes 1 817.70R - -

8537 CROWN-IMPLANT/ABUTMENT SUPPORTED CROWN - PORCELAIN WITH METAL Yes 1 817.70R - -

8538 CROWN-IMPLANT/ABUTMENT SUPPORTED CROWN - CAST METAL Yes 1 817.70R - -

8546 IMPLANT SUPPORTED CROWN RETAINER - CERAMIC Yes 1 817.70R - -

8547 IMPLANT SUPPORTED CROWN RETAINER - PORCELAIN VENEERED TO METAL Yes 1 817.70R - -

8548 CROWN RETAINER - IMPLANT/ABUTMENT SUPPORTED - CAST METAL Yes 1 817.70R - -

8551 OCCLUSAL ADJUSTMENT - MAJOR 775.90R - -

8552 VENEER - PORCELAIN (LABORATORY) 940.40R - -


8553 OCCLUSAL ADJUSTMENT - MINOR 270.60R - -

8554 VENEER - RESIN (LABORATORY) 940.40R - -

8560 COST OF CERAMIC BLOCK Yes 550.10R - -

8561 GOLD FOIL CLASS I OR IV 710.20R - -

8563 GOLD FOIL CLASS V 830.80R - -

8565 GOLD FOIL CLASS III 1 045.10R - -

8570 FABRICATION OF COMPUTER GENERATED CERAMIC RESTORATION Yes 1 334.40R - -

8578 PREFABRICATED ABUTMENT 227.50R - -

8579 CUSTOM ABUTMENT 1 037.30R - -

8580 CUSTOMISED PREFABRICATED ABUTMENT 423.20R - -

8584 CONNECTOR BAR - IMPLANT SUPPORTED 2 198.20R - -

8585 CONNECTOR BAR 2 198.20R - -

8586 STRESS BREAKER 820.00R - -

8587 COPING METAL 182.60R - -

8590 IMPLANT MAINTENANCE PROCEDURES - PER IMPLANT 100.70R - 80.90R

8592 CROWN - IMPLANT/ABUTMENT SUPPORTED Yes 1 817.50R - -

8594 REPAIR OF IMPLANT SUPPORTED PROSTHESIS 111.70R - -

8595 REPAIR OF IMPLANT ABUTMENT 111.70R - -

8597 LOCKS AND MILLED RESTS 111.70R - -

8599 PRECISION ATTACHMENT (REMOVABLE DENTURE) 272.20R - -

8600 COST OF IMPLANT COMPONENTS Yes * - -

8617 RETAINER CAST METAL (MARYLAND TYPE RETAINER) Yes 544.60R - -

8635 APEXIFICATION/APEXOGENESIS/RECALCIFICATION – PER VISIT 163.00R - -

8640 REMOVAL OF FRACTURED ROOT CANAL INSTRUMENT 425.10R - -

8652 OVERDENTURE - COMPLETE 2 198.20R - -

8653 OVERDENTURE - PARTIAL 1 758.50R - -

8654 IMPLANT SUPPORTED FIXED-DETACHABLE COMPLETE OVERDENTURE 2 472.50R - -

8655 IMPLANT SUPPORTED FIXED-DETACHABLE PARTIAL OVERDENTURE 1 977.90R - -

8657 REPLACEMENT OF PRECISION ATTACHMENT 155.60R - -

8658 INTERIM COMPLETE DENTURE 1 219.20R - -

8659 INTERIM PARTIAL DENTURE 975.30R - -


8660 ADDITIONAL FEE TO IMPLANT SUPPORTED FIXED-DETACHABLE DENTURE - PER IMPLANT 341.10R - -

8662 ADJUST COMPLETE OR PARTIAL DENTURES (REMOUNTING) 317.30R - -

8663 METAL BASE TO COMPLETE DENTURE 662.30R - -

8664 REMOUNT CROWN OR BRIDGE FOR ADJUSTMENT 317.30R - -

8667 SOFT BASE TO DENTURE (HEAT CURED) 662.30R - -

8672 ALTERED CAST TECHNIQUE (IN ADDITION TO PARTIAL DENTURE) 84.90R - -

8674 ADDITIVE PARTIAL DENTURE 997.50R - -

8723 PROVISIONAL SPLINTING - EXTRACORONAL (WIRE) - PER SEXTANT 227.50R - 227.50R

8725 PROVISIONAL SPLINTING - EXTRACORONAL (WIRE PLUS RESIN) - PER SEXTANT 330.10R - 330.10R

8727 PROVISIONAL SPLINTING - INTRACORONAL - PER TOOTH 103.60R - -

8731 INCISION & DRAINAGE OF ABSCESS - INTRA-ORAL Yes 195.60R - -

8737 ROOT PLANING - FOUR OR MORE TEETH PER QUADRANT Yes 490.80R - 336.30R

8739 ROOT PLANING - ONE TO THREE TEETH PER QUADRANT Yes 390.50R - 309.90R

8741 GINGIVECTOMY/GINGIVOPLASTY - FOUR OR MORE TEETH PER QUADRANT 640.40R - -

8743 GINGIVECTOMY OR GINGIVOPLASTY - ONE TO THREE TEETH PER QUADRANT 511.60R - -

8749 FLAP PROCEDURE, ROOT PLANING AND ONE TO THREE SURGICAL SERVICES - PER QUADRANT1 329.50R - -

8751 FLAP PROCEDURE, ROOT PLANING AND ONE TO THREE SURGICAL SERVICES - PER SEXTANT1 101.10R - -

8753 FLAP PROCEDURE, ROOT PLANING AND FOUR OR MORE SURGICAL SERVICES - PER QUADRANT1 647.80R - -

8755 FLAP PROCEDURE, ROOT PLANING AND FOUR OR MORE SURGICAL SERVICES - PER SEXTANT1 335.40R - -

