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*-
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8025
HANDLING FEE - DIRECT
MATERIALS (26% OF MATERIAL
COST TO A MAXIMUM OF R26.00) 42.00R 42.00R 42.00R 42.00R - 42.00R - -8101 ORAL EXAMINATION 233.80R 233.80R 233.80R 233.80R - 233.80R 121.60R -
8102
COMPREHENSIVE ORAL
EXAMINATION 377.60R 377.60R 377.60R 377.60R - 377.60R 196.40R -8104 LIMITED ORAL EXAMINATION 113.40R 113.40R 113.40R 113.40R - 113.40R 94.80R -8106 SPECIAL REPORT 240.00R 240.00R 240.00R 240.00R - 240.00R - -
8107
INTRAORAL RADIOGRAPH -
PERIAPICAL 94.70R 94.70R 94.70R 94.70R - 94.70R 91.20R 91.10R
8108
INTRAORAL RADIOGRAPHS -
COMPLETE SERIES 732.50R 732.50R 732.50R 732.50R - 732.50R 702.00R 702.00R
8109
INFECTION CONTROL/BARRIER
TECHNIQUES 21.00R 21.00R 21.00R 21.00R - 21.00R 21.00R 21.00R 8110 STERILIZED INSTRUMENTATION 54.30R 54.30R 54.30R 54.30R - 54.30R 54.20R 54.20R
8112
INTRAORAL RADIOGRAPH -
BITEWING 94.70R 94.70R 94.70R 94.70R - 94.70R 91.20R -
8113
INTRAORAL RADIOGRAPH -
OCCLUSAL 163.00R 163.00R 163.00R 163.00R - 163.00R - -
8114
EXTRAORAL RADIOGRAPH - HAND-
WRIST 378.40R 378.40R 378.40R 378.40R - 378.40R - -
8115
EXTRAORAL RADIOGRAPH -
PANORAMIC 378.40R 378.40R 378.40R 378.40R - 378.40R - -
8116
EXTRAORAL RADIOGRAPH -
CEPHALOMETRIC 378.40R 378.40R 378.40R 378.40R - 378.40R - -8117 DIAGNOSTIC MODELS 101.70R 101.70R 101.70R 101.70R - 101.70R - -
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 benefitTariff amount not applicable
DENIS 2020 Rates
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8118
EXTRAORAL RADIOGRAPH -
SKULL/FACIAL BONE 378.40R 378.40R 378.40R 378.40R - 378.40R - -
8119 DIAGNOSTIC MODELS MOUNTED 255.70R 255.70R 255.70R 255.70R - 255.70R - -8120 TREATMENT PLAN COMPLETED - - - - - - - -
8121
ORAL AND/OR FACIAL IMAGE
(DIGITAL/CONVENTIONAL) 101.70R 101.70R 101.70R 101.70R - 101.70R - 97.90R
8123
CARIES SUSCEPTIBILITY TESTS (BY
ARRANGEMENT) - - - - - - - -8124 PULP TESTS 27.90R - - - - - - -
8129
OFFICE/HOSPITAL VISIT – AFTER
REGULARLY SCHEDULED HOURS 352.20R 352.20R - 352.20R - 352.20R 291.90R -
8131 EMERGENCY DENTAL TREATMENT 143.60R 143.60R 143.60R 143.60R - 292.60R 121.60R 121.70R 8132 PULP REMOVAL (PULPECTOMY) 234.80R 234.80R - - - 312.20R - -
8133
RECEMENT INLAY, ONLAY, CROWN
OR VENEER 143.60R 143.60R - - - 182.20R - -
8135 REMOVE INLAY, ONLAY OR CROWN 285.60R 285.60R - - - 285.60R - -
8136
ACCESS THROUGH A PROSTHETIC
CROWN OR INLAY TO FACILITATE
ROOT CANAL TREATMENT 127.90R 127.90R - 127.90R - 127.90R - -
8137 EMERGENCY CROWN (CHAIR-SIDE) 492.30R 492.30R - - - 492.30R - -
8138
REMOVE RETENTION POST
(PREFABRICATED OR CAST) 187.40R 187.40R - - - 187.40R - -
8139 APPOINTMENT NOT KEPT /30MIN - - - - - - - -
8140
HOUSE/EXTENDED CARE
FACILITY/HOSPITAL CALL * 233.00R 233.00R - 233.00R - 233.00R 193.10R -
8141
INHALATION SEDATION - FIRST 15
MINUTES OR PART THEREOF 105.20R 105.20R - 105.20R - 105.20R - -
8143
INHALATION SEDATION - EACH
ADDNL 15 MINUTES 54.30R 54.30R - 54.30R - 54.30R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8144 INTRAVENOUS SEDATION * 63.10R 63.10R - 63.10R - 63.10R - -8145 LOCAL ANAESTHETIC - PER VISIT 91.20R 91.20R 91.20R 91.20R - 91.20R 20.70R 20.70R
8146
RESIN BONDING FOR
RESTORATIONS - - - - - - - -
8147
MONITORING EQUIPMENT FOR
INTRAVENOUS SEDATION 224.30R 224.30R - 224.30R - 224.30R - -8151 ORAL HYGIENE INSTRUCTION 143.60R - - 287.40R - 287.40R 95.50R 95.50R
8153
ORAL HYGIENE INSTRUCTION -
EACH ADDITIONAL VISIT 105.20R - - 138.30R - 138.30R 69.90R 69.90R
8154
ORAL EXAMINATION - ORAL
HYGIENIST - - - - - - - 121.70R
8155 POLISHING - COMPLETE DENTITION 143.60R 143.60R - 197.90R - 143.60R 116.80R 116.70R
8157
RE-BURNISHING AND POLISHING
OF RESTORATIONS - COMPLETE
DENTITION 143.60R - - - - - - -8158 ENAMEL MICROABRASION 131.30R - - - - - - -
8159
PROPHYLAXIS - COMPLETE
DENTITION 282.10R 282.10R - 397.80R - 282.10R 212.70R 212.70R 8160 REMOVAL OF GROSS CALCULUS - - - - - - - -
8161
TOPICAL APPLICATION OF
FLUORIDE - CHILD 143.60R 143.60R - 143.60R - 143.60R 116.80R 116.70R
8162
TOPICAL APPLICATION OF
FLUORIDE - ADULT 143.60R - - 143.60R - 143.60R 116.80R 116.70R 8163 DENTAL SEALANT 94.70R 94.70R - 94.70R - 94.70R 86.50R 86.50R
8164
LIMITED ORAL EXAMINATION -
ORAL HYGIENIST - - - - - - - 94.80R 8165 SEDATIVE FILLING 143.60R 143.60R - 143.60R - 143.60R 121.60R 121.70R
8166
APPLICATION OF DESENSITISING
RESIN, PER TOOTH 94.70R 94.70R - 94.70R - 94.70R 80.30R 80.30R
8167
APPLICATION OF DESENSITISING
MEDICAMENT, PER VISIT 110.40R 110.40R - 110.40R - 110.40R 93.60R 93.60R 8169 OCCLUSAL GUARD 551.80R 551.80R 551.80R 551.80R - 551.80R - -8171 MOUTH PROTECTOR 167.00R 167.00R 167.00R 167.00R - 167.00R - 125.20R 8172 COST OF ORTHOTIC APPLIANCE * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8173
SPACE MAINTAINER - FIXED, PER
ABUTMENT 266.40R 266.40R 266.40R 266.40R - 266.40R - -
8175 SPACE MAINTAINER - REMOVABLE 343.50R 343.50R 343.50R 343.50R - 343.50R - -8176 PERIODONTAL SCREENING 196.90R 185.80R - 196.90R - 196.90R - 147.60R
8177
ORAL HYGIENE INSTRUCTION
(PERIODONTALLY COMPROMISED
PATIENT) 217.30R - - - - - - -
8178
ORAL HYGIENE INSTRUCTION -
EACH ADDITIONAL VISIT
(PERIODONTALLY COMPROMISED
PATIENT) 117.40R - - - - - - -
8179
POLISHING - COMPLETE DENTITION
(PERIODONTALLY COMPROMISED
PATIENT) 164.80R 164.80R - 164.80R - 164.80R - 123.50R
8180
PROPHYLAXIS - COMPLETE
DENTITION (PERIODONTALLY
COMPROMISED PATIENT) * 306.60R 306.60R - 306.60R - - - 170.30R 8183 THERAPEUTIC DRUG INJECTION 63.10R - - - - - - -
8189
RE-EXAMINATION - EXISTING
CONDITION 113.40R - - - - - 94.80R 94.80R
8190
CONSULTATION - SECOND
OPINION OR ADVICE 233.80R 233.80R 233.80R 233.80R - 233.80R - -8192 SUTURE - MINOR 707.90R 707.90R - 707.90R - 707.90R - -
8194
CBCT CAPTURE AND
INTERPRETATION WITH LIMITED
FIELD OF VIEW - LESS THAN ONE
WHOLE JAW 378.40R 378.40R 378.40R 378.40R - 378.40R - -
8195
CBCT CAPTURE AND
INTERPRETATION WITH LIMITED
FIELD OF VIEW OF ONE FULL ARCH -
MANDIBLE 378.40R 378.40R 378.40R 378.40R - 378.40R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8196
CBCT CAPTURE AND
INTERPRETATION WITH LIMITED
FIELD OF VIEW OF ONE FULL ARCH -
MAXILLA WITHOUT ORBITS
AND/OR CRANIUM 378.40R 378.40R 378.40R 378.40R - 378.40R - -
8197
CBCT CAPTURE AND
INTERPRETATION WITH LIMITED
FIELD OF VIEW OF BOTH DENTAL
ARCHES - WITHOUT ORBITS
AND/OR CRANIUM 378.40R 378.40R 378.40R 378.40R - 378.40R - -
8198
CBCT CAPTURE AND
INTERPRETATION FOR TMJ SERIES
INCLUDING TWO OR MORE
EXPOSURES 378.40R 378.40R 378.40R 378.40R - 378.40R - -
8199
CBCT CAPTURE AND
INTERPRETATION WITH LIMITED
FIELD OF VIEW OF ONE FULL ARCH -
MAXILLA WITH ORBITS AND/OR
CRANIUM 378.40R 378.40R 378.40R 378.40R - 378.40R - -
8200
CBCT CAPTURE AND
INTERPRETATION WITH FIELD OF
VIEW OF BOTH DENTAL ARCHES -
WITH ORBITS AND/OR CRANIUM 378.40R 378.40R 378.40R 378.40R - 378.40R - -
8201
EXTRACTION - TOOTH OR EXPOSED
TOOTH ROOTS (FIRST PER
QUADRANT) 143.60R 215.30R 143.60R 143.60R - 143.60R 136.20R -
8202
EXTRACTION - EACH ADDITIONAL
TOOTH OR EXPOSED TOOTH
ROOTS 57.80R 86.70R 57.80R 57.80R - 57.80R 52.60R -
8213
SURGICAL REMOVAL OF RESIDUAL
ROOTS, FIRST TOOTH PER
QUADRANT 620.40R 620.40R - 620.40R - 620.40R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8214
SURGICAL REMOVAL OF RESIDUAL
