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bull bull bull
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5 bull J J J poundI11Cll l1t11poundIfll~YIl11a1ii1lflatl tl1t1Y1atl YI a6 0215141 338 al1UYI 25 ila1f1)J 2544
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VlinLnru-nlfin11 LLpoundq~fIWL1ln11ri1t1~Wfi1(lflULLVlWL~1V1u1~~t1nuii~1WL~nuVlYltluln11 LWi~nPln1VlNl~~1fl11ruq1l Lcntl1LLWn(l12JU1LllVln11ri1EJfi1(lflULLVlW ~~il
I iL 1 - il 1 fl1111il1J LL1IU Un1lJil1JI1I~1Uil~1111U111
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1 1 L ~Xl VlU1 VlYltl U 1n11n1 VIWPlU1LllVlLLpoundq 1WlUL~1V1U1VII1 1JJ fill 1 JJ LVlJJ1~JJnufill 1JJ~1Lilu
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I 0 ~ 13 fIrIl11fl1r1lflULLVlULLWVltlIil1LLUnpound1~W
1 1- 1middot 1 ~_ I I JI~ 1l(1) n1ruVl1JJU(l-31U1J1Iil1tl1fl11fo1JltlUtln 1il(lfl-3ltliJVlIil ~Vln11~LLpoundq~1Jltl LVlI1poundqtlcnLlpoundq1
LLpoundqiuYl-3VlLdflil~t1ltliJ1fuuln11 LliW LLVlULl11O~LVI(lLLfIUmiW LUUlIiU L~~fu ~ ~ ~ ~
fi1IJ1f1ULLVlULUa(l11 flUpoundq 1100 U1Vl
JALrT Ol ~ ~~t-tClt~ L~UL~ fCt
NilSrT~1lt1 JAnJAmB16LWnt- nt-JAIS nuruuU~klIlLIf llr~1IlLtCklllfbrTI1LlSnLt-ruLmJl~~MLlllUW Il rkr-I r _~-I
11 L16nJArTBISL~rTiJflW~ ~LUtrTllcf1klt-LflMLt-CLQfL~LlJAM 16M~rTiklL~MJAmBIS LIJ L~16~ 9 ~
JALrT 00pound ~~MlI v ~ ~~ pound ~ BJrBtkl1UBM LM~t-f1kIL~N~U~ (L)
JALrT 009 ~~MW LJAmBJA~kI~ISLfbfb~ITttflLrTfJ~~M M1S11~JAnLt-IlL~ 1_ ~~rshy
JALrT 0817 ~~M~ LJAmllJA~kI middot~tIT ttflLrTfJ~~MMISI1~JAMLt-IlL~ - -rshyJALrT 09pound ~~M~ LJAmllJAUkI lltIT ttflLrTfJ~~MM16I1JAMLt-IlL~ ~-rr-
nt-~ MJAmB16LIJU(PI6t-f1kIL~M~MLt-IlL~t-BIr ~ I
n~tC~~UOtu~~Lu~tI1L16U(~~IlfJl M(famphlm~~Bt-uw~t-f1kl11L~I1L16MJA1mB16LIJ
rT~t1 H Mt1MIT1 Mt-~LUJALnklLM nllrT~~llMIALMklLmiddot n lT- nBJALnklL middot1 (9) r )( Jo 1 Ir r 11 r
wnw JA1JALnklLb1~~1 1
JALrT 09pound ~~nw lrt3ru~LgL~JALMklLM ~LrTLIlMJALMklLM (9)1 1
WMWJAmLt-UMMLh~~1
JALrT 0817 ~~MW lrt3ru~LgL~MLt-U1ML) lItlWJA1~LrTLIlM (v)
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JALrL 009 ~~nw MLll~~LrTLIlM JIS~tWtIlJA~U1 (pound)
JALrT OlL ~~MW ~UIIo~tn (l)
JALrT 00 ~ ~ ~~I1W LlJAM16M~ (~)
Mt-fJUMth W~~MITB~II1tmIT1~ru(LU~M nLt-16rT(jITJAJAtMklthmJAmGIStlIWISB 17 ~ ~ ID lti _I -
JALrT Ol ~ ~~t-111cjo
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ruLI1yt~~MLlITUWI1tlSnJArTBISL~rTiWJW~ ~tUirTIltf1klt-Lfl~LUirTXI-~MLt-tLl~rL~t1UU (pound)
JAtrT 099 ~~nw t~Ut~fc
t-B~rTiWJ~MJAmB16L~Mt ~t-~fl ~bruU1U~klIltIf ~ 1l~1Iltl1k1~fb(ftt1S ntt-rutl1yt
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16 ~ll11hllflULLVlWL1middotWU1V1 LtlVi1~vhJ~Uil1W1WvbJ~1r1l ~1LLWn~
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120 U1Vl~11-1fun-1~1rL~mLfI~1W~ll111lWfI 240 U1Vl~1Vfum1~1r1l11-1q) ~lW l rj 1 ~ 1 I 1r J0 I
L11-1W1VlflW 1-1 ~Pl1U1llflUUVlWll1~rlj1WlWfiJulmLllfl~11tJ Wflll11VlflfIm~lilW
(2) m 1u1mNfln1-1u) tJ ulm1 1-1ffiri11-1U)tJ uln11 VitJ1U1fI~Lll1tJ ~~t1)tJ LLfI ~~LLfi ~t1ltJ 1Hrn11~1r LLrifl~11tJ 1laquo1~fUI11J1flULLVlWll1~~1W~W~t1)mLrifl~11tJ1W~ll11V1~fI~ 120 U1Vl
~11-1fUii~~1~L~n LLfI~ii~fI~ 360 U1Vl~11-1fUii~~1~tl11-1qJ
(3) ~J111fgti1J1fl1JLLVlWJ11~ (1) 1-17fl (2) 1l~riWLL~)~Wfi1J1flULLVII~1~f1J~1~tl1lIMLLr1f1IlW
rlj~~fl-l1~UfltJn(h~J111~n11-1Wtl1~ 14
1 7 ~J111fi1llt1ULLVlWLl11-1U1~~tl~Uii1Wri11-1U)tJulm1 ~1ulm1ll1)rljfm~nLLUU ~t1)tJWfln ~1LLWnlK-J
(1) LLViVltiliWllLLViVIU 120 U1Vl
(2) LIlilln1 90 U1Vl
(3) 1n~VltJ1fi1~llf VimU1fl~1I1jVi Wmll1m1Vl11U$11i11N~1I
80 U1V1
(4) VitJ1U1flLVlllilll Ll1Viln-J1U~11i11N~1I 60 U1Vl
50 U1Vl
to- r LLflLrlj11-1U1Vl LVlIlUIl
18 n1rll~1-1UlJtJulm1 illl)1~~1LtlUfl-J1Ll11-1U1~tl~Uii~1W1uim~tN~Ll11fl1Uln-1 (On Call) L~fl1ulm1~t1)tJ 1Il N~n11~m1ul1-1111-1U)tJulm 1~l11N1n1 1-1U~ll11 fi1llflU LLVl W1~ll1~ fOl)1~L1-1~1~$~ LtlmViuULfiltJ-Jll1~~)W1Ifl-JfIl1llflULLVlU1W 14
iil 2 fhfJIilU UVIUn1jll1ljij~1UhuliilnLPItUiI nLJ~1j1fn1j
n-11tJfIl1llflJLLVlWm1tl~Uii-J1u1Wllfliln~LfiltUflmlfl111middot~n11 ilLrljllU11~ruL~flm11tJ~W fIl1llflU LLVlW~11-11u L11-1U1~~tl~u1i-J1W1Wfilfliln~LfIiltUfln L )fl111l1m1 ~-J~ m 14 tl1il fIlfliln~LfiltUfln
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LtlVi1~1f1l1-11t1n1NVl~fll1lJrlj1LuULtlVi1~ Uflm1-1Wflrlj1nm1rlj 1-1U1m1UflnL1fl111l1n11 ntJ111fl-J1-1UIJU
ulm1LLfI~fl-Jtl1~mfin-14tlulm1LfIi~1~fuulmm11u ttltJ1~fl~111tJ1~1-1inLnN ~-JU
-4shy
2 1 lTlU1 lltllJ 1n1 ~n1WJJlJf~LlIVILLft ~~1IltAL41U1~12JfIl12J1 LiJtAIItl-3-31 tALLft~~tl~W I 0 I i PI oyen l- 11ltV
l1~ (J ft nf~VIlJ(JJB~m tA~ L~tAlJ1 t~ IIB-3tAltllJ1n11 t1~VI1 LlJUfl1li-3 2JBU2J1t1 VI L11tA1V1V1
tl[jlThl-31tAllJln1fltAfI~UnlLfIIWBnLlft1f111n11
22 ~fl~billlL~1u1~~1~flJ~1i~ltl[jlThl~1tAluLlft111l1n1nJn HlB~tl[jlThl~1tAlUftmtru~ Llfffi(JftJtl~LLfll
23 n1f~1t1~Uh IJIfllJ LLVIUn1tl[jlThl~1tA~~LUtAf1t1tlW~ LfII~fl~rlL2J~~11jCi~ fl1~tlW~ l
ilJLfIIlffi~ thCi~fl1-3rlL2J-3l~ifJLfIIrtLUtA 1 ilW-3
2~4 trfJl11 fl1 lJ1fllJLLVlUL~1~U1i ~1LLlJni~il
(1) LlItlIm rlW-3ft~ 90 lJ1V1
(2) Un~VIfJ1fi11~lJIf fJ1lJ1ftilll1 ilW~ft~ 80 U1V1
ltV tAnlll1n1VI1-3J1tA~1n1~ru~11
(3) t11lJ1ftLVIflUfI L~1Un-31tA~1n1~ruqll 60 lJ1V1
ltV
LLft~L1tAn~1ULVI fltA fI
I I(4) LI1U1V1tJ11J1ft L1tA1V1~1fi1ru~11 50 U1V1bull
~ 1 LLft~LI1tA1V1 LVI fltAfI
(5) L~1WI~1~~tA~t1jjjjjl1UiUIJiitAlJ1n11i3JLnu 4 lt2J-3 llaquo1tJifufi1(JJBlJLLVItAltA~(JJ~1 ~ ~ ltV I 10 k
flNtAfl~flIJl11 fl1IJ1fllJLLVItAVIn1tA 1J112Jllfl 1
25 i(JJf1fi1(JJflULLVItALLVItf~tl[jtm~1tAllJln1fLLlJlJ~tlltltAfln llaquo1PlfUfi11J1BlJLLVIU~1run1f
1JI~l ~tlltlf1tJft~ 50 U1V1 LLPlfl2JntALLfll ~tAfi1 IJIfllJLLVItA~1~flJ~1~Jfl~1~ufltlnrj1tlL2J~ft~ 120 lJ1V1
26 ilJl1fi1 IJIflU LLVItAVltA~ LLVI6~tl[jUii~1tAlJln1V1tAlJInn2J ln~flJfi1 (JJBlJLLVItAIJI12J Pltull1
bull Ill ltV ~ s I ltV I I ltVLLft~lJ12J1ru~1tAIJI1t1lJCUmiddotD2J1mftll 2 VI1t1ftmnruorltA LLIJI1ltintALLl1l LltAfl1IJ1flULLVItAVI LlJ
~1qJ~B~I~Utltlnrj1ilbJ-3ft~ 120 lJ1V1
jtl 3 Jih iill LLVIULIn1jiin~111~IIiIPIahfluIIiIPIatnllil4WttJ1Ll1
fi1IJ1fllJLLVItAltAn1tl[jtm~1tALl1tllJftJU1t1 LLft~lB(Jftf9l~ nltl~fJ1lJ1poundi ii L IJltA1 2JeUL~fln1 ~1t1 ~tAfi1IJ1flULLVItAL~ 2J LtltAl LfII~1flJfJ1U1ft~t1[jUii~1tAltALlmlflCJftU1t1LLpoundi~1BCJft~n L~flLUtAn11
0 l l ltV I tl - I tl - 0 - tl 0 ~ ~1-311lrun1poundi-3 nlJt11U1poundiVIIJIM llJIJI~1tA tAmiddotJJl~Llpoundi1V1(JJ n(JJIItl~lCln11I1NlIl1Jl ~1ltA LLpoundiLfl
ftjifCU1n11111 11 LLfIpounditAtJ1U1poundi~~~utl[jUii~1tAltAlIl-3 Llpoundi1~mfl1l LtlUltl~n1Ul~ftmnru-n ~~~
- 5shy
31 1xlilUUTlIIlltlUln11n1UUlL~1UU1~1JI1-JRl1-J LU-J1 ~ft-JriuRl1 -J~1LlIuntlll1UIJI1-J Lnru-n
-J11J1131W111~l1UUln11Yitl1U1~LL~~poundllbjftltl~n1~VlutJitlftCl1U~L~UU1tl1ltllUIlltlUln11
Lltl4l~1 LlIU~1il-JpoundluU-J1t11xL~1UU1~iJl)Uiil1U 32 tlIJl11fi11J1poundlULLVlUYitl1U1~~LrJiru~1il1xiJl)Uiil1uLlIuin~ru~Ll1U1tljJil LL~~Ldt1LrJi
iJl)Uiil1ULUYl1~jJilthtlLL~~Uffitlilin LftiltlULlIUn11iJl)tm11ln11tuLl~111l1m1iJn~ (hJtllntrutll)tml1UUtlml~111l1n11) ttrtrJifUfi1IJ1tlULLVlU ~lil
(1 ) Yitl1U1 ~lll1Yi 240 UTVl
(2) Yitl1U1tUVlRUR 180 U1Vl
(3) L~1UU1~Wtl1U1~ 145middotmiddotU1Vl
-De) 4 fhlJle)lLLVIUUn17t1ijtml1Ufu~1Jl7Y4inpfY4
fi1IJ1tl1JLLVlU1Un11iJl)Uiil1UU~IJI~~nIYi ilLltIJIU11-JNLYitln11rl1t1L~Ufi11J1t1ULLVlU~1Ufu 11UU1~~LrJiru~1iltxtltlnLiJiJnU1il1U-nUftlJl~~nIYi tltl1xtltln1t11~UinLnru-n ~ln
4J 00 ~ All l II1l00 bull 1 1111
41 tlIJl11R1IJ1tlULLVlULLYiVltlU1tlL1UU1VlVl ~lIru-JtlUU-J1mLfljJ1un11tlU1-JLLyenIl ~ ~lIruLlU
2543 LL~~1~LjtlUn1~Vl1llJ~fi11-J ~1rJiltln11rl1t1fi1IJ1tlULLVlU U1flfi1tlltln11 fi1Yi1UU~ bull J J 111 ~ I ~ I 11 LlUVl11LLfl~R1Li11VlYi nlltll Llt1UU1VlVl ~l1U-JtlUU-J1t1lt1nLLWVltl ~U IlJnU~1JI1Wfln IW ~UVl Ln l
LU~ 1J11-JYt1~f1l1UqJqjihdl1n L~-JL~-J iJ1~-Jlfln)U-J1t1i)fi~lt11ru1 Rl1-Jtl1qJ1 (UUJ~ 21)
WI 2542 -J11J111 7 WI 2543 Ltltl1xLunrl1t1fi11J1t1ULLVlult1m~UluiJ1~-J1ru~~lHLlIUn11 LUW1~U1n n1tilL~uluiJ1~-J1 ruL2-I I~tIIWtltxLUnrl1t1 fi1IJ1tlULLVl 11lt I n ~UU1tl1ltllVlllltlUln11
42 tlIJl11fi1IJ1tlULLVlUL1V1ih~~ilLrJi~hUn11poundlUffiIJl1-J 41 1l-J~lWUnl1Uiu1C1~il-JiJl)~l1U tllYI-Jiu~ [J1iW~ n PIW xrlWI~hUIiltl1J1mitlt11JUtlltl (J1tlUiLflVi LLfl ~1UlU(J1tlMltl
o ~J I ~ J ~ ~ 1 Q lt1 LilU1Itll LLlJlflWUVlIULLlJlflR11Vltlpoundl niJ)UIJIl1U VlJII ~VI ~l1ULlUR1IJ1tlU LLViUIJIl-JtlIJl11
bull 1 - I R11J1t1UILVllln11lJ)UIJIl1UntllLlt1UU1Vl 1J11-Jpoundl 1
~ All IJ11 I 1 - I II I 1shy43 LLWVltlU1tl L 1UII1VlVlIP11U-JtlUVI-J1t1 ~VllJ)UIJIl1UIUfl n~ruVl LlJtPl1V11tlLlJUjJfl l UlnPlfll
poundltlnLiJiJl)lliil1Utun11U~1JI1W~ n IW t trtrJifu fi1IJ1tlULLVlUYilfttll n1N LLtJiYilUn11rl1t1
fi1IJ1tlULLVlutllin~ru~Li~IULl1V11tlLlIUtlitltxfltlfll1Jl1-Jftlll 1J11-J-ift 1
- 6 shy
Iiil 5 A1f1il1JLLW1ULflf1t1lJ11JLLWW1tJ11ILtILflf1t
f)l (ltlU LLVI Wi LfIIIft~lfuLLYlVlU~l1ll~~ L~13Ji LfIIIft ii L (lWl1~nL~tl n11ltl ~Wf)l (ltlULLVIW~lfu
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1J3J-i~UYlVl6VitJi~~lWt W~lW~iiulJl Rll3J1I1 tlLLR ~WLilYl1~ L~tl LiIWn11~~tLii LLYlVl6~~n fl ll tJi1iii~lWt U1n11 ttltlLtl~IlltltrJlimn CUj ~~U
51 tf)CUn113J nl1il1CUlf)lfltlULLVIWfl13JJtl 9 LiIW~il1cultJ1nlflllrhWtl~l1ll1flfl13J JJ Q 4iC11 I
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151
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240