8756 CLINICAL CROWN LENGTHENING (ISOLATED PROCEDURE) Yes 809.80R - -

8759 PEDICLE FLAPPED GRAFT (ISOLATED PROCEDURE) 608.40R - -

8761 MASTICATORY MUCOSAL AUTOGRAFT - ONE TO FOUR TEETH (ISOLATED PROCEDURE) 661.20R - -

8762 MASTICATORY MUCOSAL AUTOGRAFT - FOUR OR MORE TEETH (ISOLATED PROCEDURE) 993.40R - -

8763 WEDGE RESECTION (ISOLATED PROCEDURE) Yes 389.00R - -

8765

HEMISECTION OF A TOOTH, RESECTION OF A ROOT OR TUNNEL PREPARATION (ISOLATED

PROCEDURE)534.60R - -

8766 BONE REGENERATION/REPAIR PROCEDURE - AS PART OF A FLAP OPERATION 318.20R - -

8767 BONE REGENERATION/REPAIR PROCEDURE - AT A SINGLE SITE 824.90R - -

8768 UNLISTED PERIODONTAL PROCEDURE 389.00R - -


8769 MEMBRANE REMOVAL (USED FOR GUIDED TISSUE REGENERATION) 389.00R - -

8770 COST OF BONE REGENERATIVE/REPAIR MATERIAL * - -

8772 SUBMUCOSAL CONNECTIVE TISSUE AUTOGRAFT (ISOLATED PROCEDURE) 668.20R - -

8773 COST OF INTRAPOCKET CHEMOTHERAPEUTIC AGENT * - -

8787 UNLISTED ORAL MEDICINE PROCEDURE 139.60R - -

8811 TRACING AND ANALYSIS OF EXTRA-ORAL FILM 37.50R - 37.50R

8839 DIAGNOSTIC SETUP 166.60R - -

8840 TREATMENT PLANNING FOR ORTHOGNATHIC SURGERY - ALL 574.40R - -

8841 ORTHO TX - FIXED LINGUAL APPLIANCE - ONE ARCH Yes * - -

8842 ORTHO TX - FIXED LINGUAL APPLIANCE - ONE ARCH, MODEATE Yes * - -

8843 ORTHO TX - FIXED LINGUAL APPLIANCE - ONE ARCH, SEVERE Yes * - -

8846 REPAIR ORTHODONTIC APPLIANCE - REMOVABLE Yes 112.60R - -

8847 REPLACE ORTHODONTIC APPLIANCE - REMOVABLE 389.00R - -

8848 REPAIR ORTHODONTIC APPLIANCE - FIXED 166.60R - -

8849 RETAINER (ORTHODONTIC) 389.00R - -

8850 TREATMENT OF MPDS - FIRST VISIT 187.50R - -

8851 TREATMENT OF MPDS - SUBSEQUENT VISIT 98.70R - -

8852 OCCLUSAL ORTHOTIC APPLIANCE 471.20R - -

8855 CONSULTATION - CLEFT PALATE THERAPY (HOUSE OR HOSPITAL) 227.50R - -

8856 CONSULTATION - CLEFT PALATE (SUBSEQUENT) 111.70R - -

8857 CONSULTATION - CLEFT PALATE (MAXIMUM) 777.00R - -

8858 ORTHO TX - FUNCTIONAL APPLIANCE Yes 2 477.60R - -

8861 ORTHO TX - PARTIAL FIXED APPLIANCE - MINOR Yes 1 647.80R - -

8862 ORTHO TX - REMOVABLE APPLIANCE Yes 1 375.40R - -

8863 ORTHO TX - EACH ADDITIONAL REMOVABLE APPLIANCE Yes 691.20R - -

8865 ORTHO TX - PARTIAL FIXED APPLIANCE - ONE ARCH Yes * - -

8866 ORTHO TX - PARTIAL FIXED APPLIANCE - BOTH ARCHES Yes * - -

8867 ORTHO TX - FIXED APPLIANCE - ONE ARCH Yes * - -

8868 ORTHO TX - FIXED APPLIANCE - ONE ARCH, MODEATE Yes * - -

8869 ORTHO TX - FIXED APPLIANCE - ONE ARCH, SEVERE Yes * - -

8873 ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 1 MILD Yes * - -


8874 ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES, CLASS 1 MILD Yes * - -

8875 ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 1 MODERATE Yes * - -

8876 ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES, CLASS 1 MODERATE Yes * - -

8877 ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 1 SEVERE Yes * - -

8878 ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES, CLASS 1 SEVERE Yes * - -

8879 ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 1 SEVERE W/ COMPLICATIONS Yes * - -

8880 ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES, CLASS 1 SEVERE W/ COMPLICATIONSYes * - -

8881 ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 2/3 MILD Yes * - -

8882 ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES, CLASS 2/3 MILD Yes * - -

8883 ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 2/3 MODERATE Yes * - -

8884 ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES, CLASS 2/3 MODERATE Yes * - -