ROOTS, SECOND AND
SUBSEQUENT TEETH'S ROOTS 478.30R 478.30R - 478.30R - 478.30R - -8220 COST OF SUTURE MATERIAL 225.00R 225.00R - 225.00R - 225.00R 225.00R -8228 ART RESTORATIONS - - - - - - - 249.20R
8231
COMPLETE DENTURES - MAXILLARY
AND MANDIBULAR 2 316.40R - - 2 316.40R - 4 836.10R - -
8232
COMPLETE DENTURE - MAXILLARY
OR MANDIBULAR 1 428.00R - - 1 428.00R - 3 383.50R - -
8233
PARTIAL DENTURE - RESIN BASE -
ONE TOOTH 664.00R - - 664.00R - 664.00R - -
8234
PARTIAL DENTURE - RESIN BASE -
TWO TEETH 664.00R - - 664.00R - 664.00R - -
8235
PARTIAL DENTURE - RESIN BASE -
THREE TEETH 993.50R - - 993.50R - 993.50R - -
8236
PARTIAL DENTURE - RESIN BASE -
FOUR TEETH 993.50R - - 993.50R - 993.50R - -
8237
PARTIAL DENTURE - RESIN BASE -
FIVE TEETH 993.50R - - 993.50R - 993.50R - -
8238
PARTIAL DENTURE - RESIN BASE -
SIX TEETH 1 317.80R - - 1 317.80R - 1 317.80R - -
8239
PARTIAL DENTURE - RESIN BASE -
SEVEN TEETH 1 317.80R - - 1 317.80R - 1 317.80R - -
8240
PARTIAL DENTURE - RESIN BASE -
EIGHT TEETH 1 317.80R - - 1 317.80R - 1 317.80R - -
8241
PARTIAL DENTURE - RESIN BASE -
NINE OR MORE TEETH 1 317.80R - - 1 317.80R - 1 317.80R - -
8244 IMMEDIATE DENTURE - MAXILLARY 1 428.00R - - 1 428.00R - 2 142.10R - -
8245
IMMEDIATE DENTURE -
MANDIBULAR 1 428.00R - - 1 428.00R - 2 142.10R - -8251 CLASP OR REST - CAST GOLD 131.30R - - - - - - -
8253 CLASP OR REST - WROUGHT GOLD 131.30R - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8255 CLASP OR REST - STAINLESS STEEL 138.30R - - - - - - -
8281
PARTIAL DENTURE - CAST METAL
FRAMEWORK ONLY * 1 549.10R - - 1 549.10R - 1 549.10R - -8391 CAST CORE WITH SINGLE POST * 329.50R - - - - 329.50R - -
8397
CAST CORE WITH PINS (ANY
NUMBER OF PINS) * 525.70R - - - - 683.40R - -8401 CROWN - FULL CAST METAL * 1 640.00R - - - - 2 414.40R - -8403 CROWN - 3/4 CAST METAL * 1 640.00R - - - - 2 414.40R - -
8404
CROWN - 3/4
PORCELAIN/CERAMIC * 1 548.80R - - - - 2 325.20R - -8405 CROWN - RESIN LABORATORY * 1 548.80R - - - - 2 325.20R - -8407 CROWN - RESIN WITH METAL * 1 640.00R - - - - 2 414.40R - -8409 CROWN - PORCELAIN/CERAMIC * 1 640.00R - - - - 2 414.40R - -
8411
CROWN - PORCELAIN VENEERED
TO METAL * 1 640.00R - - - - 2 414.40R - -8415 PONTIC - CERAMIC * 1 338.70R - - - - 1 338.60R - -8416 PONTIC - CAST METAL * 1 063.50R - - - - 1 063.60R - -8417 PONTIC - RESIN WITH METAL * 1 338.70R - - - - 1 338.60R - -
8418
PONTIC - PORCELAIN VENEERED TO
METAL * 1 338.70R - - - - 1 338.60R - -
8432
INLAY/ONLAY RETAINER - METAL -
TWO SURFACES * 637.80R - - - - 1 247.50R - -
8433
INLAY/ONLAY RETAINER - METAL -
THREE SURFACES * 1 063.50R - - - - 1 934.40R - -
8434
INLAY/ONLAY RETAINER - METAL -
FOUR OR MORE SURFACES * 1 286.10R - - - - 1 934.40R - -
8436
INLAY/ONLAY RETAINER -
PORCELAIN - TWO SURFACES * 776.20R - - - - 1 496.50R - -
8437
INLAY/ONLAY RETAINER -
PORCELAIN - THREE SURFACES * 1 279.10R - - - - 2 325.20R - -
8438
INLAY/ONLAY RETAINER -
PORCELAIN - FOUR OR MORE
SURFACES * 1 549.10R - - - - 2 325.20R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8441
CROWN RETAINER - FULL CAST
METAL * 1 640.00R - - - - 2 414.40R - -
8442
CROWN RETAINER - 3/4 CAST
METAL * 1 640.00R - - - - 2 414.40R - -8443 CROWN RETAINER - CERAMIC * 1 640.00R - - - - 2 414.40R - -
8444 CROWN RETAINER - 3/4 CERAMIC * 1 640.00R - - - - 2 414.40R - -
8445
CROWN RETAINER - PORCELAIN
VENEERED TO METAL * 1 640.00R - - - - 2 414.40R - -
8446
CROWN RETAINER - RESIN WITH
METAL * 1 640.00R - - - - 2 414.40R - -
8533
IMPLANT SUPPORTED REMOVABLE
COMPLETE OVERDENTURE * 2 574.50R - - - - 3 861.80R - -
8534
IMPLANT SUPPORTED REMOVABLE
PARTIAL OVERDENTURE * 2 059.50R - - - - 3 089.40R - -
8536
CROWN-IMPLANT/ABUTMENT
SUPPORTED CROWN -
PORCELAIN/CERAMIC * 2 128.80R - - - - 2 815.70R - -
8537
CROWN-IMPLANT/ABUTMENT
SUPPORTED CROWN - PORCELAIN
WITH METAL * 2 128.80R - - - - 2 815.70R - -
8538
CROWN-IMPLANT/ABUTMENT
SUPPORTED CROWN - CAST METAL * 2 128.80R - - - - 2 815.70R - -
8546
IMPLANT SUPPORTED CROWN
RETAINER - CERAMIC * 2 128.80R - - - - 2 815.70R - -
8547
IMPLANT SUPPORTED CROWN
RETAINER - PORCELAIN VENEERED
TO METAL * 2 128.80R - - - - 2 815.70R - -
8548
CROWN RETAINER -
IMPLANT/ABUTMENT SUPPORTED -
CAST METAL * 2 128.80R - - - - 2 815.70R - -8560 COST OF CERAMIC BLOCK * 644.10R - - - - 644.10R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8570
FABRICATION OF COMPUTER
GENERATED CERAMIC
RESTORATION * 1 562.70R - - - - 1 562.70R - -8581 CAST CORE WITH SINGLE POST * - - - - - - - -8582 CAST CORE WITH DOUBLE POST * - - - - - - - -8583 CAST CORE WITH TRIPLE POST * - - - - - - - -
8584
CONNECTOR BAR - IMPLANT
SUPPORTED * - - - - - - - -
8592
CROWN - IMPLANT/ABUTMENT
SUPPORTED * 2 128.40R - - - - 2 815.70R - -
8600 COST OF IMPLANT COMPONENTS * - - - - - - - -8611 PONTIC - SANITARY * - - - - - 1 459.60R - -8613 PONTIC - POSTERIOR * - - - - - 1 785.60R - -8615 PONTIC - ANTERIOR/PREMOLAR * - - - - - 1 929.20R - -
8617
RETAINER CAST METAL
(MARYLAND TYPE RETAINER) * 637.80R - - - - 1 247.50R - -
8643
COMPLETE DENTURES - MAXILLARY
AND MANDIBULAR. ONLY FOR
PROSTHODONTISTS * - - - - - 6 276.30R - -
8645
COMPLETE DENTURES - MAXILLARY
OR MANDIBULAR. ONLY FOR
PROSTHODONTISTS * - - - - - 7 720.10R - -
8649
IMMEDIATE DENTURE -
MAXILLARY. ONLY FOR
PROSTHODONTIST * - - - - - 3 861.80R - -
8651
IMMEDIATE DENTURE -
MANDIBULAR. ONLY FOR
PROSTHODONTIST * - - - - - 4 343.60R - -8652 OVERDENTURE - COMPLETE * 2 574.50R - - - - 3 861.80R - -8653 OVERDENTURE - PARTIAL * 2 059.50R - - - - 3 089.40R - -
8654
IMPLANT SUPPORTED FIXED-
DETACHABLE COMPLETE
OVERDENTURE * 2 895.70R - - - - 4 343.60R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8655
IMPLANT SUPPORTED FIXED-
DETACHABLE PARTIAL
OVERDENTURE * 2 316.50R - - - - 2 976.50R - -
8671
PARTIAL DENTURE - CAST METAL
FRAMEWORK WITH RESIN
DENTURE BASE * - - - - - 3 861.80R - -
8737
ROOT PLANING - FOUR OR MORE
TEETH PER QUADRANT * 574.80R - - 779.60R - 574.90R - 372.30R
8739
ROOT PLANING - ONE TO THREE
TEETH PER QUADRANT * 457.40R - - 622.10R - 457.20R - 343.00R
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 * - - - - - - - -
8858
ORTHO TX - FUNCTIONAL
APPLIANCE * - - - - - - - -
8861
ORTHO TX - PARTIAL FIXED
APPLIANCE - MINOR * - - - - - - - -
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 * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8874
ORTHO TX - FIXED LINGUAL
APPLIANCE - BOTH ARCHES, CLASS
1 MILD * - - - - - - - -
8875
ORTHO TX - FIXED APPLIANCE -
BOTH ARCHES, CLASS 1 MODERATE * - - - - - - - -
8876
ORTHO TX - FIXED LINGUAL
APPLIANCE - BOTH ARCHES, CLASS
1 MODERATE * - - - - - - - -
8877
ORTHO TX - FIXED APPLIANCE -
BOTH ARCHES, CLASS 1 SEVERE * - - - - - - - -
8878
ORTHO TX - FIXED LINGUAL
APPLIANCE - BOTH ARCHES, CLASS
1 SEVERE * - - - - - - - -
8879
ORTHO TX - FIXED APPLIANCE -
BOTH ARCHES, CLASS 1 SEVERE W/
COMPLICATIONS * - - - - - - - -
8880
ORTHO TX - FIXED LINGUAL
APPLIANCE - BOTH ARCHES, CLASS
1 SEVERE W/ COMPLICATIONS * - - - - - - - -
8881
ORTHO TX - FIXED APPLIANCE -
BOTH ARCHES, CLASS 2/3 MILD * - - - - - - - -
8882
ORTHO TX - FIXED LINGUAL
APPLIANCE - BOTH ARCHES, CLASS
2/3 MILD * - - - - - - - -
8883
ORTHO TX - FIXED APPLIANCE -
BOTH ARCHES, CLASS 2/3
MODERATE * - - - - - - - -
8884
ORTHO TX - FIXED LINGUAL
APPLIANCE - BOTH ARCHES, CLASS