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180
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400 800
un(ltnn Complex (Plastic) repair of Facial wound Flap coverage
Scrub Burn (Minor Burn) Scrub Burn (Major Burn) Escharotomy with Scrub Burn (Major Burn) Appendectomy Hydrostatic reduction of intussuception Herniorrhaphy (19i1lU Incarcerated Hernia) Hemoroidectomy (tu19i1lU Prolapse Hemoroid) Exploratomy laparotomy with negative finding Exploratomy laparotomy with Lysis adhesion Suture of intestine Anastomosis of intestine Surgery for duodenal injury Splenectomy I Splenorrhaphy Drainage of liver abscess Abdominal Drainage of Pancreatitis Cholecystectomy Cholecystectomy with explore CBD Cholecystectomy with bypass Biliary and Pancreatic bypass Pancreatectomy Whipple Operation Colostomy I Exteriorization of intestine Exploratomy laparotomy with Colostomy (tu19i1lu Gut Obstruction)
Colectomy Subtotal Colectomy Suture of PU perforation Gastrotomy ampSuture bleeding points Open Ligation of esophageal varices Pyloroplasty Trunkal vagotomy + Drainage Procedure Total and subtotal gastrectomy Perihepatic packing Suture of liver Hepatectomy Damage control Surgery (1u19i1lU severe multiple intra-abdominal injury With massive bleeding)
Exploration of neck Suture of esophageal wound Esophagostomy Esoghagectomy Thoracotomy Decortication Lobectomy (lung) Pheumonectomy Pericardiotomy
ilt 1200 1200
400 800
1200 800 600 800 800 800
1200 1200 1600 2000 1200 1200 I
1600 1200 1600 2000 2000 2000 2400
800 1200 1600 2000 1200 1200 1600 1200 1600 I
2000 1200 1600 2400 2400
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2400ICy Illy and Conduit
ORTHOPEDIC amp PLASTIC SURGERY Skin Traction 200 lSI II T I cuthJII 400 EALCllldl fixator application BOO Amputation amp disarticulation of finger amp toe 400 Amputation above and below elbow 1200 Amputation above and below knee 1200
I Hip and Shoulder disarticulation 1600 i D~Ciiqjm ICIIL of open fracture grade I amp II 400 IDebridement of ope fr~cture grade III BOO I f acute elitisIurClIIICI~C 0 bull11 IY 400 IDrainage of tendon oihCClUI palmar bursa 400 1= Illy (~lh[J Comt-ClIUnent Syndrome) BOO ArllllJlUIIIY Small joint 400
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2-4 Fracture sites 800 4- FracturE) ~ites 1200
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--------
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400
800
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or Embedded Tooth)
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Other Surgical Procedures
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200 300
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11 Marsupiafization (under local anesthesia) Gl1LLVlUJ
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under local anesthesia
13 Surgical Exposure of Unerupted Tooth For Orthod( 41 (lli11lJFl1Lfil~ilJfj ilIKUGln11lJ~Gltlu)
14 Excision of Pericoronal Gingiva ~
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16 Debridement and Suturing LL~~tutlilJlhn A-rJ
Surgical Preparation of Ridge For Denture
17 tI ~1JLL~~LL6iJ n1~GJn L14 iltatlu (AlveolectomyAlveolop Gl1LLVlUJ
18 Vestibuloplasty Gl1LLVlUJ
19 L~lJlun1~GJn (Ridge Augmentation) Gl1LLVlUJ
20 LLtlltl Epulis Fibrous Alveolar Ridge Gl1LLVlUJ
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21 Torectomy OstectomY1Ju arch
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Removal of Tumors Cysts Neoplasms
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151
300
400
400
200
400
240
240
240
70
120
120
200
250
300
180
300
200
200
250
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or Foreign Body (Cald Well Luc)
- IllUt61tJl1ilLQWlt AI 450
Treatment of Fractures
31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
- Closed Reduction (lllUt61tJl1ilLQWl~) AI 800 33 Fracture Maxilla
- Closed Reduction (lllUt61Ul1ilLQWl~VI) A~I 800 34 Alveolar Fracture
- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
I
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- IlltJt61Ul1ilLQWlt AI 250 38 Frenectomy Frenoplasty GllLLUI 140 39 Sialol ithotomy (Illut61 tJl1il LnWl~) AI 200
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MUtA n53I n 1 ~Gli4UtY1AS11pulp capping ft 60 2 IlGli4U611tJiRG Amalgam
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3
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3
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Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
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7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
LLtiL11 n11igttil~u~GItIn
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1200FJ I
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- Chairside ilu - Laboratory ilu
MUGln55SJ~(lwU
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120 120
200 200 200 300
150 150
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3000 500 250
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7 300 8
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100 11
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250ilu- Distal shoe
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ilu 500 7
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~tlLL~~Jllm)~w1in1J
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Debridement of cellulitis Incision and Drai Debridement of nlllrnTI7lrln
400 800
un(ltnn Complex (Plastic) repair of Facial wound Flap coverage
Scrub Burn (Minor Burn) Scrub Burn (Major Burn) Escharotomy with Scrub Burn (Major Burn) Appendectomy Hydrostatic reduction of intussuception Herniorrhaphy (19i1lU Incarcerated Hernia) Hemoroidectomy (tu19i1lU Prolapse Hemoroid) Exploratomy laparotomy with negative finding Exploratomy laparotomy with Lysis adhesion Suture of intestine Anastomosis of intestine Surgery for duodenal injury Splenectomy I Splenorrhaphy Drainage of liver abscess Abdominal Drainage of Pancreatitis Cholecystectomy Cholecystectomy with explore CBD Cholecystectomy with bypass Biliary and Pancreatic bypass Pancreatectomy Whipple Operation Colostomy I Exteriorization of intestine Exploratomy laparotomy with Colostomy (tu19i1lu Gut Obstruction)
Colectomy Subtotal Colectomy Suture of PU perforation Gastrotomy ampSuture bleeding points Open Ligation of esophageal varices Pyloroplasty Trunkal vagotomy + Drainage Procedure Total and subtotal gastrectomy Perihepatic packing Suture of liver Hepatectomy Damage control Surgery (1u19i1lU severe multiple intra-abdominal injury With massive bleeding)
Exploration of neck Suture of esophageal wound Esophagostomy Esoghagectomy Thoracotomy Decortication Lobectomy (lung) Pheumonectomy Pericardiotomy
ilt 1200 1200
400 800
1200 800 600 800 800 800
1200 1200 1600 2000 1200 1200 I
1600 1200 1600 2000 2000 2000 2400
800 1200 1600 2000 1200 1200 1600 1200 1600 I
2000 1200 1600 2400 2400
1200 1600 1600 2400 1200 1600 1600 2000 1200
1200 800
1200 600
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II BOOI YlVlIlI IVlVlllY 1200IUrtLt1 ulit~VVIY
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2400ICy Illy and Conduit
ORTHOPEDIC amp PLASTIC SURGERY Skin Traction 200 lSI II T I cuthJII 400 EALCllldl fixator application BOO Amputation amp disarticulation of finger amp toe 400 Amputation above and below elbow 1200 Amputation above and below knee 1200
I Hip and Shoulder disarticulation 1600 i D~Ciiqjm ICIIL of open fracture grade I amp II 400 IDebridement of ope fr~cture grade III BOO I f acute elitisIurClIIICI~C 0 bull11 IY 400 IDrainage of tendon oihCClUI palmar bursa 400 1= Illy (~lh[J Comt-ClIUnent Syndrome) BOO ArllllJlUIIIY Small joint 400
Large jOint BOO K~wire fixation for fracture 1 Fracture site 400
2-4 Fracture sites 800 4- FracturE) ~ites 1200
I Repail tendon single tendon 400 2-4 tendons BOO gt 4 tellduns 1200
IOpen reduction of oiL In (~ hip) BOQ IOpen reduction of hip dislocation 1200 Reduction amp fixation f()r long bone fracture
9RIF f()r fr~cture (M~li2VitIt-a Metatarsal Clavicle) BOO ORIF forfracturE) J8adius Ulnar Tibia Fibula) 1200 ORIF for fracture (HulTlE)rus FE)rn()~r) 1600 OR1F for Articular fracture of large joint 1600
ORIF for fracture Acetabulum Anterior I rUOLCllVI ClIII vdch 1600 ORIF forfracture Acetabulum Combine Ant And Post ApprvClv1 2400 ORIF for fracture Pelvis ArHcik flXClLIVl1 1600 ORIF for fracture Pelvis Posterior fixation 2400 hatiiit~tvlI instrurlltnmitiull for acute cord compression 2400 Pedicular screw instrumentation 2400 RtPClI ndllUl1 of limb 3600
I Repair Facial nerve 1200 I Repair Parotid duct 1200 Reduction and splint for nasal fracture 400 Reduction and fixation for mandibular fracture
--------
Reduction and fixation for mandibular fracture n Intermaxillary Fixation (IMF) 800 Reduction and fixation mandibular fracture n ORIF + IMF for mandibular 1200 fracture
400
800
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or orbital abscess Tracheostomy in post radiation therapy previous tracheostomy pediatric tracheal stenosis