8885 ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 2/3 SEVERE Yes * - -

8886 ORTHO TX - FIXED LINGUAL APPLIANCE - BOTH ARCHES, CLASS 2/3 SEVERE Yes * - -

8887 ORTHO TX - FIXED APPLIANCE - BOTH ARCHES, CLASS 2/3 SEVERE W/ COMPLICATIONS Yes * - -

8888

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

COMPLICATIONSYes * - -

8890 MONTHLY INSTALMENT ORTHO TX Yes * - -

8891 ORTHODONTIC TRANSFER Yes * - -

8892 ORTHODONTIC RE-TREATMENT Yes * - -

8908 SURGICAL REMOVAL OF ROOTS FROM MAXILLARY ANTRUM 1 619.80R - -

8909 ORAL ANTRAL FISTULA CLOSURE 1 241.80R - -

8911 CALDWELL-LUC PROCEDURE 485.90R - -

8917 BIOPSY OF ORAL TISSUE - SOFT 309.60R - -

8919 BIOPSY OF BONE - NEEDLE Yes 476.70R - -

8921 BIOPSY – EXTRA-ORAL BONE/SOFT TISSUE Yes 780.00R - -

8931 TREATMENT OF POST-EXTRACTION HAEMORRHAGE 89.80R 75.90R -

8933 TREATMENT OF HAEMORRHAGE (BLOOD DYSCRACIAS) 1 241.80R - -

8935 TREATMENT OF SEPTIC SOCKET 89.80R 75.90R -

8937 SURGICAL REMOVAL OF TOOTH 529.70R - -

8941 SURGICAL REMOVAL OF IMPACTED TOOTH - FIRST TOOTH 878.30R - -

8943 SURGICAL REMOVAL OF IMPACTED TOOTH - SECOND TOOTH 471.20R - -


8945 SURGICAL REMOVAL OF IMPACTED TOOTH - THIRD AND SUBSEQUENT TEETH 267.70R - -

8953 SURGICAL REMOVAL OF RESIDUAL ROOTS, FIRST TOOTH - PER TOOTH Yes 529.80R - -

8957 ALVEOLOTOMY OR ALVEOLECTOMY (INCLUDING EXTRACTIONS) 650.40R - -

8958 EMERGENCY TRACHEOTOMY Yes 546.50R - -

8959 PHARYNGOSTOMY Yes 546.50R - -

8961 TOOTH TRANSPLANTATION 1 066.20R - -

8962 HARVEST ILIAC CREST GRAFT 393.10R - -

8963 HARVEST RIB GRAFT 451.00R - -

8964 HARVEST CRANIUM GRAFT 353.10R - -

8965 PERIPHERAL NEURECTOMY 1 066.20R - -

8966 REPAIR OF ORONASAL FISTULA (LOCAL FLAPS) Yes 1 483.10R - -

8967 SURGICAL REMOVAL OF JAW CYST - INTRA-ORAL APPROACH 1 481.20R - -

8969 SURGICAL REMOVAL OF JAW CYST - EXTRA-ORAL APPROACH 2 372.70R - -

8971 EXCISION OF TUMOUR OF THE SOFT TISSUE 476.70R - -

8973 SURGICAL EXCISION OF TUMOURS OF THE JAW 2 372.70R - -

8975 HEMIRESECTION OF JAW EXCLUDING CONDYL Yes 2 492.50R - -

8977 SURGICAL REPAIR OF MAXILLA OR MANDIBLE - MAJOR 2 490.60R - -

8979 HARVESTING OF AUTOGENOUS GRAFTS (INTRA-ORAL) 205.40R - -

8981 SURGICAL EXPOSURE OF IMPACTED OR UNERUPTED TEETH TO AID ERUPTION 978.50R - -

8983 CORTICOTOMY - FIRST TOOTH 708.00R - -

8984 CORTICOTOMY - EACH ADDITIONAL TOOTH 359.00R - -

8985 FRENULECTOMY/FRENULOTOMY 650.40R - -

8987 REDUCTION OF MYLOHYOID RIDGES - PER SIDE 1 066.20R - -

8989 REMOVAL TORUS MANDIBULARIS 1 066.20R - -

8991 REMOVAL OF TORUS PALATINUS 1 066.20R - -

8993 SURGICAL REDUCTION OF OSSEOUS TUBEROSITY - PER SIDE 476.70R - -

8995 GINGIVECTOMY - PER JAW 948.50R - -

8997 SULCOPLASTY / VESTIBULOPLASTY 2 444.60R - -

9003 REPOSITION MENTAL FORAMEN AND NERVE - PER SIDE 1 481.20R - -

9004 LATERALIZATION OF INFERIOR DENTAL NERVE 2 386.70R - -

9005 ALVEOLAR RIDGE AUGMENTATION - TOTAL (BY BONE GRAFT) 2 492.50R - -


9007 ALVEOLAR RIDGE AUGMENTATION - TOTAL (BY ALLOPLASTIC MATERIAL) 1 568.90R - -

9008 ALVEOLAR RIDGE AUGMENTATION - ONE TO TWO TOOTH SITES 485.00R - -

9009 ALVEOLAR RIDGE AUGMENTATION - THREE ACROSS 3 OR MORE TOOTH SITES 1 078.10R - -

9010 SINUS LIFT PROCEDURE 1 619.80R - -

9011 INCISION & DRAINAGE OF ABSCESS - INTRA-ORAL (PYOGENIC) 303.30R 143.20R -

9013 INCISION & DRAINAGE OF ABSCESS - EXTRA-ORAL (PYOGENIC) Yes 414.80R - -

9015 APICECTOMY/PERIRADICULAR SURGERY - ANTERIORS (INCLUDING RETROGRADE FILLING)604.40R - -

9016 APICECTOMY/PERIRADICULAR SURGERY - MOLARS (INCLUDING RETROGRADE FILLING) 1 066.20R - -

9017 DECORTICATION, SAUCERISATION AND SEQUESTRECTOMY Yes 2 195.20R - -

9019 SEQUESTRECTOMY - INTRA ORAL PER SEXTANT AND OR RAMUS 476.70R - -

9021 SUTURE - RECONSTRUCTION, MINOR (EXCLUDES CLOSURE OF SURGICAL INCISIONS) 604.40R - -

9023 SUTURE - RECONSTRUCTION, MAJOR (EXCLUDES CLOSURE OF SURGICAL INCISIONS) 1 125.20R - -

9024 DENTO-ALVEOLAR FRACTURE - PER SEXTANT 534.60R - -

9025 MANDIBLE FRACTURE - CLOSED REDUCTION Yes 1 183.90R - -

9027 MANDIBLE FRACTURE - COMPOUND, WITH EYELET WIRING Yes 1 662.70R - -

9029 MANDIBLE FRACTURE - SPLINTS Yes 1 841.10R - -

9031 MANDIBLE FRACTURE - OPEN REDUCTION Yes 2 728.90R - -

9035 MAXILLA FRACTURE - LE FORT I OR GUERIN Yes 1 665.70R - -

9037 MAXILLA FRACTURE - LE FORT II OR MIDDLE THIRD FACE Yes 2 728.90R - -

9039 MAXILLA FRACTURE - LE FORT III OR CRANIOFACIAL DISJUNCTION Yes * - -

9041 ZYGOMATIC ARCH FRACTURE - CLOSED REDUCTION Yes 1 183.90R - -