2/3 MODERATE * - - - - - - - -
8885
ORTHO TX - FIXED APPLIANCE -
BOTH ARCHES, CLASS 2/3 SEVERE * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8886
ORTHO TX - FIXED LINGUAL
APPLIANCE - BOTH ARCHES, CLASS
2/3 SEVERE * - - - - - - - -
8887
ORTHO TX - FIXED APPLIANCE -
BOTH ARCHES, CLASS 2/3 SEVERE
W/ COMPLICATIONS * - - - - - - - -
8888
ORTHO TX - FIXED LINGUAL
APPLIANCE - BOTH ARCHES, CLASS
2/3 SEVERE W/ COMPLICATIONS * - - - - - - - -
8890 MONTHLY INSTALMENT ORTHO TX * - - - - - - - -8958 EMERGENCY TRACHEOTOMY * - - - - - - - -8959 PHARYNGOSTOMY * - - - - - - - -
8966
REPAIR OF ORONASAL FISTULA
(LOCAL FLAPS) * - - - - - - - -
8975
HEMIRESECTION OF JAW
EXCLUDING CONDYL * - - - - - - - -
8977
SURGICAL REPAIR OF MAXILLA OR
MANDIBLE - MAJOR * 2 916.90R 4 375.30R - - - - - -
9013
INCISION & DRAINAGE OF ABSCESS
- EXTRA-ORAL (PYOGENIC) * - - - - - - - -
9017
DECORTICATION, SAUCERISATION
AND SEQUESTRECTOMY * - - - - - - - -
9025
MANDIBLE FRACTURE - CLOSED
REDUCTION * - - - - - - - -
9027
MANDIBLE FRACTURE -
COMPOUND, WITH EYELET WIRING * - - - - - - - -9029 MANDIBLE FRACTURE - SPLINTS * - - - - - - - -
9031
MANDIBLE FRACTURE - OPEN
REDUCTION * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9032
REDUCTION OF MASSETER MUSCLE
AND BONE - EXTRA-ORAL
APPROACH * - - - - - - - -
9033
OPEN TREATMENT OF CONDYLAR
FRACTURE * - - - - - - - -
9035
MAXILLA FRACTURE - LE FORT I OR
GUERIN * - - - - - - - -8257 BAR - LINGUAL OR PALATAL 163.00R - - - - - - -
8259
REBASE COMPLETE OR PARTIAL
DENTURE (LABORATORY) 541.40R - - 541.40R - 781.40R - -
8261
REMODEL COMPLETE OR PARTIAL
DENTURE 869.10R - - 869.10R - 869.10R - -
8263
RELINE COMPLETE OR PARTIAL
DENTURE (CHAIR-SIDE) 343.50R - - 343.50R - 429.20R - -
8265
TISSUES CONDITIONING PER ARCH
(INCLUDING SOFT SELF-CURE
RELINE) 224.30R 224.30R - 224.30R - 287.40R - 168.20R
8267
RELINE COMPLETE OR PARTIAL
DENTURE (LABORATORY) 790.40R - - 790.40R - 790.40R - -
8269
REPAIR DENTURE OR OTHER INTRA-
ORAL APPLIANCE 182.20R - - - - 196.20R - -
8270
ADD CLASP TO EXISTING PARTIAL
DENTURE 131.30R - - - - - - -
8271
ADD TOOTH TO EXISTING PARTIAL
DENTURE 131.30R - - - - - - -
8273
IMPRESSION TO REPAIR OR
MODIFY A DENTURE OR OTHER
INTRA-ORAL APPLIANCE 105.20R - - 105.20R - 105.20R - -
8275
ADJUST COMPLETE OR PARTIAL
DENTURE 105.20R - - 105.20R - 105.20R - -8277 INLAY IN DENTURE 436.20R - - - - 860.20R - -8301 PULP CAP - DIRECT 190.90R - - - - - - -8303 PULP CAP - INDIRECT 190.90R - - - - - 172.70R -8304 RUBBER DAM PER ARCH 112.20R 112.20R - 112.20R - 112.20R - -8306 COST OF MTA - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8307 PULP AMPUTATION (PULPOTOMY) 187.40R 187.40R - 187.40R - 187.40R - -
8310 SUPPLY OF BLEACHING MATERIALS - - - - - - - -
8325
INTERNAL BLEACHING - PER
TOOTH 340.00R - - - - 510.00R - -
8327
INTERNAL BLEACHING - EACH
ADDITIONAL VISIT 163.00R - - - - 244.50R - -
8328
ROOT CANAL OBTURATION -
ANTERIORS AND PREMOLARS -
EACH ADDITIONAL CANAL 266.40R 266.40R - - - 354.40R - -
8329
ROOT CANAL THERAPY -
ANTERIORS AND PREMOLARS -
EACH ADDITIONAL CANAL 333.00R 333.00R - - - 442.80R - -
8330
REMOVAL OF ROOT CANAL
OBSTRUCTION 187.40R 187.40R - 187.40R - 187.40R - -
8332
ROOT CANAL PREPARATORY VISIT -
SINGLE CANAL TOOTH 143.60R 143.60R - - - 190.80R - -
8333
ROOT CANAL PREPARATORY VISIT -
MULTI CANAL TOOTH 201.40R 201.40R - - - 201.40R - -
8334
RE-TREATMENT OF PREVIOUSLY
COMPLETED ROOT CANAL
THERAPY, PER CANAL 212.10R 212.10R - 212.10R - 255.70R - -
8335
ROOT CANAL OBTURATION -
ANTERIORS AND PREMOLARS -
FIRST CANAL 651.80R 651.80R - - - 866.70R - -
8336
ROOT CANAL OBTURATION -
POSTERIORS - FIRST CANAL 897.00R 897.00R - - - 1 193.00R - -
8337
ROOT CANAL OBTURATION -
POSTERIORS - EACH ADDITIONAL
CANAL 266.40R 266.40R - - - 354.40R - -
8338
ROOT CANAL THERAPY -
ANTERIORS AND PREMOLARS -
FIRST CANAL 997.00R 997.00R - - - 1 325.90R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8339
ROOT CANAL THERAPY -
POSTERIORS - FIRST CANAL 1 370.10R 1 370.10R - - - 1 822.10R - -
8340
ROOT CANAL THERAPY -
POSTERIORS - EACH ADDITIONAL
CANAL 333.00R 333.00R - - - 442.80R - -8341 AMALGAM - ONE SURFACE 285.60R 285.60R - 285.60R - 285.60R 249.20R -8342 AMALGAM - TWO SURFACES 352.20R 352.20R - 352.20R - 352.20R 307.20R -8343 AMALGAM - THREE SURFACES 429.20R 429.20R - 429.20R - 429.20R 374.50R -
8344
AMALGAM - FOUR OR MORE
SURFACES 478.30R 478.30R - 478.30R - 478.30R 417.20R -
8345
PREFABRICATED POST RETENTION,
PER POST (IN ADDITION TO
RESTORATION) 282.10R 282.10R - 282.10R - 282.10R - -
8347
PIN RETENTION - FIRST PIN (IN
ADDITION TO RESTORATION) 141.80R 141.80R - 141.80R - 141.80R - -
8348
PIN RETENTION - EACH
ADDITIONAL PIN (IN ADDITION TO
RESTORATION) 131.30R 131.30R - 131.30R - 131.30R - -
8349
CARVE RESTORATION TO
ACCOMMODATE EXISTING
REMOVABLE PROSTHESIS 57.80R - - - - - - -
8350
RESIN CROWN - ANTERIOR
PRIMARY TOOTH (DIRECT) 623.10R 623.10R - 623.10R - 623.10R 543.40R -
8351 RESIN - ONE SURFACE, ANTERIOR 313.60R 313.60R - 313.60R - 313.60R 301.60R -
8352 RESIN - TWO SURFACES, ANTERIOR 394.30R 394.30R - 394.30R - 394.30R 379.00R -
8353
RESIN - THREE SURFACES,
ANTERIOR 471.30R 471.30R - 471.30R - 471.30R 452.90R -
8354
RESIN - FOUR OR MORE SURFACES,
ANTERIOR 525.70R 525.70R - 525.70R - 525.70R 505.50R -8355 VENEER - RESIN (CHAIR-SIDE) 497.70R 497.70R - 497.70R - 497.70R - -8357 PREFABRICATED METAL CROWN 292.60R 292.60R - 292.60R - 292.60R - -8361 INLAY - METAL - ONE SURFACE 436.20R - - - - 860.40R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8362
INLAY/ONLAY - METAL - TWO
SURFACES 637.80R - - - - 1 247.50R - -
8363
INLAY/ONLAY - METAL - THREE
SURFACES 1 063.50R - - - - 1 934.40R - -
8364
INLAY/ONLAY - METAL - FOUR OR
MORE SURFACES 1 286.10R - - - - 1 934.40R - -
8366
PIN RETENTION AS PART OF CAST
RESTORATION (ANY NUMBER OF
PINS) 212.10R - - - - 287.40R - -
8367 RESIN - ONE SURFACE, POSTERIOR 340.00R 340.00R - 340.00R - 340.00R 326.90R -
8368
RESIN - TWO SURFACES,
POSTERIOR 420.50R 420.50R - 420.50R - 420.50R 404.40R -
8369
RESIN - THREE SURFACES,
POSTERIOR 508.20R 508.20R - 508.20R - 508.20R 488.50R -
8370
RESIN - FOUR OR MORE SURFACES,
POSTERIOR 546.60R 546.60R - 546.60R - 546.60R 525.40R -
8371 INLAY - PORCELAIN - ONE SURFACE 525.70R - - - - 1 039.10R - -
8372
INLAY/ONLAY - PORCELAIN - TWO
SURFACES 776.20R - - - - 1 496.50R - -
8373
INLAY/ONLAY - PORCELAIN - THREE
SURFACES 1 279.10R - - - - 2 325.20R - -
8374
INLAY/ONLAY - PORCELAIN - FOUR
OR MORE SURFACES 1 549.10R - - - - 2 325.20R - -8375 PREFABRICATED RESIN CROWN 292.60R 292.60R - 292.60R - 292.60R - -
8376
CORE BUILD-UP WITH
PREFABRICATED POSTS 781.40R - - - - 781.40R - -8379 COST OF PREFABRICATED POSTS 108.80R - - - - 108.80R - -8381 INLAY - RESIN - ONE SURFACE 525.70R - - - - 1 039.10R - -
8382
INLAY/ONLAY - RESIN - TWO
SURFACES 776.20R - - - - 1 496.50R - -
8383
INLAY/ONLAY - RESIN - THREE
SURFACES 1 279.10R - - - - 2 325.20R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8384
INLAY/ONLAY - RESIN - FOUR OR
MORE SURFACES 1 549.10R - - - - 2 325.20R - -8392 CAST POST (EACH ADDITIONAL) 196.20R - - - - 196.20R - -8398 CORE BUILD-UP WITH PINS 637.80R - - - - 637.80R - -8410 PROVISIONAL CROWN * 318.80R - - 318.80R - 478.30R - -
8413
REPAIR CROWN (PERMANENT OR
PROVISIONAL) * 318.80R 318.80R - - - 318.80R - -