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200 300
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11 Marsupiafization (under local anesthesia) Gl1LLVlUJ
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under local anesthesia
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14 Excision of Pericoronal Gingiva ~
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16 Debridement and Suturing LL~~tutlilJlhn A-rJ
Surgical Preparation of Ridge For Denture
17 tI ~1JLL~~LL6iJ n1~GJn L14 iltatlu (AlveolectomyAlveolop Gl1LLVlUJ
18 Vestibuloplasty Gl1LLVlUJ
19 L~lJlun1~GJn (Ridge Augmentation) Gl1LLVlUJ
20 LLtlltl Epulis Fibrous Alveolar Ridge Gl1LLVlUJ
Excision of Bone Tissue
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Removal of Tumors Cysts Neoplasms
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Surgical Incision
151
300
400
400
200
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240
240
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120
120
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250
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180
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Treatment of Fractures
31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
- Closed Reduction (lllUt61tJl1ilLQWl~) AI 800 33 Fracture Maxilla
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- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
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Osseous Surgery
Crown Lengthening
Mucogingival Surgery
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GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
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ilt 1200 1200
400 800
1200 800 600 800 800 800
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400
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151
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400
400
200
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240
240
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70
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180
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- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
I
I
- IlltJt61Ul1ilLQWlt AI 250 38 Frenectomy Frenoplasty GllLLUI 140 39 Sialol ithotomy (Illut61 tJl1il LnWl~) AI 200
Miscellaneous Procedures 40 Gln1tlLLampgtIA (Curettage) GllLLUI 50 41 Stop Bleeding GllLLUI 40 42 GlGl1J ~l1LLampgtIAtulfilllhn AI 30 43 tBttJln1tl Dry Socket AI 30
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- 6l1ULliu1 ft 100
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6 Inlay Onlay
7 Labial Veneer
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allI UnlS 4 5 6
Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
- FGG LLA~ Stent
7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
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5 L tl tli4u (Post amp Core)
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10 i4utlAtllJ~tI1n ~1UtlA~n n1dl 1 flu
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300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
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7 300 8
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400 800
un(ltnn Complex (Plastic) repair of Facial wound Flap coverage
Scrub Burn (Minor Burn) Scrub Burn (Major Burn) Escharotomy with Scrub Burn (Major Burn) Appendectomy Hydrostatic reduction of intussuception Herniorrhaphy (19i1lU Incarcerated Hernia) Hemoroidectomy (tu19i1lU Prolapse Hemoroid) Exploratomy laparotomy with negative finding Exploratomy laparotomy with Lysis adhesion Suture of intestine Anastomosis of intestine Surgery for duodenal injury Splenectomy I Splenorrhaphy Drainage of liver abscess Abdominal Drainage of Pancreatitis Cholecystectomy Cholecystectomy with explore CBD Cholecystectomy with bypass Biliary and Pancreatic bypass Pancreatectomy Whipple Operation Colostomy I Exteriorization of intestine Exploratomy laparotomy with Colostomy (tu19i1lu Gut Obstruction)
Colectomy Subtotal Colectomy Suture of PU perforation Gastrotomy ampSuture bleeding points Open Ligation of esophageal varices Pyloroplasty Trunkal vagotomy + Drainage Procedure Total and subtotal gastrectomy Perihepatic packing Suture of liver Hepatectomy Damage control Surgery (1u19i1lU severe multiple intra-abdominal injury With massive bleeding)
Exploration of neck Suture of esophageal wound Esophagostomy Esoghagectomy Thoracotomy Decortication Lobectomy (lung) Pheumonectomy Pericardiotomy
ilt 1200 1200
400 800
1200 800 600 800 800 800
1200 1200 1600 2000 1200 1200 I
1600 1200 1600 2000 2000 2000 2400
800 1200 1600 2000 1200 1200 1600 1200 1600 I
2000 1200 1600 2400 2400
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--------
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400
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ilt 1200 1200
400 800
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400
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151
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200
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240
240
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70
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180
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- IllUt61tJl1ilLQWlt AI 450
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31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
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150 150
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un(ltnn Complex (Plastic) repair of Facial wound Flap coverage
Scrub Burn (Minor Burn) Scrub Burn (Major Burn) Escharotomy with Scrub Burn (Major Burn) Appendectomy Hydrostatic reduction of intussuception Herniorrhaphy (19i1lU Incarcerated Hernia) Hemoroidectomy (tu19i1lU Prolapse Hemoroid) Exploratomy laparotomy with negative finding Exploratomy laparotomy with Lysis adhesion Suture of intestine Anastomosis of intestine Surgery for duodenal injury Splenectomy I Splenorrhaphy Drainage of liver abscess Abdominal Drainage of Pancreatitis Cholecystectomy Cholecystectomy with explore CBD Cholecystectomy with bypass Biliary and Pancreatic bypass Pancreatectomy Whipple Operation Colostomy I Exteriorization of intestine Exploratomy laparotomy with Colostomy (tu19i1lu Gut Obstruction)
Colectomy Subtotal Colectomy Suture of PU perforation Gastrotomy ampSuture bleeding points Open Ligation of esophageal varices Pyloroplasty Trunkal vagotomy + Drainage Procedure Total and subtotal gastrectomy Perihepatic packing Suture of liver Hepatectomy Damage control Surgery (1u19i1lU severe multiple intra-abdominal injury With massive bleeding)
Exploration of neck Suture of esophageal wound Esophagostomy Esoghagectomy Thoracotomy Decortication Lobectomy (lung) Pheumonectomy Pericardiotomy
ilt 1200 1200
400 800
1200 800 600 800 800 800
1200 1200 1600 2000 1200 1200 I
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800 1200 1600 2000 1200 1200 1600 1200 1600 I
2000 1200 1600 2400 2400
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2400ICy Illy and Conduit
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2-4 Fracture sites 800 4- FracturE) ~ites 1200
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--------
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400
800
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200 300
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under local anesthesia
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17 tI ~1JLL~~LL6iJ n1~GJn L14 iltatlu (AlveolectomyAlveolop Gl1LLVlUJ
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19 L~lJlun1~GJn (Ridge Augmentation) Gl1LLVlUJ
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Removal of Tumors Cysts Neoplasms
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151
300
400
400
200
400
240
240
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70
120
120
200
250
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180
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- IllUt61tJl1ilLQWlt AI 450
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31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
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- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
I
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3
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3
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Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
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7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
LLtiL11 n11igttil~u~GItIn
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150 150
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7 300 8
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100 11
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300 - i4uvs~J
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500- Lingual holding arch ilu
ilu 500 7