9043 ZYGOMATIC ARCH FRACTURE - OPEN REDUCTION Yes 2 372.70R - -

9045

ZYGOMATIC ARCH FRACTURE - OPEN REDUCTION (REQUIRING OSTEOSYNTHESIS AND/OR

GRAFTING)Yes * - -

9046 PLACEMENT OF ZYGOMATICUS FIXTURE, PER FIXTURE Yes 2 348.00R - -

9047 OSTEOTOMY - OPEN WITH STABILISATION Yes * - -

9048 SURGICAL REMOVAL OF INTERNAL FIXATION DEVICES, PER SITE Yes 455.80R - -

9049 OSTEOTOMY - MANDIBLE BODY, ANTERIOR SEGMENTAL Yes * - -

9050 OSTEOTOMY - TOTAL SUBAPICAL Yes * - -

9051 GENIOPLASTY Yes 2 372.70R - -

9052 MIDFACIAL EXPOSURE Yes * - -


9053 CORONOIDECTOMY (INTRA-ORAL APPROACH) Yes 1 480.10R - -

9055 OSTEOTOMY - SEGMENTED, POSTERIOR Yes * - -

9057 OSTEOTOMY - SEGMENTED, ANTERIOR Yes * - -

9059 RECONSTRUCT MAXILLA - LE FORT I OSTEOTOMY, ONE PIECE Yes * - -

9060 RECONSTRUCT MAXILLA - LE FORT I OSTEOTOMY W/ REPOSITIONING AND GRAFT Yes * - -

9061 PALATAL OSTEOTOMY Yes 2 728.90R - -

9062 RECONSTRUCT MAXILLA - LE FORT I OSTEOTOMY, MULTIPLE SEGMENTS Yes * - -

9063

RECONSTRUCT MAXILLA - LE FORT 2 OSTEOTOMY (FACIAL AND POST-TRAUMATIC

DEFORMITIES)Yes * - -

9065 RECONSTRUCT MAXILLA - LE FORT 3 OSTEOTOMY (SEVERE CONGENITAL DEFORMITIES) Yes * - -

9066 SURGICAL EXPANSION - MAXILLIARY OR MANDIBULAR Yes 2 372.70R - -

9069 GLOSSECTOMY - PARTIAL Yes 1 777.20R - -

9071 GENIOHYOIDOTOMY Yes 1 066.20R - -

9072 CLOSE SECONDARY ORO-NASAL FISTULA W/ BONE GRAFTING (COMPLETE PROCEDURE) Yes * - -

9074 TMJ ARTHROSCOPY DIAGNOSTIC Yes 1 177.90R - -

9075 CONDYLECTOMY, CORONOIDECTOMY OR BOTH Yes * - -

9076 TMJ ARTROCENTESIS Yes 650.40R - -

9077 TMJ INTRA-ARTICULAR INJECTION Yes 177.50R - -

9079 TRIGGER POINT INJECTION Yes 138.50R - -

9081 CONDYLECTOMY (WARD/KOSTECKA) Yes 1 183.90R - -

9083 TMJ SRTHROPLASTY Yes * - -

9085 REDUCTION OF TMJ DISLOC W/O ANAESTHETIC Yes 235.40R - -

9087 REDUCTION OF TMJ DISLOC W/ ANAESTHETIC Yes 476.70R - -

9089 REDUCTION OF TMJ DISLOC W/ ANAESTHETIC AND IMMOBOBILISATION Yes 1 183.90R - -

9091 REDUCTION OF TMJ DISLOCATION - OPEN REDUCTION Yes * - -

9092 JOINT RECONSTRUCTION Yes * - -

9093 REMOVAL OF SALIVARY STONE (SIALOLITHOTOMY) 534.60R - -

9095 EXCISION OF SUBLINGLUAL SALIVARY GLAND Yes 1 317.50R - -

9096 EXCISION OF SALIVARY GLAND - EXTRA ORAL APPROACH Yes 1 951.90R - -

9099 UNLISTED DENTAL PROCEDURE OR SERVICE (BY REPORT) Yes 323.20R - -

9101 OBTURATOR PROSTHESIS, SURGICAL - MODIFIED DENTURE Yes 163.70R - -

9102 OBTURATOR PROSTHESIS, SURGICAL - CONTINUOUS BASE Yes 443.70R - -


9103 OBTURATOR PROSTHESIS, SURGICAL - SPLIT BASE Yes 661.20R - -

9104 OBTURATOR PROSTHESIS, INTERIM - ON EXISTING DENTURE Yes 997.50R - -

9105 OBTURATOR PROSTHESIS, INTERIM - ON NEW DENTURE Yes * - -

9106 OBTURATOR PROSTHESIS, DEFINITIVE - OPEN/HOLLOW BOX Yes 997.50R - -

9107 OBTURATOR PROSTHESIS, DEFINITIVE - SILICONE GLOVE Yes 1 926.00R - -

9108 MANDIBULAR RESECTION PROSTHESIS W/ GUIDE FLANGE Yes 2 365.90R - -

9109 MANDIBULAR RESECTION PROSTHESIS W/O GUIDE FLANGE Yes 2 198.20R - -

9110 MANDIBULAR RESECTION PROSTHESIS, PALATAL AUGMENTATION Yes 443.70R - -

9111 GLOSSAL RESECTION PROSTHESIS - SIMPLE Yes 925.50R - -

9112 GLOSSAL RESECTION PROSTHESIS - COMPLEX Yes 1 386.50R - -

9113 RADIATION CARRIER - SIMPLE Yes 997.50R - -

9114 RADIATION CARRIER - COMPLEX Yes 2 752.80R - -

9115 RADIATION SHIELD - SIMPLE Yes 997.50R - -

9116 RADIATION SHIELD - COMPLEX Yes 2 752.80R - -

9117 RADIATION CONE LOCATOR Yes 997.50R - -

9118 CHEMOTHERAPEUTIC AGENT CARRIER Yes 997.50R - -

9119 FEEDING AID PROSTHESIS, NEONATAL Yes 882.80R - -

9120 ORTHOPAEDIC APPLIANCE, ACTIVE PRESURGICAL - MINOR Yes 882.80R - -

9121 ORTHOPAEDIC APPLIANCE, ACTIVE PRESURGICAL - MODERATE Yes 1 306.50R - -

9122 ORTHOPAEDIC APPLIANCE, ACTIVE PRESURGICAL - SEVERE Yes 2 198.20R - -

9123 ORTHOPAEDIC APPLIANCE, ACTIVE PRESURGICAL - MODIFICATION Yes 111.70R - -

9125 SPEECH AID/OBTURATOR PROSTHESIS - PALATAL ALTERATION Yes 444.80R - -

9126 SPEECH AID/OBTURATOR PROSTHESIS - VELAR ALTERATION Yes 997.50R - -

9127 SPEECH AID/OBTURATOR PROSTHESIS - PHARYNGEAL ALTERATION Yes 2 198.20R - -

9128 SPEECH AID/OBTURATOR PROSTHESIS - MODIFICATION Yes 111.70R - -

9129 SPEECH AID/OBTURATOR PROSTHESIS - SURGICAL Yes 882.80R - -

9130 SPEECH AID APPLIANCE - PALATAL LIFT Yes 443.70R - -

9131 SPEECH AID APPLIANCE - PALATAL STIMULATING Yes 997.50R - -

9132 SPEECH AID APPLIANCE - BULB Yes 2 198.20R - -

9133 SPEECH AID APPLIANCE - MODIFICATION Yes 111.70R - -