8414
ADDITIONAL FEE FOR PROVISION
OF CROWN WITHIN AN EXISTING
CLASP OR REST * 94.70R - - - - 94.70R - -8419 PROVISIONAL PONTIC * 318.80R - - - - 478.30R - -
8447 PROVISIONAL CROWN RETAINER * 318.80R - - - - 478.30R - -8499 GENERAL ANAESTHETIC * - - - - - - - -
8501 CONSULTATION - PROSTHODONTIS - - - - - 297.90R - -
8503 OCCLUSION ANALYSIS MOUNTED 318.80R - - - - 478.30R - -8505 PANTOGRAPHIC RECORDING 462.60R - - - - 693.90R - -
8506
DETAILED CONSULTATION -
PROSTHODONTIST - - - - - 779.60R - -
8507
COMPREHENSIVE CONSULTATION -
PROSTHODONTIST - - - - - 478.30R - -
8508
ELECTROGNATHOGRAPHIC
RECORDING 495.30R - - - - 743.00R - -
8509
ELECTROGNATHOGRAPHIC
RECORDING WITH COMPUTER
ANALYSIS 822.30R - - - - 1 233.50R - -8514 RECEMENT BRIDGE 143.60R 143.60R - - - 182.20R - -8516 REMOVE BRIDGE 285.60R 285.60R - - - 285.60R - -
8517
REIMPLANTATION OF AVULSED
TOOTH (INCLUDE STABILISATION) 331.70R 331.70R - 331.70R - 497.70R - -8518 REPAIR BRIDGE 318.80R 318.80R - - - 318.80R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8551 OCCLUSAL ADJUSTMENT - MAJOR 908.70R - 1 363.10R - - 1 363.10R - -
8552
VENEER - PORCELAIN
(LABORATORY) 1 101.40R - - - - 1 652.30R - -
8553 OCCLUSAL ADJUSTMENT - MINOR 317.00R 434.40R 434.40R 434.40R - 434.40R - -8554 VENEER - RESIN (LABORATORY) 1 101.40R - - - - 1 652.30R - -8561 GOLD FOIL CLASS I OR IV 831.70R - - - - 1 247.50R - -8563 GOLD FOIL CLASS V 973.00R - - - - 1 459.60R - -8565 GOLD FOIL CLASS III 1 224.10R - - - - 1 836.20R - -8578 PREFABRICATED ABUTMENT 266.40R - - - - 399.50R - -8579 CUSTOM ABUTMENT 1 214.80R - - - - 1 822.20R - -
8580
CUSTOMISED PREFABRICATED
ABUTMENT * 496.60R 496.60R - - - 496.60R - -8585 CONNECTOR BAR - - - - - - - -8586 STRESS BREAKER - - - - - - - -8587 COPING METAL 213.90R - - - - 399.50R - -
8590
IMPLANT MAINTENANCE
PROCEDURES - PER IMPLANT 117.90R - - - - 177.00R - -
8594
REPAIR OF IMPLANT SUPPORTED
PROSTHESIS 130.90R - - - - 196.20R - -8595 REPAIR OF IMPLANT ABUTMENT 130.90R - - - - 196.20R - -8597 LOCKS AND MILLED RESTS 130.90R - - - - 196.20R - -
8599
PRECISION ATTACHMENT
(REMOVABLE DENTURE) 318.80R - - - - 478.30R - -
8631
ROOT CANAL THERAPY - FIRST
CANAL SPECIALIST
PROSTHODONTIST - - - - - 1 692.60R - -
8633
ROOT CANAL THERAPY - EACH
ADDITIONAL CANAL SPECIALIST
PROSTHODONTIST - - - - - 425.70R - -
8635
APEXIFICATION/APEXOGENESIS/RE
CALCIFICATION – PER VISIT 190.90R 190.90R - 190.90R - 375.20R - -
8640
REMOVAL OF FRACTURED ROOT
CANAL INSTRUMENT 497.70R - - - - 497.70R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8657
REPLACEMENT OF PRECISION
ATTACHMENT 182.20R - - - - 196.20R - -8658 INTERIM COMPLETE DENTURE 1 427.90R - - - - 2 142.00R - -8659 INTERIM PARTIAL DENTURE 1 142.30R - - - - 1 713.60R - -
8660
ADDITIONAL FEE TO IMPLANT
SUPPORTED FIXED-DETACHABLE
DENTURE - PER IMPLANT 399.50R - - - - 399.50R - -
8661
DIAGNOSTIC DENTURES
(INCLUDING TISSUE
CONDITIONING) - - - - - - - -
8662
ADJUST COMPLETE OR PARTIAL
DENTURES (REMOUNTING) 371.60R - - - - 557.30R - -
8663
METAL BASE TO COMPLETE
DENTURE 775.60R - - - - 1 163.50R - -
8664
REMOUNT CROWN OR BRIDGE FOR
ADJUSTMENT 371.60R - - - - 582.20R - -
8667
SOFT BASE TO DENTURE (HEAT
CURED) 775.60R - - - - 1 163.50R - -
8672
ALTERED CAST TECHNIQUE (IN
ADDITION TO PARTIAL DENTURE) 99.50R - - 99.50R - 149.00R - -8674 ADDITIVE PARTIAL DENTURE 1 168.20R - - - - 1 752.20R - -
8701 CONSULTATION - PERIODONTIST - - - 297.90R - - - -
8703
CONSULTATION - PERIODONTIST
(DETAILED) - - - 779.60R - - - -
8705 RE-EXAMINATION - PERIODONTIST - - - 233.00R - - - -
8707
PERIODONTAL SCREENING -
PERIODONTIST - - - 233.00R - - - -
8723
PROVISIONAL SPLINTING -
EXTRACORONAL (WIRE) - PER
SEXTANT 266.40R 266.40R - 399.50R - 399.50R - 266.40R
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8725
PROVISIONAL SPLINTING -
EXTRACORONAL (WIRE PLUS
RESIN) - PER SEXTANT 386.60R 386.60R - 580.00R - 580.00R - 386.60R
8727
PROVISIONAL SPLINTING -
INTRACORONAL - PER TOOTH 121.40R 121.40R - 182.20R - 182.20R - -
8731
INCISION & DRAINAGE OF ABSCESS
- INTRA-ORAL 229.10R 229.10R - 343.50R - - - -
8741
GINGIVECTOMY/GINGIVOPLASTY -
FOUR OR MORE TEETH PER
QUADRANT 750.00R - - 1 028.60R - - - -
8743
GINGIVECTOMY OR
GINGIVOPLASTY - ONE TO THREE
TEETH PER QUADRANT 599.20R - - 816.50R - - - -
8749
FLAP PROCEDURE, ROOT PLANING
AND ONE TO THREE SURGICAL
SERVICES - PER QUADRANT 1 557.00R - - 2 335.70R - - - -
8751
FLAP PROCEDURE, ROOT PLANING
AND ONE TO THREE SURGICAL
SERVICES - PER SEXTANT 1 289.60R - - 1 934.40R - - - -
8753
FLAP PROCEDURE, ROOT PLANING
AND FOUR OR MORE SURGICAL
SERVICES - PER QUADRANT 1 929.90R - - 2 894.70R - - - -
8755
FLAP PROCEDURE, ROOT PLANING
AND FOUR OR MORE SURGICAL
SERVICES - PER SEXTANT 1 564.00R - - 2 346.20R - - - -
8756
CLINICAL CROWN LENGTHENING
(ISOLATED PROCEDURE) * 948.40R - - 1 422.70R - - - -
8759
PEDICLE FLAPPED GRAFT
(ISOLATED PROCEDURE) 712.60R - - 1 068.80R - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8761
MASTICATORY MUCOSAL
AUTOGRAFT - ONE TO FOUR TEETH
(ISOLATED PROCEDURE) 774.40R 1 161.70R - 1 161.70R - - - -
8762
MASTICATORY MUCOSAL
AUTOGRAFT - FOUR OR MORE
TEETH (ISOLATED PROCEDURE) 1 163.50R 1 745.20R - 1 745.20R - - - -
8763
WEDGE RESECTION (ISOLATED
PROCEDURE) * 455.60R 455.60R - 683.40R - - - -
8765
HEMISECTION OF A TOOTH,
RESECTION OF A ROOT OR TUNNEL
PREPARATION (ISOLATED
PROCEDURE) 626.10R - - 939.20R - 939.20R - -
8766
BONE REGENERATION/REPAIR
PROCEDURE - AS PART OF A FLAP
OPERATION 372.60R - - 559.10R - - - -
8767
BONE REGENERATION/REPAIR
PROCEDURE - AT A SINGLE SITE 966.10R 1 449.10R - 1 449.10R - - - -
8768
UNLISTED PERIODONTAL
PROCEDURE 455.60R - - 683.40R - - - -
8769
MEMBRANE REMOVAL (USED FOR
GUIDED TISSUE REGENERATION) 455.60R 683.40R - 683.40R - - - -
8770
COST OF BONE
REGENERATIVE/REPAIR MATERIAL - - - - - - - -
8772
SUBMUCOSAL CONNECTIVE TISSUE
AUTOGRAFT (ISOLATED
PROCEDURE) 782.60R 1 174.00R - 1 174.00R - - - -
8773
COST OF INTRAPOCKET
CHEMOTHERAPEUTIC AGENT - - - - - - - -
8781
CONSULTATION - ORAL MEDICINE
(SIMPLE) - - - - - - - -
8782
CONSULTATION - ORAL MEDICINE
(COMPLEX) - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8783
CONSULTATION - ORAL MEDICINE
(SUBSEQUENT) - - - - - - - -
8787
UNLISTED ORAL MEDICINE
PROCEDURE 163.50R - - 245.30R - - - -
8801 CONSULTATION - ORTHODONTIST - - 297.90R - - - - -
8803
CONSULTATION - ORTHODONTIS
(SUBSEQUENT, RETENTION AND
POST TREATMENT) - - 173.50R - - - - -
8811
TRACING AND ANALYSIS OF EXTRA-
ORAL FILM 43.90R 43.90R 43.90R 43.90R - 43.90R - -
8837
DIAGNOSIS AND TREATMENT
PLANNING - ORTHODONTIST - - 138.30R - - - - -8839 DIAGNOSTIC SETUP 195.20R 195.20R 292.60R - - - - -
8840
TREATMENT PLANNING FOR
ORTHOGNATHIC SURGERY - ALL 672.70R 1 009.20R 1 009.20R - - - - -
8846
REPAIR ORTHODONTIC APPLIANCE -
REMOVABLE 131.90R - 197.90R - - - - -
8847
REPLACE ORTHODONTIC
APPLIANCE - REMOVABLE 455.60R - 683.40R - - - - -
8848
REPAIR ORTHODONTIC APPLIANCE -
FIXED 195.20R - 292.60R - - - - -8849 RETAINER (ORTHODONTIC) 455.60R - 683.40R - - - - -
8850 TREATMENT OF MPDS - FIRST VISIT 219.60R 219.60R 329.50R 219.60R - 329.50R - -
8851
TREATMENT OF MPDS -
SUBSEQUENT VISIT 115.60R 115.60R 173.50R 115.60R - 173.50R - -
8852 OCCLUSAL ORTHOTIC APPLIANCE 551.80R 727.10R 727.10R 727.10R - 727.10R - -
8855
CONSULTATION - CLEFT PALATE