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400 800
un(ltnn Complex (Plastic) repair of Facial wound Flap coverage
Scrub Burn (Minor Burn) Scrub Burn (Major Burn) Escharotomy with Scrub Burn (Major Burn) Appendectomy Hydrostatic reduction of intussuception Herniorrhaphy (19i1lU Incarcerated Hernia) Hemoroidectomy (tu19i1lU Prolapse Hemoroid) Exploratomy laparotomy with negative finding Exploratomy laparotomy with Lysis adhesion Suture of intestine Anastomosis of intestine Surgery for duodenal injury Splenectomy I Splenorrhaphy Drainage of liver abscess Abdominal Drainage of Pancreatitis Cholecystectomy Cholecystectomy with explore CBD Cholecystectomy with bypass Biliary and Pancreatic bypass Pancreatectomy Whipple Operation Colostomy I Exteriorization of intestine Exploratomy laparotomy with Colostomy (tu19i1lu Gut Obstruction)
Colectomy Subtotal Colectomy Suture of PU perforation Gastrotomy ampSuture bleeding points Open Ligation of esophageal varices Pyloroplasty Trunkal vagotomy + Drainage Procedure Total and subtotal gastrectomy Perihepatic packing Suture of liver Hepatectomy Damage control Surgery (1u19i1lU severe multiple intra-abdominal injury With massive bleeding)
Exploration of neck Suture of esophageal wound Esophagostomy Esoghagectomy Thoracotomy Decortication Lobectomy (lung) Pheumonectomy Pericardiotomy
ilt 1200 1200
400 800
1200 800 600 800 800 800
1200 1200 1600 2000 1200 1200 I
1600 1200 1600 2000 2000 2000 2400
800 1200 1600 2000 1200 1200 1600 1200 1600 I
2000 1200 1600 2400 2400
1200 1600 1600 2400 1200 1600 1600 2000 1200
1200 800
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2400ICy Illy and Conduit
ORTHOPEDIC amp PLASTIC SURGERY Skin Traction 200 lSI II T I cuthJII 400 EALCllldl fixator application BOO Amputation amp disarticulation of finger amp toe 400 Amputation above and below elbow 1200 Amputation above and below knee 1200
I Hip and Shoulder disarticulation 1600 i D~Ciiqjm ICIIL of open fracture grade I amp II 400 IDebridement of ope fr~cture grade III BOO I f acute elitisIurClIIICI~C 0 bull11 IY 400 IDrainage of tendon oihCClUI palmar bursa 400 1= Illy (~lh[J Comt-ClIUnent Syndrome) BOO ArllllJlUIIIY Small joint 400
Large jOint BOO K~wire fixation for fracture 1 Fracture site 400
2-4 Fracture sites 800 4- FracturE) ~ites 1200
I Repail tendon single tendon 400 2-4 tendons BOO gt 4 tellduns 1200
IOpen reduction of oiL In (~ hip) BOQ IOpen reduction of hip dislocation 1200 Reduction amp fixation f()r long bone fracture
9RIF f()r fr~cture (M~li2VitIt-a Metatarsal Clavicle) BOO ORIF forfracturE) J8adius Ulnar Tibia Fibula) 1200 ORIF for fracture (HulTlE)rus FE)rn()~r) 1600 OR1F for Articular fracture of large joint 1600
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I Repair Facial nerve 1200 I Repair Parotid duct 1200 Reduction and splint for nasal fracture 400 Reduction and fixation for mandibular fracture
--------
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400
800
ffUranIImiddottflfIARil6l (FE VE Breech assisting)
or orbital abscess Tracheostomy in post radiation therapy previous tracheostomy pediatric tracheal stenosis
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Tooth Root)
(Soft Tissue Impaction)
5 ~1 ulGl t1fljilnj~GJnLL~~tJu (Bony Impaction
or Embedded Tooth)
- Partial Bony 200 - Complete Bony 300
Other Surgical Procedures
6 ~1 GltI~1t1j1ntJu (Root Resection)
200 300
hiu 5lllnl5 lU1U
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- tlUVlU1 41 - tlUVllaquoJ 41
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10 Tooth Transplantation (11lJC1ilutluSplintingstabilizc ~
11 Marsupiafization (under local anesthesia) Gl1LLVlUJ
12 Oroantral Fistula Closure (1li11lJFllvi1 Soft Tissue ( Gl1LLVlUJ
under local anesthesia
13 Surgical Exposure of Unerupted Tooth For Orthod( 41 (lli11lJFl1Lfil~ilJfj ilIKUGln11lJ~Gltlu)
14 Excision of Pericoronal Gingiva ~
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16 Debridement and Suturing LL~~tutlilJlhn A-rJ
Surgical Preparation of Ridge For Denture
17 tI ~1JLL~~LL6iJ n1~GJn L14 iltatlu (AlveolectomyAlveolop Gl1LLVlUJ
18 Vestibuloplasty Gl1LLVlUJ
19 L~lJlun1~GJn (Ridge Augmentation) Gl1LLVlUJ
20 LLtlltl Epulis Fibrous Alveolar Ridge Gl1LLVlUJ
Excision of Bone Tissue
21 Torectomy OstectomY1Ju arch
22 Torectomy Ostectomy ~1J arch
Removal of Tumors Cysts Neoplasms
23 ~J1rAGlL~1~llU1 lJVlUilJtIU1GH~n laquo15cm) Gl1LLVlUJ
24 N1rAlLA1~lJtl1 lJVlUilJtIU1ltVltY (gt15cm) Gl1LLVlUJ
25 N1rAlLllilJilntutlilJlhntlU1GlL~n laquo15cm) Gl1LLVlUJ
26 N1rAGlLllillilntutlilJlhntlU1GltVltY (gt15cm) Gl1LLVlUJ
Surgical Incision
151
300
400
400
200
400
240
240
240
70
120
120
200
250
300
180
300
200
200
250
200
250
hlll 1flnl 1J)u a 27 LOll~QIUilllllutulfih1thnltBt drain GllLLUI 150 28 LOll~QIUilllllUUil nlfilllh n (Illut61 tJl1ilLQWl~) GllLLUI 200 29 Sequestrectomy (lllut61Ul1ilLQWlt~) GllLLUI 200 30 Maxillary Sinusotomy For Removal of Tooth Fragment
or Foreign Body (Cald Well Luc)
- IllUt61tJl1ilLQWlt AI 450
Treatment of Fractures
31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
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- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
I
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MUtA n53I n 1 ~Gli4UtY1AS11pulp capping ft 60 2 IlGli4U611tJiRG Amalgam
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3
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3
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1 600
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100041 en 1800
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allI UnlS 4 5 6
Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
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7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
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3 ~tW1U~U (Fixed Bridge)
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5 L tl tli4u (Post amp Core)
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350611 LLVIti
350 400
911 LLVIti
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1200FJ I
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- 1-5 41 ffu - ~1nni1 541 ffu
13 ~~v1u~Ua~GlGl (Removable Bridge) ilu 14 f1uLO~~u1um1ua~~1Glg1u~Fl~n( TP )
-1-2 ~ ilu - 3-5 ~ ilu - 6-9 ~ ilu
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17 Mouth guard Night GuardSoft splint ilu 18 Speech Aid ilu 19 11~u~Sl1v~ULO~~G1~ Tissue Conditioner
- Single denture Flu - RPDAPD (chairside) Fl~u
20 L~~i1U~UL~~~ (Reline)
- Single denture (chairside) ilu
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21 Rebase full dentures ilu 22 Repair denture
- Chairside ilu - Laboratory ilu
MUGln55SJ~(lwU
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4 n16JLLAFl~uGifl11 tJ~u LtJ~~UA1~ Fl~u
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iGl5
600 700 350
300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
i
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6 iRecheck AJ 50
7 300 8
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50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
LAsectellJVS~IJ-elJi4u (Pit and Fissure Sealant) I 41 50 3 100Preventive Resin Restoration (PRR) 41
MUniiJJd~u ttl n 1 170Pulpotomy 41 2 iPulpectomy
300 - i4uvs~J
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400 3
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- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
un(ltnn Complex (Plastic) repair of Facial wound Flap coverage
Scrub Burn (Minor Burn) Scrub Burn (Major Burn) Escharotomy with Scrub Burn (Major Burn) Appendectomy Hydrostatic reduction of intussuception Herniorrhaphy (19i1lU Incarcerated Hernia) Hemoroidectomy (tu19i1lU Prolapse Hemoroid) Exploratomy laparotomy with negative finding Exploratomy laparotomy with Lysis adhesion Suture of intestine Anastomosis of intestine Surgery for duodenal injury Splenectomy I Splenorrhaphy Drainage of liver abscess Abdominal Drainage of Pancreatitis Cholecystectomy Cholecystectomy with explore CBD Cholecystectomy with bypass Biliary and Pancreatic bypass Pancreatectomy Whipple Operation Colostomy I Exteriorization of intestine Exploratomy laparotomy with Colostomy (tu19i1lu Gut Obstruction)
Colectomy Subtotal Colectomy Suture of PU perforation Gastrotomy ampSuture bleeding points Open Ligation of esophageal varices Pyloroplasty Trunkal vagotomy + Drainage Procedure Total and subtotal gastrectomy Perihepatic packing Suture of liver Hepatectomy Damage control Surgery (1u19i1lU severe multiple intra-abdominal injury With massive bleeding)
Exploration of neck Suture of esophageal wound Esophagostomy Esoghagectomy Thoracotomy Decortication Lobectomy (lung) Pheumonectomy Pericardiotomy
ilt 1200 1200
400 800
1200 800 600 800 800 800
1200 1200 1600 2000 1200 1200 I
1600 1200 1600 2000 2000 2000 2400
800 1200 1600 2000 1200 1200 1600 1200 1600 I
2000 1200 1600 2400 2400
1200 1600 1600 2400 1200 1600 1600 2000 1200
1200 800
1200 600
- UJI bullbull aul IJ Itt BOOICYStOIiIIIUIi2jJtIY