9134 UNSPECIFIED SPEECH AID APPLIANCE Yes * - -


9135 AURICULAR PROSTHESIS - SIMPLE Yes 2 752.80R - -

9136 AURICULAR PROSTHESIS - COMPLEX Yes * - -

9137 NASAL PROSTHESIS - SIMPLE Yes 2 752.80R - -

9138 NASAL PROSTHESIS - COMPLEX Yes * - -

9139 OCULAR PROSTHESIS - INTERIM Yes 997.50R - -

9140 OCULAR PROSTHESIS - MODIFIED STOCK APPLIANCE Yes 2 474.40R - -

9141 OCULAR PROSTHESIS - CUSTOM APPLIANCE Yes * - -

9142 ORBITAL PROSTHESIS - SIMPLE Yes 2 474.40R - -

9143 ORBITAL PROSTHESIS - COMPLEX Yes * - -

9148 UNSPECIFIED BODY PROSTHESIS - SIMPLE Yes 2 474.40R - -

9149 UNSPECIFIED BODY PROSTHESIS - COMPLEX Yes * - -

9150 FACIAL PROSTHESIS, SURGICAL - SIMPLE Yes 1 926.00R - -

9151 FACIAL PROSTHESIS, SURGICAL - COMPLEX Yes 2 474.40R - -

9155 CRANIAL PROSTHESIS Yes 997.50R - -

9156 CRANIAL IMPLANT PROSTHESIS, CUSTOM MADE Yes 1 203.90R - -

9157 FACIAL IMPLANT PROSTHESIS, CUSTOM MADE - SIMPLE Yes 601.40R - -

9158 FACIAL IMPLANT PROSTHESIS, CUSTOM MADE - COMPLEX Yes 1 203.90R - -

9159 OCULAR IMPLANT PROSTHESIS, CUSTOM MADE Yes 601.40R - -

9160 BODY IMPLANT PROSTHESIS - CUSTOM MADE Yes 2 677.00R - -

9161 SURGICAL SPLINT - SIMPLE Yes 272.20R - -

9162 SURGICAL SPLINT - COMPLEX Yes 997.50R - -

9163 SURGICAL TEMPLATE - SIMPLE Yes 272.20R - -

9164 SURGICAL TEMPLATE - COMPLEX Yes 997.50R - -

9165 SURGICAL CONFORMER - SIMPLE Yes 272.20R - -

9166 SURGICAL CONFORMER - COMPLEX Yes 997.50R - -

9167 TRISMUS APPLIANCE (SIMPLE) Yes 111.70R - -

9168 TRISMUS APPLIANCE (COMPLEX) Yes 997.50R - -

9169 ORTHOSES APPLIANCE Yes 2 198.20R - -

9170 FACIAL PALSY APPLIANCE Yes 661.20R - -

9171 COMMISSURE SPLINT Yes 272.20R - -

9172 ORAL RETRACTOR, DYNAMIC - PER ARM Yes 272.20R - -


9174 UNSPECIFIED BURN APPLIANCE * - -

9175 THEATRE ATTENDANCE (MAXFAC PROSTHOD) /HOUR 368.00R - -

9180 SURGICAL PLACEMENT OF SUB-PERIOSTEAL IMPLANT - PREPARATORY STAGE 1 613.80R - -

9181 SURGICAL PLACEMENT OF SUB-PERIOSTEAL IMPLANT - PLACEMENT STAGE 1 613.80R - -

9182 SURGICAL PLACEMENT OF ENDOSTEAL IMPLANT PLATE 807.80R - -

9183 SURGICAL PLACEMENT OF ENDOSSEUS IMPLANT - FIRST PER QUADRANT 1 137.10R - -

9184 SURGICAL PLACEMENT OF ENDOSSEUS IMPLANT - SECOND PER QUADRANT 851.30R - -

9185 SURGICAL PLACEMENT OF ENDOSSEUS IMPLANT - THIRD AND SUBSEQUENT PER QUADRANT569.90R - -

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 421.80R - -

9191 SURGICAL EXPOSURE OF ENDOSSEUS IMPLANT - SECOND PER QUADRANT 317.10R - -

9192 SURGICAL EXPOSURE OF ENDOSSEUS IMPLANT - THIRD AND SUBSEQUENT PER QUADRANT212.40R - -

9198 SURGICAL REMOVAL OF IMPLANT 525.70R - -

9220 REPAIR CLEFT HARD PALATE - UNILATERAL Yes * - -

9222 REPAIR CLEFT HARD PALATE - BILATERAL (ONE PROCEDURE) Yes * - -

9224 REPAIR CLEFT HARD PALATE - BILATERAL (TWO PROCEDURES) Yes * - -

9226 REPAIR CLEFT SOFT PALATE - W/O MUSCLE RECONSTRUCTION Yes * - -

9228 REPAIR CLEFT SOFT PALATE - W/ MUSCLE RECONSTRUCTION Yes * - -

9230 REPAIR SUBMUCOSAL CLEFT AND/OR BIFID UVULA - W/ MUSCLE RECONSTRUCTION Yes * - -

9232 VELOPHARYNGEAL RECONSTRUCTION - UNCOMPLICATED Yes * - -

9234 VELOPHARYNGEAL RECONSTRUCTION - COMPLICATED Yes * - -

9238 REPAIR ORONASAL FISTULA (ONE PROCEDURE) Yes 2 484.60R - -

9240 REPAIR ORONASAL FISTULA (TWO PROCEDURES) Yes * - -

9246 SECONDARY PERIOSTEAL FLAPS Yes 2 166.30R - -

9248 LIPADHESION Yes 809.80R - -

9250 REPAIR CLEFT LIP - UNILATERAL W/O MUSCLE RECONSTRUCTION Yes 1 426.30R - -

9252 REPAIR CLEFT LIP - UNILATERAL W/ MUSCLE RECONSTRUCTION Yes 1 933.90R - -

9254 REPAIR CLEFT LIP - BILATERAL W/O MUSCLE RECONSTRUCTION Yes 1 991.70R - -


9256 REPAIR CLEFT LIP - BILATERAL W/ MUSCLE RECONSTRUCTION Yes * - -

9258 REPAIR ANTERIOR NASAL FLOOR Yes 777.00R - -

9260 REVISION OF SECONDARY CLEFT LIP DEFORMITY - PARTIAL Yes 777.00R - -

9262 REVISION OF SECONDARY CLEFT LIP DEFORMITY - TOTAL W/ MUSCLE RECONSTRUCTIONYes 1 755.50R - -

9264 ABBE-FLAP - TWO STAGES Yes 1 987.90R - -

9266 RECONSTRUCT COLUMELLA Yes 1 175.00R - -

9268 RECONSTRUCT NOSE DUE TO CLEFT DEFORMITY - PARTIAL Yes 1 493.10R - -

9270 RECONSTRUCT NOSE DUE TO CLEFT DEFORMITY - COMPLETE Yes 2 359.90R - -

9272 PARANASAL AUGMENTATION FOR NASAL BASE DEVIATION Yes 1 175.00R - -

9301 CASTING AND TRIMMING OF MODEL IN PLASTER (YELLOW/WHITE), PER MODEL 34.90R - -

9303 CASTING AND TRIMMING OF MODEL IN SUPER-HARD STONE (DIE-STONE) PER MODEL 49.60R - -

9305 CASTING AND TRIMMING OF STUDY MODEL, PER MODEL 91.90R - -

