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13.1.1.1 62101 fl@l-ii11,11111a1A111.1,1%1 200

13.1.1.2 62102 0@uil11`irdiEnn (Ledu nal,till'inilti) 350

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13.1.1.3 62103. ehoioLei5iniqu'ri lIA'il@ion 380

13.1.1.4 62104 frt$io Soft Tissue Impact Tcx)thl:iiMillrinillu Rf 350

13.1.1.5 62105 eii9).9*AtipivilailtINIUEJn5onriTj nilar,ilti

Partial Bony Impact/ Embedd5ci-ToOTh til 700

13.1.1.6 62106 iiiiirveial

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13.1.1.7 62107 tj'ironimuYIniht (Root resection) irlutin t,h 660

13.1.1.8 62108 -,ii;-;:i'tirtia -ra7-111i11,1 (Root resection) 'Num qii 760

13.1.1.9 62109 r:r4inialViL1ainin (Retrograde) ill1°A17 -1 .1 rd 1,300

13.1.1.10 62110 r,ii$imi.tar,vrdn'Imin (Retrograde) 'N'trvi,i'l ;61 . 1,480

13.1.1.11 62111 Root Amputation/ Bicuspidization/

Hemisection qii 870

13.1.2 ai'Enzgu uon@inilti

13.1.2.1 62201 Marsupialization oili,ormil 710

13.1.2.2 62202 Oroantral Fistula Closure 111571.] Soft

Tissue Graft iiti34111 750

13.1.2.3 62203 Excision of Pericoronal Gingival il 350

13.1.2.4 62204 Biopsy of Oral. Tissue (Hard/Soft) oi.-11.1,vitil 400

1312.5 62205 Debridement and Suturing

iiN a titi'dol 111 fl

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13.1.2.6 62206 Alveolectomy/Alveoloplasty Litietiiii`u iiii,Lvitil 500

13.1.2.7 62207 Vestibuloplasty iiiivitil 500

13.1.2.8 62208 La31,Ainn'T,n (Ridge Augmentation)

1.2.15-mnItv 0.iill1/1111 800

13.1.2.9 62209 LAT Epulis, Fibrous Alveolar Ridge g-iii,vitil 500

13.1.2.10 62210 Torectomy, Ostectomy Uti

(1.il'n1 stent) Arch 860

13.1.2.11 62211 Torectomy, Ostectomy '11

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13.1.2.12 62212 e,i1ALaltqlti vTiu,vith 600

13.1 2.13 62213 t,ilAt.alttralroualvulvallift,i >1.5 cm vhilv►til 790

13.1.2.14 62214 csii&,1101F,filvd@lthntliiWn <1.5 cm i-iii,Vitil 590

13.1.2.15 62215 e,i-AiilmattedolthnvinAvinj >1.5 cm iiiLl.w.:11 790

13.1.2.16 62216 N -mit-mrvalniatetiomJin oi'lLvinil 340

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13.1.3.1 62301 Letinielern% (Intra Arch) L 6kiSubluxation FIT,I 680

13.1.3.2 62302 Fracture Mandible - Closed Reduction .., f151 1,300

13.1.3.3 62303 Fracture Maxilla - Closed Reduction .,' Fr-51 1,300

13.1.3.4 62304 Alveolar Fracture - Closed Reduction Arch 680

13.1.3.5 62310 Off Arch Bar ..; 0111 250

13.1.3.6 1 62311 Removal Suspension Wire 41 250

13.1.3.7 62312 Plate and Screw/Wire Removal MI1 410

13.1.4 Correction or Repair Procedures

13.1.4.1 62401 Frenectomy, Frenoptasty init'w..i 400

13.1.4.2 62402 Sialolithotomy t f151 770

13.1.5 Miscellaneous procedures

13.1.5.1 62501 Alluatti'doltinn Fii'l 130

13.1.5.2 62502 VEinTrIvi Dry Socket t m7:1 150

13.1.5.3 62504 Wound dressing with Coe-pack : without

splint f15-1 270

13.1.5.4 62505 Wound dressing with Coe-pack : with

splint

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13.1.5.5 62506 Special procedure stop disorder bleed

(gel foam)

. M54 340

13.1.5.6 62507 Surgical stent ' Arch 660

13.1.5.7 62508 Special procedure stop disorder bleed

(surgicel)

. fi55 1,000

13.2 italn513-npur,

13.2.1 67101 WhenfiTn/Puip capping ..1 240

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13.2.3 67202 vilukaErTml Amalgam 2 kt.1 .4 5i 360

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13.3.1 1 63101 tgtaswlaLkt_l'ii_T?igna.1 700

13.3.2 63102 Pulpotomy 'Null-nal ‘`ii 500

13.3.3 63103 Pulpotomy IN'ild4 rzi. 1,060

13.3.4 63104 Pulpectomy qtri ,n7Talum ci 820

13.3.5 63105 Pulpectomy*Lrellinai ..1 t 970

13.3.6 63110 n -li'fre-wraollnillnirt7-1 .1 66 1,750

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13.3.8 63112 rn7.5rrtrwiaall -inil91n7ID (vvrarr-mu 1-4 Tin) isi 3,500

13.3.9 63120 Apexification/ Recalcification , ml 420

13.3.10 63130 riAl@nS*Nt.rilmiti 141 RC" LINn -maiiiem fii'l 340

13.3.11 63140 Internal root repair of perforation defects 6711 1,130

13.4 lniivgivIE.ii

13.4.1 64101 riAmi-mitrvillJin v71.1.11n 280

13.4.2 64102 Root planing/ Curettage Qualdant 400

13.4.3 64103 . .

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13.4.4 64110 Flap Operation ALLvri11 600 13.4.5 64111 Osseous Surgery Filuvitil 780

13.4.6 64112 Crown Lengthening ..1 t 780

13.4.7 64120 Mucogingival Surgery (Periodontitis) -

CPFP, APFPlalLinl7viiiimu ilavill ,1 860

13.4.8 64121 Mucogingival Surgery (Periodontitis) -

FGG Uzi Stent11.11, 6dMILaileM kit,i,141,11 1,290

13.4.9 64122 Mucogingival Surgery (Periodontitis) - GTR

tIldn -r7Lailont, gli,1,141.11 1,000

13.4.10 I 64123 Gingivectomy or Gingivoplasty 400 13.4.11 64130 ireraloiC.;'lanilli (Periodontal Splint) A wmil 400 13.4.12 64131 LifiNnn,nilur4 .1.1ni - LQr, ° 1-..***-----

13.4.13 64132 N Ltfiletinleruillirmia -1 - ,,, - , \ \ fli'1,1 400

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13.5.5 60301 Dental Upper & Lower Casts

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13.5.6 61101 vigvtY1^1@a549 4/iatiln fr-15.1 170

13.5.7 61301 Dental Pulp Vitality Tests ,

fol5 80

13.5.8 62112

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