THERAPY (HOUSE OR HOSPITAL) 266.40R - 399.50R - - 399.50R - -
8856
CONSULTATION - CLEFT PALATE
(SUBSEQUENT) 130.90R - 196.20R - - 196.20R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8857
CONSULTATION - CLEFT PALATE
(MAXIMUM) 910.00R - 1 364.90R - - 1 364.90R - -
8862
ORTHO TX - REMOVABLE
APPLIANCE * - - - - - - - -
8863
ORTHO TX - EACH ADDITIONAL
REMOVABLE APPLIANCE * - - - - - - - -8891 ORTHODONTIC TRANSFER * - - - - - - - -8892 ORTHODONTIC RE-TREATMENT * - - - - - - - -8935 TREATMENT OF SEPTIC SOCKET 105.20R 164.80R - 105.20R - 105.20R 88.80R -8901 CONSULTATION - MFOS - 297.90R - - - - - -
8902 CONSULTATION - MFOS (DETAILED) - 779.60R - - - - - -
8903
HOUSE/HOSP/NURSING HOME
CONSULTATION - MFOS - 261.00R - - - - - -
8904
HOUSE/HOSP/NURSING HOME
CONSULTATION (SUBSEQUENT) -
MFOS - 173.50R - - - - - -
8905
AFTER REGULARLY HOURS
CONSULTATION - MFOS - 382.10R - - - - - -
8907
HOUSE/HOSP/NURSING HOME
CONSULTATION (MAXIMUM PER
WEEK) - MFOS - 434.40R - - - - - -
8908
SURGICAL REMOVAL OF ROOTS
FROM MAXILLARY ANTRUM 1 897.00R 2 845.60R - - - - - -8909 ORAL ANTRAL FISTULA CLOSURE 1 454.30R 2 181.40R - - - - - -8911 CALDWELL-LUC PROCEDURE 569.00R 853.40R - - - - - -8917 BIOPSY OF ORAL TISSUE - SOFT 362.70R 483.50R - 483.50R - - - -8919 BIOPSY OF BONE - NEEDLE * 558.30R 837.50R - - - - - -
8921
BIOPSY – EXTRA-ORAL BONE/SOFT
TISSUE * 913.50R 1 370.10R - - - - - -
8931
TREATMENT OF POST-EXTRACTION
HAEMORRHAGE 105.20R 630.80R - 105.20R - 105.20R 88.80R -
8933
TREATMENT OF HAEMORRHAGE
(BLOOD DYSCRACIAS) 1 454.30R 2 181.40R - 1 454.30R - 1 454.30R - -8937 SURGICAL REMOVAL OF TOOTH 620.40R 837.50R - 620.40R - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8941
SURGICAL REMOVAL OF IMPACTED
TOOTH - FIRST TOOTH 1 028.60R 1 352.70R - 1 028.60R - - - -
8943
SURGICAL REMOVAL OF IMPACTED
TOOTH - SECOND TOOTH 551.80R 728.80R - 551.80R - - - -
8945
SURGICAL REMOVAL OF IMPACTED
TOOTH - THIRD AND SUBSEQUENT
TEETH 313.60R 413.50R - 313.60R - - - -
8953
SURGICAL REMOVAL OF RESIDUAL
ROOTS, FIRST TOOTH - PER TOOTH 620.40R 837.50R - 837.40R - - - -
8957
ALVEOLOTOMY OR
ALVEOLECTOMY (INCLUDING
EXTRACTIONS) 761.70R 1 142.50R - 761.70R - - - -8961 TOOTH TRANSPLANTATION 1 248.70R 1 873.10R - - - - - -8962 HARVEST ILIAC CREST GRAFT 460.40R 565.80R - - - - - -8963 HARVEST RIB GRAFT 528.10R 792.10R - - - - - -8964 HARVEST CRANIUM GRAFT 413.50R 620.40R - - - - - -8965 PERIPHERAL NEURECTOMY 1 248.70R 1 873.10R - - - - - -
8967
SURGICAL REMOVAL OF JAW CYST -
INTRA-ORAL APPROACH 1 734.70R 2 602.10R - - - - - -
8969
SURGICAL REMOVAL OF JAW CYST -
EXTRA-ORAL APPROACH 2 778.80R 4 168.40R - - - - - -
8971
EXCISION OF TUMOUR OF THE
SOFT TISSUE 558.30R 837.50R - 837.50R - - - -
8973
SURGICAL EXCISION OF TUMOURS
OF THE JAW 2 778.80R 4 168.40R - - - - - -
8979
HARVESTING OF AUTOGENOUS
GRAFTS (INTRA-ORAL) 240.50R 360.90R - 360.90R - - - -
8981
SURGICAL EXPOSURE OF
IMPACTED OR UNERUPTED TEETH
TO AID ERUPTION 1 146.00R 1 561.30R - 1 561.30R - - - -
9003
REPOSITION MENTAL FORAMEN
AND NERVE - PER SIDE 1 734.70R 2 602.10R - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
8983 CORTICOTOMY - FIRST TOOTH 829.20R 1 244.00R - - - - - -
8984
CORTICOTOMY - EACH ADDITIONAL
TOOTH 420.50R 630.80R - - - - - -8985 FRENULECTOMY/FRENULOTOMY 761.70R 1 142.50R - 1 142.50R - - - -
8987
REDUCTION OF MYLOHYOID
RIDGES - PER SIDE 1 248.70R 1 873.10R - - - - - -
8989 REMOVAL TORUS MANDIBULARIS 1 248.70R 1 873.10R - - - - - -8991 REMOVAL OF TORUS PALATINUS 1 248.70R 1 873.10R - - - - - -
8993
SURGICAL REDUCTION OF
OSSEOUS TUBEROSITY - PER SIDE 558.30R 837.50R - - - - - -8995 GINGIVECTOMY - PER JAW 1 110.90R 1 666.50R - - - - - -
8997 SULCOPLASTY / VESTIBULOPLASTY 2 863.10R 4 294.80R - 4 294.80R - - - -
9004
LATERALIZATION OF INFERIOR
DENTAL NERVE 2 795.30R 4 193.10R - - - - - -
9005
ALVEOLAR RIDGE AUGMENTATION -
TOTAL (BY BONE GRAFT) 2 919.20R 4 378.70R - 4 378.70R - - - -
9007
ALVEOLAR RIDGE AUGMENTATION -
TOTAL (BY ALLOPLASTIC MATERIAL) 1 837.40R 2 756.20R - - - - - -
9008
ALVEOLAR RIDGE AUGMENTATION -
ONE TO TWO TOOTH SITES 568.00R 1 039.10R - 1 039.10R - - - -
9009
ALVEOLAR RIDGE AUGMENTATION -
THREE ACROSS 3 OR MORE TOOTH
SITES 1 262.70R 1 894.00R - 1 894.00R - - - -9010 SINUS LIFT PROCEDURE 1 897.00R 2 845.60R - 2 845.60R - - - -
9011
INCISION & DRAINAGE OF ABSCESS
- INTRA-ORAL (PYOGENIC) 355.20R 532.60R - - - - 167.70R -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9015
APICECTOMY/PERIRADICULAR
SURGERY - ANTERIORS (INCLUDING
RETROGRADE FILLING) 707.90R 939.20R - 939.20R - 939.20R - -
9016
APICECTOMY/PERIRADICULAR
SURGERY - MOLARS (INCLUDING
RETROGRADE FILLING) 1 248.70R 1 873.10R - 1 873.10R - 1 873.10R - -
9019
SEQUESTRECTOMY - INTRA ORAL
PER SEXTANT AND OR RAMUS 558.30R 837.50R - - - - - -
9021
SUTURE - RECONSTRUCTION,
MINOR (EXCLUDES CLOSURE OF
SURGICAL INCISIONS) 707.90R 939.20R - - - - - -
9023
SUTURE - RECONSTRUCTION,
MAJOR (EXCLUDES CLOSURE OF
SURGICAL INCISIONS) 1 317.80R 1 976.50R - - - - - -
9024
DENTO-ALVEOLAR FRACTURE - PER
SEXTANT 626.10R 939.20R - - - - - -
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) * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9046
PLACEMENT OF ZYGOMATICUS
FIXTURE, PER FIXTURE * - - - - - - - -
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) * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9066
SURGICAL EXPANSION -
MAXILLIARY OR MANDIBULAR * - - - - - - - -
9067
DISTRACTION OSTEOGENESIS -
ACROSS ONE TO TWO TOOTH SITES - - - 13 071.50R - - - -
9068
DISTRACTION OSTEOGENESIS -
ACROSS THREE TO FIVE TOOTH
SITES - - - 13 071.50R - - - -9069 GLOSSECTOMY - PARTIAL * - - - - - - - -
9070
DISTRACTION OSTEOGENESIS -
FULL ARCH - - - 13 071.50R - - - -9071 GENIOHYOIDOTOMY * - - - - - - - -
9072
CLOSE SECONDARY ORO-NASAL
FISTULA W/ BONE GRAFTING
(COMPLETE PROCEDURE) * - - - - - - - -
9074 TMJ ARTHROSCOPY DIAGNOSTIC * - - - - - - - -
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 * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9091
REDUCTION OF TMJ DISLOCATION -
OPEN REDUCTION * - - - - - - - -9092 JOINT RECONSTRUCTION * - - - - - - - -
9093
REMOVAL OF SALIVARY STONE
(SIALOLITHOTOMY) 626.10R 939.20R - - - - - -
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 * - - - - - - - -
9109
MANDIBULAR RESECTION
PROSTHESIS W/O GUIDE FLANGE * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
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 * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
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 * - - - - - - - -
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 * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
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) * - - - - - - - -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 * 1 890.00R 1 889.90R - - - - - -
9181
SURGICAL PLACEMENT OF SUB-
PERIOSTEAL IMPLANT -
PLACEMENT STAGE * 1 890.00R 1 889.90R - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9182
SURGICAL PLACEMENT OF
ENDOSTEAL IMPLANT PLATE * 946.10R 1 419.20R - 1 419.20R - - - -
9183
SURGICAL PLACEMENT OF
ENDOSSEUS IMPLANT - FIRST PER
QUADRANT * 1 331.70R 1 810.00R - 1 810.00R - 1 809.70R - -
9184
SURGICAL PLACEMENT OF
ENDOSSEUS IMPLANT - SECOND
PER QUADRANT * 997.00R 1 357.90R - 1 357.90R - 1 357.40R - -