9307 CASTING AND TRIMMING OF GNATHOSTATIC MODEL, PER MODEL. 119.50R - -

9309 NEW TRIMMED BASE TO SUPPLIED MODEL, PER MODEL 42.30R - -

9311 TRIMMING OF SUPPLIED MODEL, PER MODEL 25.70R - -

9312 GINGIVAL TISSUE MASK PER IMPLANT 198.50R - -

9313 DUPLICATING MODEL, PER MODEL 106.60R - -

9314 REFRACTORY MODEL, PER UNIT 104.80R - -

9315

MODELS AND DUPLICATE MODELS (VIRGIN MODEL) FOR CROWN AND BRIDGE, WORK

INCLUSIVE OF ONE REMOVABLE DIE145.20R - -

9317 SECTIONAL MODELS FOR CROWN AND BRIDGE, WORK INCLUSIVE OF ONE REMOVABLE DIE128.70R - -

9319 EACH ADDITIONAL REMOVABLE DIE FOR ITEMS 9315 AND 9317 PER DIE 33.10R - -

9320 INDEXED OR MODEL TRAY PER DIE (NOT MORE THAN 9319) 33.10R - -

9321 OCCLUSION BLOCK, PER BLOCK 126.80R - -

9323 OCCLUSION BLOCK ON BASEPLATE, PER BLOCK 159.90R - -

9327

INFECTION CONTROL PER IMPRESSION, DENTURE (WAX OR ACRYLIC) OR ANY ITEM IN

CONTACT WITH BODY FLUIDS23.90R - -

9329 FIT AND SUPPLY OF DISPOSABLE ARTICULATOR 62.50R - -

9330 DELIVERY / COLLECTION FEE PER COMPLETED PROCEDURE (MAXIMUM 4) * - -

9331 FULL UPPER AND LOWER DENTURES 1 705.80R - -


9333 FULL UPPER OR LOWER DENTURE 998.10R - -

9335 SET-UP AND WAXING OF FULL UPPER AND LOWER DENTURES 588.20R - -

9337 SET-UP AND WAXING OF FULL UPPER OR LOWER DENTURE 393.40R - -

9339 WAXING AND FINISHING OF FULL UPPER AND LOWER DENTURES 1 045.90R - -

9341 WAXING AND FINISHING OF FULL UPPER OR LOWER DENTURE 584.50R - -

9343

ADDITIONAL FEE FOR DENTURES ON FULLY ADJUSTABLE ARTICULATOR AT REQUEST OF

DENTIST1 665.40R - -

9345 ADDITIONAL FEE FOR IMMEDIATE DENTURES, OR TOOTH SOCKETED 23.90R - -

9346 ADDITIONAL FEE FOR IMMEDIATE DENTURES, PER TOOTH NOT SOCKETED. 12.90R - -

9347

ADDITIONAL FEE FOR EACH RETRY FROM THE THIRD AND UPWARDS AT AN AGREED

QUANTUM OF TIME TO BE CALCULATED AT HOURLY RATE378.70R - -

9351 SET-UP AND FINISH OF ONE-TOOTH DENTURE 457.70R - -

9352 SET-UP AND FINISH OF TWO-TOOTH DENTURE 487.10R - -

9353 SET-UP AND FINISH OF THREE-TOOTH DENTURE 522.00R - -

9354 SET-UP AND FINISH OF FOUR-TOOTH DENTURE 551.40R - -

9355 SET-UP AND FINISH OF FIVE-TOOTH DENTURE 595.60R - -

9356 SET-UP AND FINISH OF SIX-TOOTH DENTURE 711.40R - -

9357 SET-UP AND FINISH OF SEVEN-TOOTH DENTURE 845.50R - -

9358 SET-UP AND FINISH OF EIGHT-TOOTH DENTURE 897.00R - -

9359 SET-UP AND FINISH NINE OR MORE TOOTH DENTURE 919.10R - -

9361 SET-UP AND WAXING OF ONE-TOOTH DENTURE 130.50R - -

9362 SET-UP AND WAXING OF TWO-TOOTH DENTURE 158.10R - -

9363 SET-UP AND WAXING OF THREE-TOOTH DENTURE 180.10R - -

9364 SET-UP AND WAXING OF FOUR-TOOTH DENTURE 209.60R - -

9365 SET-UP AND WAXING OF FIVE-TOOTH DENTURE 231.60R - -

9366 SET-UP AND WAXING OF SIX-TOOTH DENTURE 273.90R - -

9367 SET-UP AND WAXING OF SEVEN-TOOTH DENTURE 301.50R - -

9368 SET-UP AND WAXING OF EIGHT-TOOTH DENTURE 323.50R - -

9369 SET-UP AND WAXING OF NINE OR MORE TOOTH DENTURE 345.60R - -

9371 WAXING AND FINISHING OF ONE-TOOTH DENTURE 358.40R - -

9372 WAXING AND FINISHING OF TWO-TOOTH DENTURE 365.80R - -

9373 WAXING AND FINISHING OF THREE-TOOTH DENTURE 371.30R - -


9374 WAXING AND FINISHING OF FOUR-TOOTH DENTURE 378.70R - -

9375 WAXING AND FINISHING OF FIVE-TOOTH DENTURE 393.40R - -

9376 WAXING AND FINISHING OF SIX-TOOTH DENTURE 408.10R - -

9377 WAXING AND FINISHING OF SEVEN-TOOTH DENTURE 509.20R - -

9378 WAXING AND FINISHING OF EIGHTH-TOOTH DENTURE 529.40R - -

9379 WAXING AND FINISHING OF NINE OR MORE TOOTH DENTURE 558.80R - -

9383 ADDITIONAL FEE FOR FINISHING DENTURE IN TOOTH COLOUR MATERIAL, PER TOOTH 88.20R - -

9385 ADDITIONAL FEE FOR SUPPLYING FINISHED DENTURE ON DUPLICATE MODEL 167.30R - -

9391

BASIC CHARGE WHICH INCLUDES REPAIR OF ONE FRACTURE, OR ADDITION OF ONE TOOTH, OR

ADDITION OF ONE CLASP290.40R - -

9393 ADDITIONAL CHARGE FOR EACH ADDITIONAL FRACTURE, OR TOOTH, OR CLASP 90.10R - -

9395 ADDITIONAL FEE FOR USING WIRE STRENGTHENER 102.90R - -

9397 ADDITIONAL FEE FOR USING PRE-FORMED STRENGTHENER 110.30R - -

9398 ADDITIONAL FEE FOR USING MESH STRENGTHENER IN REPAIR PROCEDURE 174.60R - -

9403 DOX GRINDING OF UPPER AND LOWER DENTURES 163.60R - -

9407 HEKA BASE TECHNIQUE PER UPPER OR LOWER DENTURE 386.00R - -

9409 FREGO FRAME 167.30R - -

9411 TEMPLATE PER UPPER OR LOWER DENTURE 461.40R - -

9413 RELINE/REBASE OF SINGLE DENTURE 580.90R - -

9415 REMODEL OF SINGLE DENTURE 893.30R - -

9417 SOFT BASE RELINE PER DENTURE 1 466.80R - -