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2400ICy Illy and Conduit
ORTHOPEDIC amp PLASTIC SURGERY Skin Traction 200 lSI II T I cuthJII 400 EALCllldl fixator application BOO Amputation amp disarticulation of finger amp toe 400 Amputation above and below elbow 1200 Amputation above and below knee 1200
I Hip and Shoulder disarticulation 1600 i D~Ciiqjm ICIIL of open fracture grade I amp II 400 IDebridement of ope fr~cture grade III BOO I f acute elitisIurClIIICI~C 0 bull11 IY 400 IDrainage of tendon oihCClUI palmar bursa 400 1= Illy (~lh[J Comt-ClIUnent Syndrome) BOO ArllllJlUIIIY Small joint 400
Large jOint BOO K~wire fixation for fracture 1 Fracture site 400
2-4 Fracture sites 800 4- FracturE) ~ites 1200
I Repail tendon single tendon 400 2-4 tendons BOO gt 4 tellduns 1200
IOpen reduction of oiL In (~ hip) BOQ IOpen reduction of hip dislocation 1200 Reduction amp fixation f()r long bone fracture
9RIF f()r fr~cture (M~li2VitIt-a Metatarsal Clavicle) BOO ORIF forfracturE) J8adius Ulnar Tibia Fibula) 1200 ORIF for fracture (HulTlE)rus FE)rn()~r) 1600 OR1F for Articular fracture of large joint 1600
ORIF for fracture Acetabulum Anterior I rUOLCllVI ClIII vdch 1600 ORIF forfracture Acetabulum Combine Ant And Post ApprvClv1 2400 ORIF for fracture Pelvis ArHcik flXClLIVl1 1600 ORIF for fracture Pelvis Posterior fixation 2400 hatiiit~tvlI instrurlltnmitiull for acute cord compression 2400 Pedicular screw instrumentation 2400 RtPClI ndllUl1 of limb 3600
I Repair Facial nerve 1200 I Repair Parotid duct 1200 Reduction and splint for nasal fracture 400 Reduction and fixation for mandibular fracture
--------
Reduction and fixation for mandibular fracture n Intermaxillary Fixation (IMF) 800 Reduction and fixation mandibular fracture n ORIF + IMF for mandibular 1200 fracture
400
800
ffUranIImiddottflfIARil6l (FE VE Breech assisting)
or orbital abscess Tracheostomy in post radiation therapy previous tracheostomy pediatric tracheal stenosis
XRAY
Embolization FNA under ance Percutaneous drain under 1rnUtO
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200 300
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Surgical Preparation of Ridge For Denture
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Removal of Tumors Cysts Neoplasms
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151
300
400
400
200
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240
240
240
70
120
120
200
250
300
180
300
200
200
250
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120 120
200 200 200 300
150 150
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3000 500 250
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250ilu- Distal shoe
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ilu 500 7
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1200 800
1200 600
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--------
Reduction and fixation for mandibular fracture n Intermaxillary Fixation (IMF) 800 Reduction and fixation mandibular fracture n ORIF + IMF for mandibular 1200 fracture
400
800
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or orbital abscess Tracheostomy in post radiation therapy previous tracheostomy pediatric tracheal stenosis
XRAY
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Tooth Root)
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or Embedded Tooth)
- Partial Bony 200 - Complete Bony 300
Other Surgical Procedures
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200 300
hiu 5lllnl5 lU1U
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- tlUVlU1 41 - tlUVllaquoJ 41
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10 Tooth Transplantation (11lJC1ilutluSplintingstabilizc ~
11 Marsupiafization (under local anesthesia) Gl1LLVlUJ
12 Oroantral Fistula Closure (1li11lJFllvi1 Soft Tissue ( Gl1LLVlUJ
under local anesthesia
13 Surgical Exposure of Unerupted Tooth For Orthod( 41 (lli11lJFl1Lfil~ilJfj ilIKUGln11lJ~Gltlu)
14 Excision of Pericoronal Gingiva ~
15 Biopsy of Oral Tissue (HardSoft) Gl1LLVlUJ
16 Debridement and Suturing LL~~tutlilJlhn A-rJ
Surgical Preparation of Ridge For Denture
17 tI ~1JLL~~LL6iJ n1~GJn L14 iltatlu (AlveolectomyAlveolop Gl1LLVlUJ
18 Vestibuloplasty Gl1LLVlUJ
19 L~lJlun1~GJn (Ridge Augmentation) Gl1LLVlUJ
20 LLtlltl Epulis Fibrous Alveolar Ridge Gl1LLVlUJ
Excision of Bone Tissue
21 Torectomy OstectomY1Ju arch
22 Torectomy Ostectomy ~1J arch
Removal of Tumors Cysts Neoplasms
23 ~J1rAGlL~1~llU1 lJVlUilJtIU1GH~n laquo15cm) Gl1LLVlUJ
24 N1rAlLA1~lJtl1 lJVlUilJtIU1ltVltY (gt15cm) Gl1LLVlUJ
25 N1rAlLllilJilntutlilJlhntlU1GlL~n laquo15cm) Gl1LLVlUJ
26 N1rAGlLllillilntutlilJlhntlU1GltVltY (gt15cm) Gl1LLVlUJ
Surgical Incision
151
300
400
400
200
400
240
240
240
70
120
120
200
250
300
180
300
200
200
250
200
250
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or Foreign Body (Cald Well Luc)
- IllUt61tJl1ilLQWlt AI 450
Treatment of Fractures
31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
- Closed Reduction (lllUt61tJl1ilLQWl~) AI 800 33 Fracture Maxilla
- Closed Reduction (lllUt61Ul1ilLQWl~VI) A~I 800 34 Alveolar Fracture
- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
I
I
- IlltJt61Ul1ilLQWlt AI 250 38 Frenectomy Frenoplasty GllLLUI 140 39 Sialol ithotomy (Illut61 tJl1il LnWl~) AI 200
Miscellaneous Procedures 40 Gln1tlLLampgtIA (Curettage) GllLLUI 50 41 Stop Bleeding GllLLUI 40 42 GlGl1J ~l1LLampgtIAtulfilllhn AI 30 43 tBttJln1tl Dry Socket AI 30
MUtA n53I n 1 ~Gli4UtY1AS11pulp capping ft 60 2 IlGli4U611tJiRG Amalgam
- 6l1ULliu1 ft 100
hclu -sIInl-s MU11J i 15041- 2 Gi1u
170- 3 Gi1U ~ 1 180- fiuGi 4 Gi1uiiu11hil Amalgam overlay
3 ~GlNuGiltl~mG)~hvdjilui4u (compositeGIFlowable composite)
- G11ULGltll
- 2 Gi1U
- 3 Gi1U
- fi)UGi 4 Gl1uiiu111il Composite onlay (dire 4 ~GlrJGlllil)i1)t11)i4U (Spacing)
5 JrutNULGlpoundltl1ufUlL esfl1 nulJ (Band)
- i4ufl i1lJUil tI
- i4UflmiddotS1l1
6 Inlay Onlay
7 Labial Veneer
- Direct
- Indirect
~UtGlGlDUor
1 fl1i~fl131A~ ))1 fli4U
- i4lJU1
- i4Ufl1lJUil tI 1 1fl
- i4Ufl1lJUiltl 2 1fl
- i4Ufli1lJ
ApexificationRecalcification
3
2 Wilflli4u (Non-vital Bleaching)
4 L~ULGlGl iluchJ11rGl~flLaU i4UU1- i4Ufl1lJUiltl
L~ULGlGl iluchi11rGl~flLaU i4uflnlJ5
tAtiuGlill U 1 GlUU1~1t1 ~)111fl (illJllGli4u)
Root PlaningCurettage
3
2 Flap Operation
~ 130
18041 20041 22041
llil) 300
41 120
120~
70041
Ift 240 Ift 500
1 600
41 600
100041 en 1800
A~) 120
A~) 120
~ 150 Ift 200
~)111fl 120
Qualdant 150 Gi1LLU) 250
allI UnlS 4 5 6
Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
- FGG LLA~ Stent
7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
LLtiL11 n11igttil~u~GItIn
- LltilW1~Gi1LLVIti
- ~ItI1n
11 fntt1 inn11L~tl1~ULGI tI n11Vl1 tl1
MUCAntJuziw 1 A1tlU~U (Crown)
2 Cantilever Bridge
3 ~tW1U~U (Fixed Bridge)
- 3 -5 FJ1lGl
- lJ1nn11 5 FJ1lGl
4 Etched Bridge
5 L tl tli4u (Post amp Core)
- Amalgam Core
- Composite Core
- Pin R1L~~~1lJU Amalgam Core
- Pin R1L~l~1lJ1J Composite Core
- Coping I pin LVI1t1
A1tllJi4ui(1 A)11 (n1dlqn L~U)6 7 tl~~W1U~U1tlA1tllJi4U1tlLtltl (LltilW1~ Abutment)
Recementation A)tl1Ji4UVItl~~W1Ui4U8 9 lftllJ Porcelain LGltltll Composite
10 i4utlAtllJ~tI1n ~1UtlA~n n1dl 1 flu
- fllJWGl1t1 polysulfide
11 i4utlAtllJ~ItI1n ~1UtlA~n n1dl 2 flu
- fllJWGl1t1 polysulfide
1amp)u i 350911 LLVIti
25041
350611 LLVIti
350 400
911 LLVIti
2009i1LLVIti
40A~
60Af
200Af
3041
90041 900flu
650 FJUGl
FJ1lGl
700 ffu 500
25041 25041 30041 300~
41 350 FJ1lGl 200
200 100
~ flu
A~ 150911 LLVIti
flu 650
1200FJ I
ihiu 5on15 I htl 12 ~uL~~~u1um1ua~~~1ulA~~ (Metallic Partial Denture)
- 1-5 41 ffu - ~1nni1 541 ffu
13 ~~v1u~Ua~GlGl (Removable Bridge) ilu 14 f1uLO~~u1um1ua~~1Glg1u~Fl~n( TP )
-1-2 ~ ilu - 3-5 ~ ilu - 6-9 ~ ilu
-10-15fl ilu
- 16 41 ~ul1 ilu 15 Hard acrylic occlusal splint Gi1LLwuu 16 Adjust Occlusal splint Fl~u
17 Mouth guard Night GuardSoft splint ilu 18 Speech Aid ilu 19 11~u~Sl1v~ULO~~G1~ Tissue Conditioner
- Single denture Flu - RPDAPD (chairside) Fl~u
20 L~~i1U~UL~~~ (Reline)
- Single denture (chairside) ilu
- RPDAPD (chairside) ffu - Laboratory ilu
21 Rebase full dentures ilu 22 Repair denture
- Chairside ilu - Laboratory ilu
MUGln55SJ~(lwU
1 ~1J Consult Gln~L14~11uLLNu~~fJu Fl~u
2 X-rayvi1tJ~i~A~WtJ1nci1~ltJ Cephampmodel analy Fl~u
11uLLNUn1~n~1 flu~lh~
3 tmLFl~JSj ~~~f1Uliil~~~LLtiu (tNuf1UUULLA~A1J) 1~
tm face mask head gear chin cup
4 n16JLLAFl~uGifl11 tJ~u LtJ~~UA1~ Fl~u
(1J~~1m 18-24 FlJ)
iGl5
600 700 350
300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
i
I
nunl~ei1U 1i1UlU 5 ClelGlLA1ih1fi eltGli4Uti1lGlGGl LLtiu 300
1a retainer ClelGl1Gi 300 1ft retainer GGlutiu 400
6 iRecheck AJ 50
7 300 8
1ftLA1elJfi eltillGl CI elGl61 ilu
50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
LAsectellJVS~IJ-elJi4u (Pit and Fissure Sealant) I 41 50 3 100Preventive Resin Restoration (PRR) 41
MUniiJJd~u ttl n 1 170Pulpotomy 41 2 iPulpectomy
300 - i4uvs~J
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400 3
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4 4t
200 5
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200 6