9185
SURGICAL PLACEMENT OF
ENDOSSEUS IMPLANT - THIRD AND
SUBSEQUENT PER QUADRANT * 667.50R 909.50R - 909.50R - - - -
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 * 494.00R 669.20R - 669.20R - 669.20R - -
9191
SURGICAL EXPOSURE OF
ENDOSSEUS IMPLANT - SECOND
PER QUADRANT * 371.40R 503.00R - 503.00R - 503.00R - -
9192
SURGICAL EXPOSURE OF
ENDOSSEUS IMPLANT - THIRD AND
SUBSEQUENT PER QUADRANT * 248.70R 338.20R - 338.20R - 338.20R - -
9198 SURGICAL REMOVAL OF IMPLANT * 615.60R 923.50R - 923.50R - 615.70R - -
9201
CONSULTATION - ORAL
PATHOLOGIST - - - - - - - -
9203
HOUSE/HOSP/NURSING HOME
CONSULTATION - ORAL
PATHOLOGIST - - - - - - - -
Trf
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required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9205
CONSULTATION - ORAL
PATHOLOGIST (SUBSEQUENT) - - - - - - - -
9207
AFTER HOURS VISIT - ORAL
PATHOLOGIST - - - - - - - -
9220
REPAIR CLEFT HARD PALATE -
UNILATERAL * - - - - - - - -
9222
REPAIR CLEFT HARD PALATE -
BILATERAL (ONE PROCEDURE) * - - - - - - - -
9224
REPAIR CLEFT HARD PALATE -
BILATERAL (TWO PROCEDURES) * - - - - - - - -
9226
REPAIR CLEFT SOFT PALATE - W/O
MUSCLE RECONSTRUCTION * - - - - - - - -
9228
REPAIR CLEFT SOFT PALATE - W/
MUSCLE RECONSTRUCTION * - - - - - - - -
9230
REPAIR SUBMUCOSAL CLEFT
AND/OR BIFID UVULA - W/
MUSCLE RECONSTRUCTION * - - - - - - - -
9232
VELOPHARYNGEAL
RECONSTRUCTION -
UNCOMPLICATED * - - - - - - - -
9234
VELOPHARYNGEAL
RECONSTRUCTION - COMPLICATED * - - - - - - - -
9238
REPAIR ORONASAL FISTULA (ONE
PROCEDURE) * - - - - - - - -
9240
REPAIR ORONASAL FISTULA (TWO
PROCEDURES) * - - - - - - - -9246 SECONDARY PERIOSTEAL FLAPS * - - - - - - - -9248 LIPADHESION * - - - - - - - -
9250
REPAIR CLEFT LIP - UNILATERAL
W/O MUSCLE RECONSTRUCTION * - - - - - - - -
9252
REPAIR CLEFT LIP - UNILATERAL W/
MUSCLE RECONSTRUCTION * - - - - - - - -
Trf
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required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9254
REPAIR CLEFT LIP - BILATERAL W/O
MUSCLE RECONSTRUCTION * - - - - - - - -
9256
REPAIR CLEFT LIP - BILATERAL W/
MUSCLE RECONSTRUCTION * - - - - - - - -9258 REPAIR ANTERIOR NASAL FLOOR * - - - - - - - -
9260
REVISION OF SECONDARY CLEFT
LIP DEFORMITY - PARTIAL * - - - - - - - -
9262
REVISION OF SECONDARY CLEFT
LIP DEFORMITY - TOTAL W/
MUSCLE RECONSTRUCTION * - - - - - - - -9264 ABBE-FLAP - TWO STAGES * - - - - - - - -9266 RECONSTRUCT COLUMELLA * - - - - - - - -
9268
RECONSTRUCT NOSE DUE TO CLEFT
DEFORMITY - PARTIAL * - - - - - - - -
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 - - - - - - - -
Trf
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*Pre-
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required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
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 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 58.10R - -
9305
CASTING AND TRIMMING OF
STUDY MODEL, PER MODEL 107.60R 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 139.90R - -
Trf
CodeTariffDescription
*Pre-
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required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9309
NEW TRIMMED BASE TO SUPPLIED
MODEL, PER MODEL 49.50R 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 30.10R - -
9312
GINGIVAL TISSUE MASK PER
IMPLANT 232.50R 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 124.90R - -9314 REFRACTORY MODEL, PER UNIT 122.70R 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 170.10R - - 170.10R 170.10R 170.10R - -
9317
SECTIONAL MODELS FOR CROWN
AND BRIDGE, WORK INCLUSIVE OF
ONE REMOVABLE DIE 150.70R - - - 150.70R 150.70R - -
9319
EACH ADDITIONAL REMOVABLE
DIE FOR ITEMS 9315 AND 9317 PER
DIE 38.70R - - 38.70R 38.70R 38.70R - -
9320
INDEXED OR MODEL TRAY PER DIE
(NOT MORE THAN 9319) 38.70R - - - 38.70R 38.70R - -9321 OCCLUSION BLOCK, PER BLOCK 148.50R 148.50R - - 148.50R 148.50R - -
9323
OCCLUSION BLOCK ON BASEPLATE,
PER BLOCK 187.30R - - - 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 28.00R - -
9329
FIT AND SUPPLY OF DISPOSABLE
ARTICULATOR 73.20R - 73.20R - 73.20R 73.20R - -
9330
DELIVERY / COLLECTION FEE PER
COMPLETED PROCEDURE
(MAXIMUM 4) - - - - - - - -
Trf
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General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9331
FULL UPPER AND LOWER
DENTURES 1 997.70R 1 997.70R - - 1 997.70R 1 997.70R - -
9333 FULL UPPER OR LOWER DENTURE 1 168.90R - - - 1 168.90R 1 168.90R - -
9335
SET-UP AND WAXING OF FULL
UPPER AND LOWER DENTURES 688.90R - - - 688.90R 688.90R - -
9337
SET-UP AND WAXING OF FULL
UPPER OR LOWER DENTURE 460.70R - - - 460.70R 460.70R - -
9339
WAXING AND FINISHING OF FULL
UPPER AND LOWER DENTURES 1 224.90R - - - 1 224.90R 1 224.90R - -
9341
WAXING AND FINISHING OF FULL
UPPER OR LOWER DENTURE 684.60R - - - 684.60R 684.60R - -
9343
ADDITIONAL FEE FOR DENTURES
ON FULLY ADJUSTABLE
ARTICULATOR AT REQUEST OF
DENTIST 1 950.40R - - - 1 950.40R 1 950.40R - -
9345
ADDITIONAL FEE FOR IMMEDIATE
DENTURES, OR TOOTH SOCKETED 28.00R - - - 28.00R 28.00R - -
9346
ADDITIONAL FEE FOR IMMEDIATE
DENTURES, PER TOOTH NOT
SOCKETED. 15.10R - - 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 443.50R - -
9351
SET-UP AND FINISH OF ONE-
TOOTH DENTURE 536.00R - - 536.00R 536.00R 536.00R - -
9352
SET-UP AND FINISH OF TWO-
TOOTH DENTURE 570.50R - - 570.50R 570.50R 570.50R - -
9353
SET-UP AND FINISH OF THREE-
TOOTH DENTURE 611.40R - - 611.40R 611.40R 611.40R - -
Trf
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General
Dental
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Maxillo-Facial &
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(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9354
SET-UP AND FINISH OF FOUR-
TOOTH DENTURE 645.80R - - 645.80R 645.80R 645.80R - -
9355
SET-UP AND FINISH OF FIVE-TOOTH
DENTURE 697.50R - - 697.50R 697.50R 697.50R - -
9356
SET-UP AND FINISH OF SIX-TOOTH
DENTURE 833.10R - - 833.10R 833.10R 833.10R - -
9357
SET-UP AND FINISH OF SEVEN-
TOOTH DENTURE 990.20R - - 990.20R 990.20R 990.20R - -
9358
SET-UP AND FINISH OF EIGHT-
TOOTH DENTURE 1 050.50R - - 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 1 076.40R - -
9361
SET-UP AND WAXING OF ONE-
TOOTH DENTURE 152.80R - - 152.80R 152.80R 152.80R - -
9362
SET-UP AND WAXING OF TWO-
TOOTH DENTURE 185.10R - - 185.10R 185.10R 185.10R - -
9363
SET-UP AND WAXING OF THREE-
TOOTH DENTURE 211.00R - - 211.00R 211.00R 211.00R - -
9364
SET-UP AND WAXING OF FOUR-
TOOTH DENTURE 245.40R - - 245.40R 245.40R 245.40R - -
9365
SET-UP AND WAXING OF FIVE-
TOOTH DENTURE 271.20R - - 271.20R 271.20R 271.20R - -
9366
SET-UP AND WAXING OF SIX-
TOOTH DENTURE 320.80R - - 320.80R 320.80R 320.80R - -
9367
SET-UP AND WAXING OF SEVEN-
TOOTH DENTURE 353.10R - - 353.10R 353.10R 353.10R - -
9368
SET-UP AND WAXING OF EIGHT-
TOOTH DENTURE 378.90R - - 378.90R 378.90R 378.90R - -
9369
SET-UP AND WAXING OF NINE OR
MORE TOOTH DENTURE 404.70R - - 404.70R 404.70R 404.70R - -
9371
WAXING AND FINISHING OF ONE-
TOOTH DENTURE 419.80R - - 419.80R 419.80R 419.80R - -
9372
WAXING AND FINISHING OF TWO-
TOOTH DENTURE 428.40R - - 428.40R 428.40R 428.40R - -
Trf
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*Pre-