9419 SOFT BASE TO NEW DENTURE, PER DENTURE 1 466.80R - -

9423 LINGUAL OR PALATAL BAR 218.70R - -

9425 CLEANING AND POLISHING OF EXISTING DENTURE, PER DENTURE 178.30R - -

9427 MESH STRENGTHENER 152.60R - -

9429 THEATRE/ CONSULTATION OUT OF LABORATORY PER HOUR OR PART THEREOF 378.70R - -

9431 SPECIAL TRAY, ACRYLIC, EACH 143.40R - -

9432 SPECIAL TRAY LIGHT CURE, EACH 156.20R - -

9433 SPECIAL TRAY IN BASE PLATE MATERIAL, EACH 147.10R - -

9435 PROVISION OF SINGLE ARM CLASP, TO PARTIAL DENTURE 75.40R - -

9437 PROVISION OF DOUBLE ARM CLASP, TO PARTIAL DENTURE 130.50R - -

9439 PROVISION OF SINGLE ARM CLASP WITH REST, TO PARTIAL DENTURE 169.10R - -


9441 PROVISION OF DOUBLE ARM CLASP WITH REST, TO PARTIAL DENTURE 227.90R - -

9443 PROVISION OF PREFORMED ROACH CLASP, TO PARTIAL DENTURE 97.40R - -

9445 PROVISION OF REST ONLY TO PARTIAL DENTURE 97.40R - -

9447 CAST CLASP 341.90R - -

9448

CASTING AND TRIMMING OF MODEL FROM IMPRESSION INSIDE OCCLUSION BLOCK OR WAX

TRY IN62.50R - -

9450 FINISHING OF ACRYLIC WORK ON ANY CHROME COBALT OR GOLD PROSTHESIS 130.50R - -

9453

BASIC CHARGE - WHICH EXCLUDES MODELS AND ANY SPECIAL TRAYS WHICH MAY BE

REQUIRED BY THE DENTIST, BUT INCLUDES REFRACTORY MODEL1 023.80R - -

9455 ADDITIONAL CHARGE FOR EACH ONE ARM CLASP 42.30R - -

9457 ADDITIONAL CHARGE FOR EACH ROACH CLASP 71.70R - -

9459 ADDITIONAL CHARGE FOR EACH REST 38.60R - -

9461 ADDITIONAL CHARGE FOR CONTINUOUS CLASP, PER TOOTH 42.30R - -

9463 ADDITIONAL CHARGE FOR LINGUAL BAR, PER TOOTH PASSED 99.30R - -

9465 ADDITIONAL CHARGE FOR PALATAL BAR 158.10R - -

9469 ADDITIONAL CHARGE FOR SADDLE WITH FINISHING LINE, PER TOOTH 69.90R - -

9471 ADDITIONAL CHARGE FOR SADDLE WITHOUT FINISHING LINE, PER TOOTH 40.40R - -

9473 ADDITIONAL CHARGE FOR HORSESHOE SADDLE, PER TOOTH 69.90R - -

9475 ADDITIONAL CHARGE FOR FITTING OF TOOTH TO METAL BACKING, PER TOOTH 47.80R - -

9479 ADDITIONAL CHARGE FOR FITTING ONE DISTAL-EXTENSION HINGE 141.50R - -

9480 ADDITIONAL CHARGE PER MILLED EDGE PER TOOTH 123.20R - -

9481 ADDITIONAL CHARGE FOR EACH SOLDERING JOINT 172.80R - -

9483 ADDITIONAL CHARGE FOR SOLDERING RETENTION 209.60R - -

9485 ADDITIONAL CHARGE FOR EACH ADDITIONAL RETENTION SOLDERING JOINT 64.30R - -

9487 ADDITIONAL CHARGE FOR EACH WELDING JOINT 211.40R - -

9489 ADDITIONAL CHARGE FOR FITTING SWING LOCK 172.80R - -

9491 ADDITIONAL CHARGE FOR EACH BACKING CAST 169.10R - -

9493

ADDITIONAL CHARGE FOR EACH STEELS BACKING OR PONTIC CAST (PLASTIC WORK TO BE

CHARGED IN ADDITION)183.80R - -

9495

BASIC FEE FOR THE REPAIRING OF OR ADDITION TO ANY APPLIANCE NECESSITATING THE

CASTING OF A MODEL (9301)266.50R - -

9497

BASIC FEE IF A NEW SECTION IS TO BE FABRICATED AND WHERE ITEM 9495 DOES NOT APPLY

(9301)303.30R - -


9501 CERAMIC JACKET CROWN/CEROMER CROWN OR PONTIC Yes 1 163.50R - -

9502 CERAMIC METAL SUBSTITUTE COPING Yes 939.30R - -

9505 CERAMIC BONDED CROWN OR PONTIC Yes 1 536.70R - -

9507 POST-SOLDER INVESTED JOINT, PER JOINT 314.30R - -

9511 INLAY IN PORCELAIN VENEER CROWN 507.30R - -

9512 CERAMIC, INLAY/ONLAY, BRIDGE RETAINER Yes 1 193.00R - -

9513 CERAMIC POST Yes 468.70R - -

9515 PORCELAIN SHOULDER PER UNIT (NOT APPLICABLE TO PONTICS) 102.90R - -

9520

ADDITIONAL FEE FOR CROWN- & BRIDGE WORK PERFORMED ON A MOVABLE CONDYLE

ARTICULATOR PER UNIT49.60R - -

9521 FULL METAL CROWN, MOD, THREE-QUARTER CROWN Yes 950.30R - -

9524 INDIRECT COMPOSITE RESIN INLAY 259.10R - -

9525 CLASS IV, MO, DO, CERVICAL/OCCLUSAL INLAY Yes 783.00R - -

9526 ADDITIONAL FEE FOR ONE PIECE CASTING OF CROWN OR INLAY ON POST 239.00R - -

9533 FULL METAL PONTIC Yes 702.20R - -

9535 ABUTMENT THIMBLE CAST 658.10R - -

9539 CASTING OF REST ONLY 266.50R - -

9545 CAST POST WITH THIMBLE, INDIRECT Yes 468.70R - -

9546 MULTIPLE POST Yes 775.70R - -

9547 MANUFACTURE CAST POST AND CORE TO EXISTING CROWN Yes 612.10R - -

9549 C.S.P. ATTACHMENT (STEIGER) 2 066.10R - -

9550 MILLING MILLED EDGE PER UNIT 658.10R - -

9551 TELESCOPE CROWN 1 621.20R - -

9553 COMPOSITE/ACRYLIC VENEER CROWN/PONTIC, INDIRECT Yes 1 295.90R - -

9557 COMPOSITE/ACRYLIC JACKET CROWN, INDIRECT Yes 915.40R - -

9559 COMPOSITE/ACRYLIC VENEER POST CROWN Yes 1 281.20R - -

9560 INDIRECT COMPOSITE RESIN VENEER 542.30R - -

9561 COMPOSITE/ACRYLIC JACKET CROWN, DIRECT Yes 625.00R - -

9563 TEMPORARY ACRYLIC/COMPOSITE CROWN PER UNIT 446.70R - -

9565 COMPOSITE/ACRYLIC-FACING REPLACED 520.20R - -