1fJLA1elJpoundlelf(uV1 ( Space Maintainer) LLlJllClelGl161 ilu
1fJLA1elJfielf(uV1 ( Space Maintainer) LLlJlJGGl LLtiu
- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
- UJI bullbull aul IJ Itt BOOICYStOIiIIIUIi2jJtIY
II BOOI YlVlIlI IVlVlllY 1200IUrtLt1 ulit~VVIY
I I to rolith shy 1600tluVLUIIIY I~t- IULUI II) I TransurcuII dl Rp middotmiddotmiddotmiddotln (TUR) 1200 OrchidltIII1Y I Orch BOOY
2400ICy Illy and Conduit
ORTHOPEDIC amp PLASTIC SURGERY Skin Traction 200 lSI II T I cuthJII 400 EALCllldl fixator application BOO Amputation amp disarticulation of finger amp toe 400 Amputation above and below elbow 1200 Amputation above and below knee 1200
I Hip and Shoulder disarticulation 1600 i D~Ciiqjm ICIIL of open fracture grade I amp II 400 IDebridement of ope fr~cture grade III BOO I f acute elitisIurClIIICI~C 0 bull11 IY 400 IDrainage of tendon oihCClUI palmar bursa 400 1= Illy (~lh[J Comt-ClIUnent Syndrome) BOO ArllllJlUIIIY Small joint 400
Large jOint BOO K~wire fixation for fracture 1 Fracture site 400
2-4 Fracture sites 800 4- FracturE) ~ites 1200
I Repail tendon single tendon 400 2-4 tendons BOO gt 4 tellduns 1200
IOpen reduction of oiL In (~ hip) BOQ IOpen reduction of hip dislocation 1200 Reduction amp fixation f()r long bone fracture
9RIF f()r fr~cture (M~li2VitIt-a Metatarsal Clavicle) BOO ORIF forfracturE) J8adius Ulnar Tibia Fibula) 1200 ORIF for fracture (HulTlE)rus FE)rn()~r) 1600 OR1F for Articular fracture of large joint 1600
ORIF for fracture Acetabulum Anterior I rUOLCllVI ClIII vdch 1600 ORIF forfracture Acetabulum Combine Ant And Post ApprvClv1 2400 ORIF for fracture Pelvis ArHcik flXClLIVl1 1600 ORIF for fracture Pelvis Posterior fixation 2400 hatiiit~tvlI instrurlltnmitiull for acute cord compression 2400 Pedicular screw instrumentation 2400 RtPClI ndllUl1 of limb 3600
I Repair Facial nerve 1200 I Repair Parotid duct 1200 Reduction and splint for nasal fracture 400 Reduction and fixation for mandibular fracture
--------
Reduction and fixation for mandibular fracture n Intermaxillary Fixation (IMF) 800 Reduction and fixation mandibular fracture n ORIF + IMF for mandibular 1200 fracture
400
800
ffUranIImiddottflfIARil6l (FE VE Breech assisting)
or orbital abscess Tracheostomy in post radiation therapy previous tracheostomy pediatric tracheal stenosis
XRAY
Embolization FNA under ance Percutaneous drain under 1rnUtO
Organ Transplant ihL 11UilnL1Sl11tjm1 ri1 VI UGl ilGl11Fi1Gl illJ LLVIutuRnttmtLun poundI-j1pound1t1J~fil1I
General anesthesia General anesthesia General anesthesia poundI il ASA Class 3
poundI Acute Renal Failure
IAlJltOI)SV VI1iltlL1tjPl1lUGl1LLStiltl5V1pound11911lUGli 11UmauFi1GlillJLLVIUGl1111tLjpoundllJ
n1VI11 qtlti1111
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50
100 200
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- n1S1l1rJLMliil~1I1E11111tilmii iltiltUYl11 LUil1M1J
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1 fl1jVh~Glllfl1jGi1UxUGlflj1lIUilflna1j1tffl1j ~~GiillLilufljrtl~11A1111-i1Liluu~~ Gi il IttBfl1jtUL1~1j1tffl1jil pound111 LGlllOl ~Glll fl1jOlVi1~ ~Gi ill11ii ilUlnu~~SlA1111-i1Lilu
Ol~~Gi illVi1 u~~Gi il IVi1 Gl111111 GIj]1 U1J ill1i)tf1ftOWxUGI fljill
2 Gi illfi1l-1UGIt 11 nj~lJ1Un11A1lJlllfi1lJLA il t 11 n1jlJ n 1jGi 1 UxUGI njjllxltUua~ Uilnn~1j1tfn1jil ti11 L l-1111~~1I U~~~~GiillVi111 t111UL~t1lJL~ tllJl1UtUL1~1u~~Uiln n~1j1tfn111Jill~tlBn1jV1nAUciil~lJl-11jwtl1t1lJn1j V0middot 3 LmilU
3 11pound1 fl1j~Gllln1j~1lJ1Gij~1I11 tA~1jm1L~tllJ L~tII lJl1Ul-1~il~Glll n1j~tlJn1j tU~11J1xUGlnj11IOltnAL~tII l-1~il~Gllln1jOltlJfl1jtu~1t11~U 1
1U
~1GlLil1j1ntJUGlnFl11ililn (Surgical Removal of
Tooth Root)
(Soft Tissue Impaction)
5 ~1 ulGl t1fljilnj~GJnLL~~tJu (Bony Impaction
or Embedded Tooth)
- Partial Bony 200 - Complete Bony 300
Other Surgical Procedures
6 ~1 GltI~1t1j1ntJu (Root Resection)
200 300
hiu 5lllnl5 lU1U
7 ~h rAGl LU=UiI cnJ~1pound111 ntlu (Retrog rade )
- tlUVlU1 41 - tlUVllaquoJ 41
8 Root AmputationBicuspidizationHemisection 41 9 Tooth Reimplantation andor Stabilization of ~
Accidentay Avulsed or Displaced Tooth (112J Splinting Gl1t1
Composite wire or Arch Bar)
10 Tooth Transplantation (11lJC1ilutluSplintingstabilizc ~
11 Marsupiafization (under local anesthesia) Gl1LLVlUJ
12 Oroantral Fistula Closure (1li11lJFllvi1 Soft Tissue ( Gl1LLVlUJ
under local anesthesia
13 Surgical Exposure of Unerupted Tooth For Orthod( 41 (lli11lJFl1Lfil~ilJfj ilIKUGln11lJ~Gltlu)
14 Excision of Pericoronal Gingiva ~
15 Biopsy of Oral Tissue (HardSoft) Gl1LLVlUJ
16 Debridement and Suturing LL~~tutlilJlhn A-rJ
Surgical Preparation of Ridge For Denture
17 tI ~1JLL~~LL6iJ n1~GJn L14 iltatlu (AlveolectomyAlveolop Gl1LLVlUJ
18 Vestibuloplasty Gl1LLVlUJ
19 L~lJlun1~GJn (Ridge Augmentation) Gl1LLVlUJ
20 LLtlltl Epulis Fibrous Alveolar Ridge Gl1LLVlUJ
Excision of Bone Tissue
21 Torectomy OstectomY1Ju arch
22 Torectomy Ostectomy ~1J arch
Removal of Tumors Cysts Neoplasms
23 ~J1rAGlL~1~llU1 lJVlUilJtIU1GH~n laquo15cm) Gl1LLVlUJ
24 N1rAlLA1~lJtl1 lJVlUilJtIU1ltVltY (gt15cm) Gl1LLVlUJ
25 N1rAlLllilJilntutlilJlhntlU1GlL~n laquo15cm) Gl1LLVlUJ
26 N1rAGlLllillilntutlilJlhntlU1GltVltY (gt15cm) Gl1LLVlUJ
Surgical Incision
151
300
400
400
200
400
240
240
240
70
120
120
200
250
300
180
300
200
200
250
200
250
hlll 1flnl 1J)u a 27 LOll~QIUilllllutulfih1thnltBt drain GllLLUI 150 28 LOll~QIUilllllUUil nlfilllh n (Illut61 tJl1ilLQWl~) GllLLUI 200 29 Sequestrectomy (lllut61Ul1ilLQWlt~) GllLLUI 200 30 Maxillary Sinusotomy For Removal of Tooth Fragment
or Foreign Body (Cald Well Luc)
- IllUt61tJl1ilLQWlt AI 450
Treatment of Fractures
31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
- Closed Reduction (lllUt61tJl1ilLQWl~) AI 800 33 Fracture Maxilla
- Closed Reduction (lllUt61Ul1ilLQWl~VI) A~I 800 34 Alveolar Fracture
- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
I
I
- IlltJt61Ul1ilLQWlt AI 250 38 Frenectomy Frenoplasty GllLLUI 140 39 Sialol ithotomy (Illut61 tJl1il LnWl~) AI 200
Miscellaneous Procedures 40 Gln1tlLLampgtIA (Curettage) GllLLUI 50 41 Stop Bleeding GllLLUI 40 42 GlGl1J ~l1LLampgtIAtulfilllhn AI 30 43 tBttJln1tl Dry Socket AI 30
MUtA n53I n 1 ~Gli4UtY1AS11pulp capping ft 60 2 IlGli4U611tJiRG Amalgam
- 6l1ULliu1 ft 100
hclu -sIInl-s MU11J i 15041- 2 Gi1u
170- 3 Gi1U ~ 1 180- fiuGi 4 Gi1uiiu11hil Amalgam overlay
3 ~GlNuGiltl~mG)~hvdjilui4u (compositeGIFlowable composite)
- G11ULGltll
- 2 Gi1U
- 3 Gi1U
- fi)UGi 4 Gl1uiiu111il Composite onlay (dire 4 ~GlrJGlllil)i1)t11)i4U (Spacing)
5 JrutNULGlpoundltl1ufUlL esfl1 nulJ (Band)
- i4ufl i1lJUil tI
- i4UflmiddotS1l1
6 Inlay Onlay
7 Labial Veneer
- Direct
- Indirect
~UtGlGlDUor
1 fl1i~fl131A~ ))1 fli4U
- i4lJU1
- i4Ufl1lJUil tI 1 1fl
- i4Ufl1lJUiltl 2 1fl
- i4Ufli1lJ
ApexificationRecalcification
3
2 Wilflli4u (Non-vital Bleaching)
4 L~ULGlGl iluchJ11rGl~flLaU i4UU1- i4Ufl1lJUiltl
L~ULGlGl iluchi11rGl~flLaU i4uflnlJ5
tAtiuGlill U 1 GlUU1~1t1 ~)111fl (illJllGli4u)
Root PlaningCurettage
3
2 Flap Operation
~ 130
18041 20041 22041
llil) 300
41 120
120~
70041
Ift 240 Ift 500
1 600
41 600
100041 en 1800
A~) 120
A~) 120
~ 150 Ift 200
~)111fl 120
Qualdant 150 Gi1LLU) 250
allI UnlS 4 5 6
Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
- FGG LLA~ Stent
7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
LLtiL11 n11igttil~u~GItIn
- LltilW1~Gi1LLVIti
- ~ItI1n
11 fntt1 inn11L~tl1~ULGI tI n11Vl1 tl1
MUCAntJuziw 1 A1tlU~U (Crown)
2 Cantilever Bridge
3 ~tW1U~U (Fixed Bridge)
- 3 -5 FJ1lGl
- lJ1nn11 5 FJ1lGl
4 Etched Bridge
5 L tl tli4u (Post amp Core)
- Amalgam Core
- Composite Core
- Pin R1L~~~1lJU Amalgam Core
- Pin R1L~l~1lJ1J Composite Core
- Coping I pin LVI1t1
A1tllJi4ui(1 A)11 (n1dlqn L~U)6 7 tl~~W1U~U1tlA1tllJi4U1tlLtltl (LltilW1~ Abutment)
Recementation A)tl1Ji4UVItl~~W1Ui4U8 9 lftllJ Porcelain LGltltll Composite
10 i4utlAtllJ~tI1n ~1UtlA~n n1dl 1 flu
- fllJWGl1t1 polysulfide
11 i4utlAtllJ~ItI1n ~1UtlA~n n1dl 2 flu
- fllJWGl1t1 polysulfide
1amp)u i 350911 LLVIti
25041
350611 LLVIti
350 400
911 LLVIti
2009i1LLVIti
40A~
60Af
200Af
3041
90041 900flu
650 FJUGl
FJ1lGl
700 ffu 500
25041 25041 30041 300~
41 350 FJ1lGl 200
200 100
~ flu
A~ 150911 LLVIti
flu 650
1200FJ I
ihiu 5on15 I htl 12 ~uL~~~u1um1ua~~~1ulA~~ (Metallic Partial Denture)
- 1-5 41 ffu - ~1nni1 541 ffu
13 ~~v1u~Ua~GlGl (Removable Bridge) ilu 14 f1uLO~~u1um1ua~~1Glg1u~Fl~n( TP )
-1-2 ~ ilu - 3-5 ~ ilu - 6-9 ~ ilu
-10-15fl ilu
- 16 41 ~ul1 ilu 15 Hard acrylic occlusal splint Gi1LLwuu 16 Adjust Occlusal splint Fl~u
17 Mouth guard Night GuardSoft splint ilu 18 Speech Aid ilu 19 11~u~Sl1v~ULO~~G1~ Tissue Conditioner
- Single denture Flu - RPDAPD (chairside) Fl~u
20 L~~i1U~UL~~~ (Reline)
- Single denture (chairside) ilu
- RPDAPD (chairside) ffu - Laboratory ilu
21 Rebase full dentures ilu 22 Repair denture
- Chairside ilu - Laboratory ilu
MUGln55SJ~(lwU
1 ~1J Consult Gln~L14~11uLLNu~~fJu Fl~u
2 X-rayvi1tJ~i~A~WtJ1nci1~ltJ Cephampmodel analy Fl~u
11uLLNUn1~n~1 flu~lh~
3 tmLFl~JSj ~~~f1Uliil~~~LLtiu (tNuf1UUULLA~A1J) 1~
tm face mask head gear chin cup
4 n16JLLAFl~uGifl11 tJ~u LtJ~~UA1~ Fl~u