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General
Dental
Practice (54)
Maxillo-Facial &
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(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9373
WAXING AND FINISHING OF THREE-
TOOTH DENTURE 434.80R - - 434.80R 434.80R 434.80R - -
9374
WAXING AND FINISHING OF FOUR-
TOOTH DENTURE 443.50R - - 443.50R 443.50R 443.50R - -
9375
WAXING AND FINISHING OF FIVE-
TOOTH DENTURE 460.70R - - 460.70R 460.70R 460.70R - -
9376
WAXING AND FINISHING OF SIX-
TOOTH DENTURE 477.90R - - 477.90R 477.90R 477.90R - -
9377
WAXING AND FINISHING OF SEVEN-
TOOTH DENTURE 596.30R - - 596.30R 596.30R 596.30R - -
9378
WAXING AND FINISHING OF
EIGHTH-TOOTH DENTURE 620.00R - - 620.00R 620.00R 620.00R - -
9379
WAXING AND FINISHING OF NINE
OR MORE TOOTH DENTURE 654.40R - - 654.40R 654.40R 654.40R - -
9383
ADDITIONAL FEE FOR FINISHING
DENTURE IN TOOTH COLOUR
MATERIAL, PER TOOTH 103.30R - - 103.30R 103.30R 103.30R - -
9385
ADDITIONAL FEE FOR SUPPLYING
FINISHED DENTURE ON DUPLICATE
MODEL 195.90R - - 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 340.10R - 340.10R 340.10R 340.10R 340.10R - -
9393
ADDITIONAL CHARGE FOR EACH
ADDITIONAL FRACTURE, OR
TOOTH, OR CLASP 105.50R - 105.50R 105.50R 105.50R 105.50R - -
9395
ADDITIONAL FEE FOR USING WIRE
STRENGTHENER 120.60R - 120.60R 120.60R 120.60R 120.60R - -
9397
ADDITIONAL FEE FOR USING PRE-
FORMED STRENGTHENER 129.20R - 129.20R 129.20R 129.20R 129.20R - -
Trf
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General
Dental
Practice (54)
Maxillo-Facial &
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Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9398
ADDITIONAL FEE FOR USING MESH
STRENGTHENER IN REPAIR
PROCEDURE 204.50R - - 204.50R 204.50R 204.50R - -9401 CLEAR BASE - - - - - - - -
9403
DOX GRINDING OF UPPER AND
LOWER DENTURES 191.60R - - 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 452.10R - -9409 FREGO FRAME 195.90R - - 195.90R 195.90R 195.90R - -9410 BLEACHING TRAY - - - - - - - -
9411
TEMPLATE PER UPPER OR LOWER
DENTURE 540.30R - - 540.30R 540.30R 540.30R - -
9413
RELINE/REBASE OF SINGLE
DENTURE 680.30R - - 680.30R 680.30R 680.30R - -9415 REMODEL OF SINGLE DENTURE 1 046.20R - - 1 046.20R 1 046.20R 1 046.20R - -9417 SOFT BASE RELINE PER DENTURE 1 717.90R - - 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 1 717.90R - -9421 GUM TINTING PER DENTURE - - - - - - - -9423 LINGUAL OR PALATAL BAR 256.20R - 256.20R 256.20R 256.20R 256.20R - -
9425
CLEANING AND POLISHING OF
EXISTING DENTURE, PER DENTURE 208.80R - - 208.80R 208.80R 208.80R - -9427 MESH STRENGTHENER 178.70R - - 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 443.50R - -9431 SPECIAL TRAY, ACRYLIC, EACH 167.90R - - 167.90R 167.90R 167.90R - -9432 SPECIAL TRAY LIGHT CURE, EACH 183.00R - - 183.00R 183.00R 183.00R - -
Trf
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General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9433
SPECIAL TRAY IN BASE PLATE
MATERIAL, EACH 172.20R - - 172.20R 172.20R 172.20R - -
9435
PROVISION OF SINGLE ARM CLASP,
TO PARTIAL DENTURE 88.30R - - 88.30R 88.30R 88.30R - -
9437
PROVISION OF DOUBLE ARM
CLASP, TO PARTIAL DENTURE 152.80R - - 152.80R 152.80R 152.80R - -
9439
PROVISION OF SINGLE ARM CLASP
WITH REST, TO PARTIAL DENTURE 198.10R - - 198.10R 198.10R 198.10R - -
9441
PROVISION OF DOUBLE ARM CLASP
WITH REST, TO PARTIAL DENTURE 266.90R - - 266.90R 266.90R 266.90R - -
9443
PROVISION OF PREFORMED
ROACH CLASP, TO PARTIAL
DENTURE 114.10R - - 114.10R 114.10R 114.10R - -
9445
PROVISION OF REST ONLY TO
PARTIAL DENTURE 114.10R - - 114.10R 114.10R 114.10R - -9447 CAST CLASP 400.40R - - 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 73.20R - -
9450
FINISHING OF ACRYLIC WORK ON
ANY CHROME COBALT OR GOLD
PROSTHESIS 152.80R 152.80R 152.80R 152.80R 152.80R 152.80R - -
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 1 199.10R - - - 1 199.10R 1 199.10R - -
9455
ADDITIONAL CHARGE FOR EACH
ONE ARM CLASP 49.50R - - - 49.50R 49.50R - -
Trf
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General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9457
ADDITIONAL CHARGE FOR EACH
ROACH CLASP 83.90R - - - 83.90R 83.90R - -
9459
ADDITIONAL CHARGE FOR EACH
REST 45.20R - - - 45.20R 45.20R - -
9461
ADDITIONAL CHARGE FOR
CONTINUOUS CLASP, PER TOOTH 49.50R - - - 49.50R 49.50R - -
9463
ADDITIONAL CHARGE FOR LINGUAL
BAR, PER TOOTH PASSED 116.20R - - - 116.20R 116.20R - -
9465
ADDITIONAL CHARGE FOR PALATAL
BAR 185.10R - - - 185.10R 185.10R - -
9467 ADDITIONAL CHARGE FOR ONLAY - - - - - - - -
9469
ADDITIONAL CHARGE FOR SADDLE
WITH FINISHING LINE, PER TOOTH 81.80R - - - 81.80R 81.80R - -
9471
ADDITIONAL CHARGE FOR SADDLE
WITHOUT FINISHING LINE, PER
TOOTH 47.40R - - - 47.40R 47.40R - -
9473
ADDITIONAL CHARGE FOR
HORSESHOE SADDLE, PER TOOTH 81.80R - - - 81.80R 81.80R - -
9475
ADDITIONAL CHARGE FOR FITTING
OF TOOTH TO METAL BACKING,
PER TOOTH 56.00R - - - 56.00R 56.00R - -
9479
ADDITIONAL CHARGE FOR FITTING
ONE DISTAL-EXTENSION HINGE 165.80R - - - 165.80R 165.80R - -
9480
ADDITIONAL CHARGE PER MILLED
EDGE PER TOOTH 144.20R - - - 144.20R 144.20R - -
9481
ADDITIONAL CHARGE FOR EACH
SOLDERING JOINT 202.40R - - - 202.40R 202.40R - -
9483
ADDITIONAL CHARGE FOR
SOLDERING RETENTION 245.40R - - - 245.40R 245.40R - -
Trf
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General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9485
ADDITIONAL CHARGE FOR EACH
ADDITIONAL RETENTION
SOLDERING JOINT 75.30R - - - 75.30R 75.30R - -
9487
ADDITIONAL CHARGE FOR EACH
WELDING JOINT 247.60R - - - 247.60R 247.60R - -
9489
ADDITIONAL CHARGE FOR FITTING
SWING LOCK 202.40R - - - 202.40R 202.40R - -
9491
ADDITIONAL CHARGE FOR EACH
BACKING CAST 198.10R - - - 198.10R 198.10R - -
9493
ADDITIONAL CHARGE FOR EACH
STEELS BACKING OR PONTIC CAST
(PLASTIC WORK TO BE CHARGED IN
ADDITION) 215.30R - - - 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 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 355.20R - -
9501
CERAMIC JACKET
CROWN/CEROMER CROWN OR
PONTIC * 1 362.70R - - - 1 362.70R 1 362.70R - -
9502
CERAMIC METAL SUBSTITUTE
COPING * 1 100.00R - - - 1 100.00R 1 100.00R - -
9505
CERAMIC BONDED CROWN OR
PONTIC * 1 799.70R - - 1 697.90R 1 799.70R 1 799.70R - -
9507
POST-SOLDER INVESTED JOINT,
PER JOINT 368.10R - - - 368.10R 368.10R - -
9511
INLAY IN PORCELAIN VENEER
CROWN - - - - - - - -
9512
CERAMIC, INLAY/ONLAY, BRIDGE
RETAINER * 1 397.10R - - - 1 397.10R 1 397.10R - -9513 CERAMIC POST * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9515
PORCELAIN SHOULDER PER UNIT
(NOT APPLICABLE TO PONTICS) 120.60R - - 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 58.10R - -
9521
FULL METAL CROWN, MOD, THREE-
QUARTER CROWN * 1 113.00R - - - 1 113.00R 1 113.00R - -
9524 INDIRECT COMPOSITE RESIN INLAY - - - - - - - -
9525
CLASS IV, MO, DO,
CERVICAL/OCCLUSAL INLAY * 917.10R - - - 917.10R 917.10R - -
9526
ADDITIONAL FEE FOR ONE PIECE
CASTING OF CROWN OR INLAY ON
POST 279.80R - - - 279.80R 279.80R - -9531 PIN-LEDGE INLAY - - - - - - - -9533 FULL METAL PONTIC * 822.30R - - - 822.30R 822.30R - -9535 ABUTMENT THIMBLE CAST 770.70R - - - 770.70R 770.70R - -9537 PRECISION LOCK AND REST CAST - - - - - - - -9538 LOCK AND REST CAST - - - - - - - -9539 CASTING OF REST ONLY 312.10R - - - 312.10R 312.10R - -