9566 PORCELAIN/ CEROMER FACING REPLACED 943.00R - -

9569 WAXING OF CROWN TO EXISTING DENTURE 367.60R - -


9570

ADDITIONAL FEE FOR EACH REMAKE AT AN AGREED QUANTUM OF TIME TO BE CALCULATED

AT AN HOURLY RATE378.70R - -

9571 BASIC CHARGE WHICH INCLUDES ACRYLIC BASE 465.10R - -

9572 BASIC CHARGE NON ACRYLIC BASE 224.30R - -

9573 ADDITIONAL CHARGE FOR FITTING FIRST EXPANSION SCREW 88.20R - -

9575 ADDITIONAL FEE FOR FITTING SUBSEQUENT EXPANSION SCREWS 75.40R - -

9576 ADDITIONAL FEE FOR FULL ACLUSAL BITE PLATE 261.00R - -

9577 ADDITIONAL FEE FOR BITE PLATE ANTERIOR 88.20R - -

9578 ADDITIONAL FEE FOR BITE PLATE POSTERIOR 88.20R - -

9579 ADDITIONAL FEE FOR FITTING TONGUE GUARD 110.30R - -

9581 ADDITIONAL FEE FOR FLAT OR INCLINED PLANE 68.00R - -

9583 ADDITIONAL FEE FOR ADAMS CRIB 80.90R - -

9585 ADDITIONAL FEE FOR JACKSON CRIB 84.50R - -

9587 ADDITIONAL FEE FOR BALL CLASP 95.60R - -

9589 ADDITIONAL FEE FOR SINGLE ARM CLASP 73.50R - -

9591 ADDITIONAL FEE FOR DOUBLE ARM CLASP 128.70R - -

9593 ADDITIONAL FEE FOR FITTING SINGLE LOOP FINGER SPRING 60.70R - -

9595 ADDITIONAL FEE FOR FITTING DOUBLE LOOP FINGER SPRING 71.70R - -

9597 ADDITIONAL FEE FOR FITTING BUCCAL RETRACTION SPRING 53.30R - -

9599 ADDITIONAL FEE FOR FITTING APRON SPRING 137.90R - -

9603 ADDITIONAL FEE FOR FITTING COFFIN SPRING 132.30R - -

9605 ADDITIONAL FEE FOR FITTING QUAD HELIX 147.10R - -

9607 ADDITIONAL FEE FOR FITTING FLAPPER OR “T”-SPRING 110.30R - -

9609 ADDITIONAL FEE FOR FITTING ALL SPRINGS WITH TUBING, EACH 123.20R - -

9611 ADDITIONAL FEE FOR FITTING LABIAL ARCH 69.90R - -

9613 ADDITIONAL FEE FOR FITTING BUCCAL ARCH 82.70R - -

9615 ADDITIONAL FEE FOR FITTING ROBERTS RETRACTOR 154.40R - -

9619 ADDITIONAL FEE FOR FITTING TWIN WIRE ARCH EXTRA-ORAL ARCH 193.00R - -

9620 ADDITIONAL FEE LIP BUMPER 80.90R - -

9621 ADDITIONAL FEE FOR FITTING EXTRA-ORAL ARCH 183.80R - -

9622 ADDITIONAL FEE FOR FITTING SPACE MAINTAINER ARCH 80.90R - -

9623 ADDITIONAL FEE FOR EACH SPOT-WELDING JOINT 36.80R - -


9625 ADDITIONAL FEE FOR EACH SOLDERING JOINT 58.80R - -

9627 ADDITIONAL FEE FOR EACH INVESTED SOLDERING JOINT 163.60R - -

9629 ADDITIONAL FEE FOR EACH HOOK FOR ELASTIC TRACTION 53.30R - -

9633 ORAL SCREEN 424.60R - -

9635 ANDRESEN OR NORWEGIAN APPLIANCE 759.20R - -

9637 TOOTH POSITIONER 875.00R - -

9639 GUNNING SPLINT 1 165.40R - -

9641 FRANKEL APPLIANCE 1 124.90R - -

9643 CHIN CAP 373.10R - -

9645 BIONATOR 761.00R - -

9651

PINCHED OR SWAGED BAND WITH WELDED ATTACHMENT (EXCLUDING COST OF

ATTACHMENT)224.30R - -

9653 PINCHED OR SWAGED BAND WITH SOLDERED ATTACHMENT 294.10R - -

9700 DIATORICS 1 X 6/8 183.90R - -

9702 DIATORICS, ODDS, ANTERIOR 62.50R - -

9704 DIATORICS, ODDS, POSTERIOR 62.50R - -

9720 SOFT BASE MATERIAL PER DENTURE 665.40R - -

9722 ACRYLIC PER DENTURE 75.20R - -

9726 PREFORMED BALL OR ROACH CLASP 12.90R - -

9728 COST OF LINGUAL / PALATAL BAR 150.70R - -

9729 COST OF MESH STRENGTHENER 79.00R - -

9730 COST OF PRE-FABRICATED BURN-OUT COMPONENT, PER COMPONENT 78.20R - -

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 79.00R - -

9741 COST OF COBALT CHROME CASTING ALLOY 125.00R - -

9742 COST OF SPECIALISED COBALT CHROME CASTING METAL E G VITALLIUM, TITANIUM 1.39R - -

9748 COST OF NON-PRECIOUS CASTING ALLOY Yes 141.60R - -

9756 COST OF SILVER SOLDER, PER GRAM 46.10R - -

9757 CEROMER MATERIAL - PER UNIT 939.40R - -

9758 FIBER RE-ENFORCED MATERIAL PER UNIT 309.50R - -


9759 FIBRE POST Yes 468.70R - -

9761 CERAMIC MATERIAL 1.39R - -

9762 COST OF ANTERIOR ORTHODONTIC ATTACHMENT, PER ATTACHMENT 27.50R - -

9763 ORTHODONTIC MATERIAL 27.50R - -

9764 COST OF POSTERIOR ORTHODONTIC ATTACHMENT, PER ATTACHMENT 27.50R - -

9765 PREFORMED COMPONENTS 14.70R - -

9766 COST OF EXPANSION SCREW, PER SCREW 31.30R - -

9767 SOLDERING MATERIAL 7.33R - -

9768 COST OF BUCCAL TUBE/TRANSFER TUBE, PER TUBE * - -

9770 COST OF J-HOOK, PER HOOK 29.40R - -

9772 COST OF LINGUAL BUTTONS, PER BUTTON 29.40R - -

9775 R/A CASE * - -

9776 COST OF MOUTH PROTECTOR MATERIAL 1.39R - -

9778 COST OF ARCH WIRE 7.33R - -

9779 DUAL LAMINATE MATERIAL 1.39R - -

9786

TRIMMING, WAXING AND FINISHING OF IMPLANT ABUTMENT - CROWN AND BRIDGE WORK

ONLY, PER ABUTMENT262.90R - -

9787 WAXING, MILLING AND FINISHING OF A CUSTOM ABUTMENT 512.80R - -

9789 FINISHING OF PROSTHESIS ON IMPLANT STRUCTURE PER ARCH 1 023.80R - -

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