(1J~~1m 18-24 FlJ)
iGl5
600 700 350
300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
i
I
nunl~ei1U 1i1UlU 5 ClelGlLA1ih1fi eltGli4Uti1lGlGGl LLtiu 300
1a retainer ClelGl1Gi 300 1ft retainer GGlutiu 400
6 iRecheck AJ 50
7 300 8
1ftLA1elJfi eltillGl CI elGl61 ilu
50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
LAsectellJVS~IJ-elJi4u (Pit and Fissure Sealant) I 41 50 3 100Preventive Resin Restoration (PRR) 41
MUniiJJd~u ttl n 1 170Pulpotomy 41 2 iPulpectomy
300 - i4uvs~J
- i4UVSU1 ~
400 3
4t 1ftAlelllfJULvs~n 1~ilIJlJlfUtfJUU1UIJ 200
4 4t
200 5
411ftAlellJfJUelA~ nlJl fUtfJUU1UIJ
200 6
1fJLA1elJpoundlelf(uV1 ( Space Maintainer) LLlJllClelGl161 ilu
1fJLA1elJfielf(uV1 ( Space Maintainer) LLlJlJGGl LLtiu
- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
--------
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151
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(Soft Tissue Impaction)
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or Embedded Tooth)
- Partial Bony 200 - Complete Bony 300
Other Surgical Procedures
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200 300
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- tlUVlU1 41 - tlUVllaquoJ 41
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10 Tooth Transplantation (11lJC1ilutluSplintingstabilizc ~
11 Marsupiafization (under local anesthesia) Gl1LLVlUJ
12 Oroantral Fistula Closure (1li11lJFllvi1 Soft Tissue ( Gl1LLVlUJ
under local anesthesia
13 Surgical Exposure of Unerupted Tooth For Orthod( 41 (lli11lJFl1Lfil~ilJfj ilIKUGln11lJ~Gltlu)
14 Excision of Pericoronal Gingiva ~
15 Biopsy of Oral Tissue (HardSoft) Gl1LLVlUJ
16 Debridement and Suturing LL~~tutlilJlhn A-rJ
Surgical Preparation of Ridge For Denture
17 tI ~1JLL~~LL6iJ n1~GJn L14 iltatlu (AlveolectomyAlveolop Gl1LLVlUJ
18 Vestibuloplasty Gl1LLVlUJ
19 L~lJlun1~GJn (Ridge Augmentation) Gl1LLVlUJ
20 LLtlltl Epulis Fibrous Alveolar Ridge Gl1LLVlUJ
Excision of Bone Tissue
21 Torectomy OstectomY1Ju arch
22 Torectomy Ostectomy ~1J arch
Removal of Tumors Cysts Neoplasms
23 ~J1rAGlL~1~llU1 lJVlUilJtIU1GH~n laquo15cm) Gl1LLVlUJ
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26 N1rAGlLllillilntutlilJlhntlU1GltVltY (gt15cm) Gl1LLVlUJ
Surgical Incision
151
300
400
400
200
400
240
240
240
70
120
120
200
250
300
180
300
200
200
250
200
250
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or Foreign Body (Cald Well Luc)
- IllUt61tJl1ilLQWlt AI 450
Treatment of Fractures
31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
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- Closed Reduction (lllUt61Ul1ilLQWl~VI) A~I 800 34 Alveolar Fracture
- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
I
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- fi)UGi 4 Gl1uiiu111il Composite onlay (dire 4 ~GlrJGlllil)i1)t11)i4U (Spacing)
5 JrutNULGlpoundltl1ufUlL esfl1 nulJ (Band)
- i4ufl i1lJUil tI
- i4UflmiddotS1l1
6 Inlay Onlay
7 Labial Veneer
- Direct
- Indirect
~UtGlGlDUor
1 fl1i~fl131A~ ))1 fli4U
- i4lJU1
- i4Ufl1lJUil tI 1 1fl
- i4Ufl1lJUiltl 2 1fl
- i4Ufli1lJ
ApexificationRecalcification
3
2 Wilflli4u (Non-vital Bleaching)
4 L~ULGlGl iluchJ11rGl~flLaU i4UU1- i4Ufl1lJUiltl
L~ULGlGl iluchi11rGl~flLaU i4uflnlJ5
tAtiuGlill U 1 GlUU1~1t1 ~)111fl (illJllGli4u)
Root PlaningCurettage
3
2 Flap Operation
~ 130
18041 20041 22041
llil) 300
41 120
120~
70041
Ift 240 Ift 500
1 600
41 600
100041 en 1800
A~) 120
A~) 120
~ 150 Ift 200
~)111fl 120
Qualdant 150 Gi1LLU) 250
allI UnlS 4 5 6
Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
- FGG LLA~ Stent
7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
LLtiL11 n11igttil~u~GItIn
- LltilW1~Gi1LLVIti
- ~ItI1n
11 fntt1 inn11L~tl1~ULGI tI n11Vl1 tl1
MUCAntJuziw 1 A1tlU~U (Crown)
2 Cantilever Bridge
3 ~tW1U~U (Fixed Bridge)
- 3 -5 FJ1lGl
- lJ1nn11 5 FJ1lGl
4 Etched Bridge
5 L tl tli4u (Post amp Core)
- Amalgam Core
- Composite Core
- Pin R1L~~~1lJU Amalgam Core
- Pin R1L~l~1lJ1J Composite Core
- Coping I pin LVI1t1
A1tllJi4ui(1 A)11 (n1dlqn L~U)6 7 tl~~W1U~U1tlA1tllJi4U1tlLtltl (LltilW1~ Abutment)
Recementation A)tl1Ji4UVItl~~W1Ui4U8 9 lftllJ Porcelain LGltltll Composite
10 i4utlAtllJ~tI1n ~1UtlA~n n1dl 1 flu
- fllJWGl1t1 polysulfide
11 i4utlAtllJ~ItI1n ~1UtlA~n n1dl 2 flu
- fllJWGl1t1 polysulfide
1amp)u i 350911 LLVIti
25041
350611 LLVIti
350 400
911 LLVIti
2009i1LLVIti
40A~
60Af
200Af
3041
90041 900flu
650 FJUGl
FJ1lGl
700 ffu 500
25041 25041 30041 300~
41 350 FJ1lGl 200
200 100
~ flu
A~ 150911 LLVIti
flu 650
1200FJ I
ihiu 5on15 I htl 12 ~uL~~~u1um1ua~~~1ulA~~ (Metallic Partial Denture)
- 1-5 41 ffu - ~1nni1 541 ffu
13 ~~v1u~Ua~GlGl (Removable Bridge) ilu 14 f1uLO~~u1um1ua~~1Glg1u~Fl~n( TP )
-1-2 ~ ilu - 3-5 ~ ilu - 6-9 ~ ilu
-10-15fl ilu
- 16 41 ~ul1 ilu 15 Hard acrylic occlusal splint Gi1LLwuu 16 Adjust Occlusal splint Fl~u
17 Mouth guard Night GuardSoft splint ilu 18 Speech Aid ilu 19 11~u~Sl1v~ULO~~G1~ Tissue Conditioner
- Single denture Flu - RPDAPD (chairside) Fl~u
20 L~~i1U~UL~~~ (Reline)
- Single denture (chairside) ilu
- RPDAPD (chairside) ffu - Laboratory ilu
21 Rebase full dentures ilu 22 Repair denture
- Chairside ilu - Laboratory ilu
MUGln55SJ~(lwU
1 ~1J Consult Gln~L14~11uLLNu~~fJu Fl~u
2 X-rayvi1tJ~i~A~WtJ1nci1~ltJ Cephampmodel analy Fl~u
11uLLNUn1~n~1 flu~lh~
3 tmLFl~JSj ~~~f1Uliil~~~LLtiu (tNuf1UUULLA~A1J) 1~
tm face mask head gear chin cup
4 n16JLLAFl~uGifl11 tJ~u LtJ~~UA1~ Fl~u
(1J~~1m 18-24 FlJ)
iGl5
600 700 350
300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
i
I
nunl~ei1U 1i1UlU 5 ClelGlLA1ih1fi eltGli4Uti1lGlGGl LLtiu 300
1a retainer ClelGl1Gi 300 1ft retainer GGlutiu 400
6 iRecheck AJ 50
7 300 8
1ftLA1elJfi eltillGl CI elGl61 ilu
50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
LAsectellJVS~IJ-elJi4u (Pit and Fissure Sealant) I 41 50 3 100Preventive Resin Restoration (PRR) 41
MUniiJJd~u ttl n 1 170Pulpotomy 41 2 iPulpectomy
300 - i4uvs~J
- i4UVSU1 ~
400 3
4t 1ftAlelllfJULvs~n 1~ilIJlJlfUtfJUU1UIJ 200
4 4t
200 5
411ftAlellJfJUelA~ nlJl fUtfJUU1UIJ
200 6
1fJLA1elJpoundlelf(uV1 ( Space Maintainer) LLlJllClelGl161 ilu
1fJLA1elJfielf(uV1 ( Space Maintainer) LLlJlJGGl LLtiu
- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
IunIl1bull nnI tiampll n111J1Vhn1UIl1~~m~1ttilEltMn11~mt16i1E1ti1ULihLLQdln11luV1nil1n1 nri1V16i~lJn1 400 illtlilM1iln1S1IilA1tAnlt1 nSdl~ihElMLln ~ihElqm~u M1il~1I1E1~u9ln11JtnClGl tmiiLIlIEIlffu tGlElLnUn1tiIS1~~nlt1AfluSn1liluWYlrJiil1MrlJ~1I1E1uGicUS1E1 tunSdl 6ilil
- n1S1hElftuilW
- n1S1hEILMAil~1I1E1M1JtilS6l
- n1J1hElLMAilN1I1E1ililA
- n11h[lLMAil~1I1[111ntlaquo1hR1JLMa1
- n1hElLMAm~1I1[11111tllnnCltil i
- n1JlhEILMAil~1I1E11111t~1JU1
- n1J1hElLMAil1111tqm~UYl11~tilL11i
- n1S1l1 E1LMA il ~111U1111tLtil11 rJLtt[llJWtfu
- n1S1l1E1LMAil~1I1[11111t6ilJ11[1
- n1S1l1rJLMAil~1I1[11111tA111JGlutaltilllfunCltil - n1J1l1rJLMAil~1I1[11111tlaquolhR1JLMa1 uatM1E1hLlhKu1J1n
- n1S1lUILM A il ~111 [l1111t61ti1L~il1UUJI uat61 tilL~iltunStLLstaltiI uat1J1 a1 LE1qm~U - n1S1l1rJLMAilej1l1E11111tlaquo1h1l1ti1LAiltil uatlaquolhLflutltiltln6l
0
w n1S1l1E1LMli il ~111 pound1111111~1ULLJI
- n1S1l1rJLMliil~1I1E11111tilmii iltiltUYl11 LUil1M1J
- - -- ----- ---- ---
ulaquovitfiM-sMaUUlIIU)1UMUWlIIU
MlmllWLLQ1Amu
xUGl uow VI dOltlll1~nutul-11h tllJfl1jUil fI L 1 ~j1tffl1j t 1Gi~lJFi1G1 illJ uVlUtU
~GIj1 Ol fi1 l-1UGl Gl111 ~fltt nU1J ilhnUl-1~il~Glll fl1 jOltlll1~ 111
1 fl1jVh~Glllfl1jGi1UxUGlflj1lIUilflna1j1tffl1j ~~GiillLilufljrtl~11A1111-i1Liluu~~ Gi il IttBfl1jtUL1~1j1tffl1jil pound111 LGlllOl ~Glll fl1jOlVi1~ ~Gi ill11ii ilUlnu~~SlA1111-i1Lilu
Ol~~Gi illVi1 u~~Gi il IVi1 Gl111111 GIj]1 U1J ill1i)tf1ftOWxUGI fljill
2 Gi illfi1l-1UGIt 11 nj~lJ1Un11A1lJlllfi1lJLA il t 11 n1jlJ n 1jGi 1 UxUGI njjllxltUua~ Uilnn~1j1tfn1jil ti11 L l-1111~~1I U~~~~GiillVi111 t111UL~t1lJL~ tllJl1UtUL1~1u~~Uiln n~1j1tfn111Jill~tlBn1jV1nAUciil~lJl-11jwtl1t1lJn1j V0middot 3 LmilU
3 11pound1 fl1j~Gllln1j~1lJ1Gij~1I11 tA~1jm1L~tllJ L~tII lJl1Ul-1~il~Glll n1j~tlJn1j tU~11J1xUGlnj11IOltnAL~tII l-1~il~Gllln1jOltlJfl1jtu~1t11~U 1
1U
~1GlLil1j1ntJUGlnFl11ililn (Surgical Removal of
Tooth Root)
(Soft Tissue Impaction)
5 ~1 ulGl t1fljilnj~GJnLL~~tJu (Bony Impaction
or Embedded Tooth)
- Partial Bony 200 - Complete Bony 300
Other Surgical Procedures
6 ~1 GltI~1t1j1ntJu (Root Resection)
200 300
hiu 5lllnl5 lU1U
7 ~h rAGl LU=UiI cnJ~1pound111 ntlu (Retrog rade )
- tlUVlU1 41 - tlUVllaquoJ 41
8 Root AmputationBicuspidizationHemisection 41 9 Tooth Reimplantation andor Stabilization of ~
Accidentay Avulsed or Displaced Tooth (112J Splinting Gl1t1
Composite wire or Arch Bar)
10 Tooth Transplantation (11lJC1ilutluSplintingstabilizc ~
11 Marsupiafization (under local anesthesia) Gl1LLVlUJ
12 Oroantral Fistula Closure (1li11lJFllvi1 Soft Tissue ( Gl1LLVlUJ
under local anesthesia
13 Surgical Exposure of Unerupted Tooth For Orthod( 41 (lli11lJFl1Lfil~ilJfj ilIKUGln11lJ~Gltlu)
14 Excision of Pericoronal Gingiva ~
15 Biopsy of Oral Tissue (HardSoft) Gl1LLVlUJ
16 Debridement and Suturing LL~~tutlilJlhn A-rJ
Surgical Preparation of Ridge For Denture