9541
METAL INLAY OR POST, CAST
DIRECT - - - - - - - -
9543
GOLD/PRE-SOLDER INVESTED
JOINT - - - - - - - -
9545
CAST POST WITH THIMBLE,
INDIRECT * 548.90R - - - 548.90R 548.90R - -9546 MULTIPLE POST * 908.40R - - - 908.40R 908.40R - -
9547
MANUFACTURE CAST POST AND
CORE TO EXISTING CROWN * 716.80R - - - 716.80R 716.80R - -9549 C.S.P. ATTACHMENT (STEIGER) - - - - - - - -9550 MILLING MILLED EDGE PER UNIT 770.70R - - - 770.70R 770.70R - -9551 TELESCOPE CROWN - - - - - - - -
9553
COMPOSITE/ACRYLIC VENEER
CROWN/PONTIC, INDIRECT * 1 517.70R - - - 1 517.70R 1 517.70R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9557
COMPOSITE/ACRYLIC JACKET
CROWN, INDIRECT * 1 072.10R - - - 1 072.10R 1 072.10R - -
9559
COMPOSITE/ACRYLIC VENEER POST
CROWN * 1 500.40R - - - 1 500.40R 1 500.40R - -
9560
INDIRECT COMPOSITE RESIN
VENEER - - - - - - - -
9561
COMPOSITE/ACRYLIC JACKET
CROWN, DIRECT * 731.90R - - - 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 609.20R - -
9566
PORCELAIN/ CEROMER FACING
REPLACED 1 104.30R - - - 1 104.30R 1 104.30R - -
9569
WAXING OF CROWN TO EXISTING
DENTURE 430.50R - - - 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 544.60R 544.60R 544.60R 544.60R 544.60R 544.60R - -
9572 BASIC CHARGE NON ACRYLIC BASE 262.60R - 262.60R - 262.60R - - -
9573
ADDITIONAL CHARGE FOR FITTING
FIRST EXPANSION SCREW 103.30R - 103.30R - 103.30R - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9575
ADDITIONAL FEE FOR FITTING
SUBSEQUENT EXPANSION SCREWS 88.30R - 88.30R - 88.30R - - -
9576
ADDITIONAL FEE FOR FULL
ACLUSAL BITE PLATE 305.70R 305.70R 305.70R 305.70R 305.70R 305.70R - -
9577
ADDITIONAL FEE FOR BITE PLATE
ANTERIOR 103.30R 103.30R 103.30R - 103.30R 103.30R - -
9578
ADDITIONAL FEE FOR BITE PLATE
POSTERIOR 103.30R 103.30R 103.30R - 103.30R 103.30R - -
9579
ADDITIONAL FEE FOR FITTING
TONGUE GUARD 129.20R - 129.20R - 129.20R - - -
9581
ADDITIONAL FEE FOR FLAT OR
INCLINED PLANE 79.70R - 79.70R - 79.70R - - -
9583 ADDITIONAL FEE FOR ADAMS CRIB 94.70R - 94.70R - 94.70R - - -
9585
ADDITIONAL FEE FOR JACKSON
CRIB 99.00R - 99.00R - 99.00R - - -
9587 ADDITIONAL FEE FOR BALL CLASP 111.90R 111.90R 111.90R 111.90R 111.90R - - -
9589
ADDITIONAL FEE FOR SINGLE ARM
CLASP 86.10R - 86.10R - 86.10R - - -
9591
ADDITIONAL FEE FOR DOUBLE
ARM CLASP 150.70R - 150.70R - 150.70R - - -
9593
ADDITIONAL FEE FOR FITTING
SINGLE LOOP FINGER SPRING 71.00R - 71.00R - 71.00R - - -
9595
ADDITIONAL FEE FOR FITTING
DOUBLE LOOP FINGER SPRING 83.90R - 83.90R - 83.90R - - -
9597
ADDITIONAL FEE FOR FITTING
BUCCAL RETRACTION SPRING 62.40R - 62.40R - 62.40R - - -
9599
ADDITIONAL FEE FOR FITTING
APRON SPRING 161.40R - 161.40R - 161.40R - - -
9603
ADDITIONAL FEE FOR FITTING
COFFIN SPRING 155.00R - 155.00R - 155.00R - - -
9605
ADDITIONAL FEE FOR FITTING
QUAD HELIX 172.20R - 172.20R - 172.20R - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9607
ADDITIONAL FEE FOR FITTING
FLAPPER OR “T”-SPRING 129.20R - 129.20R - 129.20R - - -
9609
ADDITIONAL FEE FOR FITTING ALL
SPRINGS WITH TUBING, EACH 144.20R - 144.20R - 144.20R - - -
9611
ADDITIONAL FEE FOR FITTING
LABIAL ARCH 81.80R - 81.80R - 81.80R - - -
9613
ADDITIONAL FEE FOR FITTING
BUCCAL ARCH 96.90R - 96.90R - 96.90R - - -
9615
ADDITIONAL FEE FOR FITTING
ROBERTS RETRACTOR 180.80R - 180.80R - 180.80R - - -9617 INVISIBLE RETAINER - - - - - - - -
9619
ADDITIONAL FEE FOR FITTING
TWIN WIRE ARCH EXTRA-ORAL
ARCH 226.00R - 226.00R - 226.00R - - -9620 ADDITIONAL FEE LIP BUMPER 94.70R - 94.70R - 94.70R - - -
9621
ADDITIONAL FEE FOR FITTING
EXTRA-ORAL ARCH 215.30R - 215.30R - 215.30R - - -
9622
ADDITIONAL FEE FOR FITTING
SPACE MAINTAINER ARCH 94.70R - 94.70R - 94.70R - - -
9623
ADDITIONAL FEE FOR EACH SPOT-
WELDING JOINT 43.10R - 43.10R - 43.10R - - -
9625
ADDITIONAL FEE FOR EACH
SOLDERING JOINT 68.90R - 68.90R - 68.90R - - -
9627
ADDITIONAL FEE FOR EACH
INVESTED SOLDERING JOINT 191.60R - 191.60R - 191.60R - - -
9629
ADDITIONAL FEE FOR EACH HOOK
FOR ELASTIC TRACTION 62.40R - 62.40R - 62.40R - - -
9631
MOUTH PROTECTOR (GUM
GUARD) - - - - - - - -9633 ORAL SCREEN 497.30R 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 889.10R - -9637 TOOTH POSITIONER 1 024.70R - 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 1 364.80R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9641 FRANKEL APPLIANCE 1 317.50R - 1 317.50R - 1 317.50R - - -9643 CHIN CAP 437.00R - 437.00R - 437.00R - - -9645 BIONATOR 891.20R - 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 - 262.60R - - -
9653
PINCHED OR SWAGED BAND WITH
SOLDERED ATTACHMENT 344.40R - 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 215.50R - -9702 DIATORICS, ODDS, ANTERIOR 73.30R - - 73.30R 73.30R 73.30R - -9704 DIATORICS, ODDS, POSTERIOR 73.30R - - 73.30R 73.30R 73.30R - -
9706
COST OF BLEACHING TRAY
MATERIAL - - - - - - - -
9720
SOFT BASE MATERIAL PER
DENTURE 779.30R - - 779.30R 779.30R 779.30R - -9722 ACRYLIC PER DENTURE 88.20R 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 15.20R - -
9728 COST OF LINGUAL / PALATAL BAR 176.40R - - - 176.40R 176.40R - -9729 COST OF MESH STRENGTHENER 92.60R - - - 92.60R 92.60R - -
9730
COST OF PRE-FABRICATED BURN-
OUT COMPONENT, PER
COMPONENT 91.60R - - - 91.60R 91.60R - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
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 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 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 * 165.70R - - 165.70R - 165.70R - -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 54.00R - -9757 CEROMER MATERIAL - PER UNIT 1 100.10R - - - 1 100.00R 1 100.10R - -
9758
FIBER RE-ENFORCED MATERIAL
PER UNIT 362.40R - 362.40R 362.40R 362.40R 362.40R - -9759 FIBRE POST * - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9760
COMPOSITE RESTORATION
MATERIAL - - - - - - - -9761 CERAMIC MATERIAL - - - - - - - -
9762
COST OF ANTERIOR ORTHODONTIC
ATTACHMENT, PER ATTACHMENT 32.10R - 32.10R - 32.10R - - -9763 ORTHODONTIC MATERIAL 32.10R 32.10R 32.10R - 32.10R - - -
9764
COST OF POSTERIOR
ORTHODONTIC ATTACHMENT, PER
ATTACHMENT 32.10R - 32.10R - 32.10R - - -9765 PREFORMED COMPONENTS 17.20R - 17.20R - 17.20R 17.20R - -
9766
COST OF EXPANSION SCREW, PER
SCREW 36.60R - 36.60R - 36.60R - - -9767 SOLDERING MATERIAL 8.59R - 8.59R - 8.59R 8.59R - -
9768
COST OF BUCCAL TUBE/TRANSFER
TUBE, PER TUBE - - - - - - - -9770 COST OF J-HOOK, PER HOOK 34.40R - 34.40R - 34.40R - - -
9772
COST OF LINGUAL BUTTONS, PER
BUTTON 34.40R - 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 8.59R - 8.59R - 8.59R - - -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 - - - - - - - -
Trf
CodeTariffDescription
*Pre-
authorisation
required
General
Dental
Practice (54)
Maxillo-Facial &
Oral Surgery
(62)
Orthodontics
(64)
Periodontics
(92)
Dental
Technicians
(93)
Prostodontics
(94)
Dental
Therapists
(95)
Oral
Hygiene
(113)
9784
ALIGNMENT OF DOLDER BAR AND
CLIPS * - - - - - - - -
9786
TRIMMING, WAXING AND
FINISHING OF IMPLANT
ABUTMENT - CROWN AND BRIDGE
WORK ONLY, PER ABUTMENT 307.80R - - 307.80R 307.80R 307.80R - -
9787
WAXING, MILLING AND FINISHING
OF A CUSTOM ABUTMENT 600.60R - - - 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 1 199.10R - - - 1 199.10R 1 199.10R - -