17 tI ~1JLL~~LL6iJ n1~GJn L14 iltatlu (AlveolectomyAlveolop Gl1LLVlUJ
18 Vestibuloplasty Gl1LLVlUJ
19 L~lJlun1~GJn (Ridge Augmentation) Gl1LLVlUJ
20 LLtlltl Epulis Fibrous Alveolar Ridge Gl1LLVlUJ
Excision of Bone Tissue
21 Torectomy OstectomY1Ju arch
22 Torectomy Ostectomy ~1J arch
Removal of Tumors Cysts Neoplasms
23 ~J1rAGlL~1~llU1 lJVlUilJtIU1GH~n laquo15cm) Gl1LLVlUJ
24 N1rAlLA1~lJtl1 lJVlUilJtIU1ltVltY (gt15cm) Gl1LLVlUJ
25 N1rAlLllilJilntutlilJlhntlU1GlL~n laquo15cm) Gl1LLVlUJ
26 N1rAGlLllillilntutlilJlhntlU1GltVltY (gt15cm) Gl1LLVlUJ
Surgical Incision
151
300
400
400
200
400
240
240
240
70
120
120
200
250
300
180
300
200
200
250
200
250
hlll 1flnl 1J)u a 27 LOll~QIUilllllutulfih1thnltBt drain GllLLUI 150 28 LOll~QIUilllllUUil nlfilllh n (Illut61 tJl1ilLQWl~) GllLLUI 200 29 Sequestrectomy (lllut61Ul1ilLQWlt~) GllLLUI 200 30 Maxillary Sinusotomy For Removal of Tooth Fragment
or Foreign Body (Cald Well Luc)
- IllUt61tJl1ilLQWlt AI 450
Treatment of Fractures
31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
- Closed Reduction (lllUt61tJl1ilLQWl~) AI 800 33 Fracture Maxilla
- Closed Reduction (lllUt61Ul1ilLQWl~VI) A~I 800 34 Alveolar Fracture
- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
I
I
- IlltJt61Ul1ilLQWlt AI 250 38 Frenectomy Frenoplasty GllLLUI 140 39 Sialol ithotomy (Illut61 tJl1il LnWl~) AI 200
Miscellaneous Procedures 40 Gln1tlLLampgtIA (Curettage) GllLLUI 50 41 Stop Bleeding GllLLUI 40 42 GlGl1J ~l1LLampgtIAtulfilllhn AI 30 43 tBttJln1tl Dry Socket AI 30
MUtA n53I n 1 ~Gli4UtY1AS11pulp capping ft 60 2 IlGli4U611tJiRG Amalgam
- 6l1ULliu1 ft 100
hclu -sIInl-s MU11J i 15041- 2 Gi1u
170- 3 Gi1U ~ 1 180- fiuGi 4 Gi1uiiu11hil Amalgam overlay
3 ~GlNuGiltl~mG)~hvdjilui4u (compositeGIFlowable composite)
- G11ULGltll
- 2 Gi1U
- 3 Gi1U
- fi)UGi 4 Gl1uiiu111il Composite onlay (dire 4 ~GlrJGlllil)i1)t11)i4U (Spacing)
5 JrutNULGlpoundltl1ufUlL esfl1 nulJ (Band)
- i4ufl i1lJUil tI
- i4UflmiddotS1l1
6 Inlay Onlay
7 Labial Veneer
- Direct
- Indirect
~UtGlGlDUor
1 fl1i~fl131A~ ))1 fli4U
- i4lJU1
- i4Ufl1lJUil tI 1 1fl
- i4Ufl1lJUiltl 2 1fl
- i4Ufli1lJ
ApexificationRecalcification
3
2 Wilflli4u (Non-vital Bleaching)
4 L~ULGlGl iluchJ11rGl~flLaU i4UU1- i4Ufl1lJUiltl
L~ULGlGl iluchi11rGl~flLaU i4uflnlJ5
tAtiuGlill U 1 GlUU1~1t1 ~)111fl (illJllGli4u)
Root PlaningCurettage
3
2 Flap Operation
~ 130
18041 20041 22041
llil) 300
41 120
120~
70041
Ift 240 Ift 500
1 600
41 600
100041 en 1800
A~) 120
A~) 120
~ 150 Ift 200
~)111fl 120
Qualdant 150 Gi1LLU) 250
allI UnlS 4 5 6
Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
- FGG LLA~ Stent
7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
LLtiL11 n11igttil~u~GItIn
- LltilW1~Gi1LLVIti
- ~ItI1n
11 fntt1 inn11L~tl1~ULGI tI n11Vl1 tl1
MUCAntJuziw 1 A1tlU~U (Crown)
2 Cantilever Bridge
3 ~tW1U~U (Fixed Bridge)
- 3 -5 FJ1lGl
- lJ1nn11 5 FJ1lGl
4 Etched Bridge
5 L tl tli4u (Post amp Core)
- Amalgam Core
- Composite Core
- Pin R1L~~~1lJU Amalgam Core
- Pin R1L~l~1lJ1J Composite Core
- Coping I pin LVI1t1
A1tllJi4ui(1 A)11 (n1dlqn L~U)6 7 tl~~W1U~U1tlA1tllJi4U1tlLtltl (LltilW1~ Abutment)
Recementation A)tl1Ji4UVItl~~W1Ui4U8 9 lftllJ Porcelain LGltltll Composite
10 i4utlAtllJ~tI1n ~1UtlA~n n1dl 1 flu
- fllJWGl1t1 polysulfide
11 i4utlAtllJ~ItI1n ~1UtlA~n n1dl 2 flu
- fllJWGl1t1 polysulfide
1amp)u i 350911 LLVIti
25041
350611 LLVIti
350 400
911 LLVIti
2009i1LLVIti
40A~
60Af
200Af
3041
90041 900flu
650 FJUGl
FJ1lGl
700 ffu 500
25041 25041 30041 300~
41 350 FJ1lGl 200
200 100
~ flu
A~ 150911 LLVIti
flu 650
1200FJ I
ihiu 5on15 I htl 12 ~uL~~~u1um1ua~~~1ulA~~ (Metallic Partial Denture)
- 1-5 41 ffu - ~1nni1 541 ffu
13 ~~v1u~Ua~GlGl (Removable Bridge) ilu 14 f1uLO~~u1um1ua~~1Glg1u~Fl~n( TP )
-1-2 ~ ilu - 3-5 ~ ilu - 6-9 ~ ilu
-10-15fl ilu
- 16 41 ~ul1 ilu 15 Hard acrylic occlusal splint Gi1LLwuu 16 Adjust Occlusal splint Fl~u
17 Mouth guard Night GuardSoft splint ilu 18 Speech Aid ilu 19 11~u~Sl1v~ULO~~G1~ Tissue Conditioner
- Single denture Flu - RPDAPD (chairside) Fl~u
20 L~~i1U~UL~~~ (Reline)
- Single denture (chairside) ilu
- RPDAPD (chairside) ffu - Laboratory ilu
21 Rebase full dentures ilu 22 Repair denture
- Chairside ilu - Laboratory ilu
MUGln55SJ~(lwU
1 ~1J Consult Gln~L14~11uLLNu~~fJu Fl~u
2 X-rayvi1tJ~i~A~WtJ1nci1~ltJ Cephampmodel analy Fl~u
11uLLNUn1~n~1 flu~lh~
3 tmLFl~JSj ~~~f1Uliil~~~LLtiu (tNuf1UUULLA~A1J) 1~
tm face mask head gear chin cup
4 n16JLLAFl~uGifl11 tJ~u LtJ~~UA1~ Fl~u
(1J~~1m 18-24 FlJ)
iGl5
600 700 350
300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
i
I
nunl~ei1U 1i1UlU 5 ClelGlLA1ih1fi eltGli4Uti1lGlGGl LLtiu 300
1a retainer ClelGl1Gi 300 1ft retainer GGlutiu 400
6 iRecheck AJ 50
7 300 8
1ftLA1elJfi eltillGl CI elGl61 ilu
50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
LAsectellJVS~IJ-elJi4u (Pit and Fissure Sealant) I 41 50 3 100Preventive Resin Restoration (PRR) 41
MUniiJJd~u ttl n 1 170Pulpotomy 41 2 iPulpectomy
300 - i4uvs~J
- i4UVSU1 ~
400 3
4t 1ftAlelllfJULvs~n 1~ilIJlJlfUtfJUU1UIJ 200
4 4t
200 5
411ftAlellJfJUelA~ nlJl fUtfJUU1UIJ
200 6
1fJLA1elJpoundlelf(uV1 ( Space Maintainer) LLlJllClelGl161 ilu
1fJLA1elJfielf(uV1 ( Space Maintainer) LLlJlJGGl LLtiu
- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
- - -- ----- ---- ---
ulaquovitfiM-sMaUUlIIU)1UMUWlIIU
MlmllWLLQ1Amu
xUGl uow VI dOltlll1~nutul-11h tllJfl1jUil fI L 1 ~j1tffl1j t 1Gi~lJFi1G1 illJ uVlUtU
~GIj1 Ol fi1 l-1UGl Gl111 ~fltt nU1J ilhnUl-1~il~Glll fl1 jOltlll1~ 111
1 fl1jVh~Glllfl1jGi1UxUGlflj1lIUilflna1j1tffl1j ~~GiillLilufljrtl~11A1111-i1Liluu~~ Gi il IttBfl1jtUL1~1j1tffl1jil pound111 LGlllOl ~Glll fl1jOlVi1~ ~Gi ill11ii ilUlnu~~SlA1111-i1Lilu
Ol~~Gi illVi1 u~~Gi il IVi1 Gl111111 GIj]1 U1J ill1i)tf1ftOWxUGI fljill
2 Gi illfi1l-1UGIt 11 nj~lJ1Un11A1lJlllfi1lJLA il t 11 n1jlJ n 1jGi 1 UxUGI njjllxltUua~ Uilnn~1j1tfn1jil ti11 L l-1111~~1I U~~~~GiillVi111 t111UL~t1lJL~ tllJl1UtUL1~1u~~Uiln n~1j1tfn111Jill~tlBn1jV1nAUciil~lJl-11jwtl1t1lJn1j V0middot 3 LmilU
3 11pound1 fl1j~Gllln1j~1lJ1Gij~1I11 tA~1jm1L~tllJ L~tII lJl1Ul-1~il~Glll n1j~tlJn1j tU~11J1xUGlnj11IOltnAL~tII l-1~il~Gllln1jOltlJfl1jtu~1t11~U 1
1U
~1GlLil1j1ntJUGlnFl11ililn (Surgical Removal of
Tooth Root)
(Soft Tissue Impaction)
5 ~1 ulGl t1fljilnj~GJnLL~~tJu (Bony Impaction
or Embedded Tooth)
- Partial Bony 200 - Complete Bony 300
Other Surgical Procedures
6 ~1 GltI~1t1j1ntJu (Root Resection)
200 300
hiu 5lllnl5 lU1U
7 ~h rAGl LU=UiI cnJ~1pound111 ntlu (Retrog rade )
- tlUVlU1 41 - tlUVllaquoJ 41
8 Root AmputationBicuspidizationHemisection 41 9 Tooth Reimplantation andor Stabilization of ~
Accidentay Avulsed or Displaced Tooth (112J Splinting Gl1t1
Composite wire or Arch Bar)
10 Tooth Transplantation (11lJC1ilutluSplintingstabilizc ~
11 Marsupiafization (under local anesthesia) Gl1LLVlUJ
12 Oroantral Fistula Closure (1li11lJFllvi1 Soft Tissue ( Gl1LLVlUJ
under local anesthesia
13 Surgical Exposure of Unerupted Tooth For Orthod( 41 (lli11lJFl1Lfil~ilJfj ilIKUGln11lJ~Gltlu)
14 Excision of Pericoronal Gingiva ~
15 Biopsy of Oral Tissue (HardSoft) Gl1LLVlUJ
16 Debridement and Suturing LL~~tutlilJlhn A-rJ
Surgical Preparation of Ridge For Denture
17 tI ~1JLL~~LL6iJ n1~GJn L14 iltatlu (AlveolectomyAlveolop Gl1LLVlUJ
18 Vestibuloplasty Gl1LLVlUJ
19 L~lJlun1~GJn (Ridge Augmentation) Gl1LLVlUJ
20 LLtlltl Epulis Fibrous Alveolar Ridge Gl1LLVlUJ
Excision of Bone Tissue
21 Torectomy OstectomY1Ju arch
22 Torectomy Ostectomy ~1J arch
Removal of Tumors Cysts Neoplasms
23 ~J1rAGlL~1~llU1 lJVlUilJtIU1GH~n laquo15cm) Gl1LLVlUJ
24 N1rAlLA1~lJtl1 lJVlUilJtIU1ltVltY (gt15cm) Gl1LLVlUJ
25 N1rAlLllilJilntutlilJlhntlU1GlL~n laquo15cm) Gl1LLVlUJ
26 N1rAGlLllillilntutlilJlhntlU1GltVltY (gt15cm) Gl1LLVlUJ
Surgical Incision
151
300
400
400
200
400
240
240
240
70
120
120
200
250
300
180
300
200
200
250
200
250
hlll 1flnl 1J)u a 27 LOll~QIUilllllutulfih1thnltBt drain GllLLUI 150 28 LOll~QIUilllllUUil nlfilllh n (Illut61 tJl1ilLQWl~) GllLLUI 200 29 Sequestrectomy (lllut61Ul1ilLQWlt~) GllLLUI 200 30 Maxillary Sinusotomy For Removal of Tooth Fragment
or Foreign Body (Cald Well Luc)
- IllUt61tJl1ilLQWlt AI 450
Treatment of Fractures
31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
- Closed Reduction (lllUt61tJl1ilLQWl~) AI 800 33 Fracture Maxilla
- Closed Reduction (lllUt61Ul1ilLQWl~VI) A~I 800 34 Alveolar Fracture
- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
I
I
- IlltJt61Ul1ilLQWlt AI 250 38 Frenectomy Frenoplasty GllLLUI 140 39 Sialol ithotomy (Illut61 tJl1il LnWl~) AI 200
Miscellaneous Procedures 40 Gln1tlLLampgtIA (Curettage) GllLLUI 50 41 Stop Bleeding GllLLUI 40 42 GlGl1J ~l1LLampgtIAtulfilllhn AI 30 43 tBttJln1tl Dry Socket AI 30
MUtA n53I n 1 ~Gli4UtY1AS11pulp capping ft 60 2 IlGli4U611tJiRG Amalgam
- 6l1ULliu1 ft 100
hclu -sIInl-s MU11J i 15041- 2 Gi1u
170- 3 Gi1U ~ 1 180- fiuGi 4 Gi1uiiu11hil Amalgam overlay
3 ~GlNuGiltl~mG)~hvdjilui4u (compositeGIFlowable composite)
- G11ULGltll
- 2 Gi1U
- 3 Gi1U
- fi)UGi 4 Gl1uiiu111il Composite onlay (dire 4 ~GlrJGlllil)i1)t11)i4U (Spacing)
5 JrutNULGlpoundltl1ufUlL esfl1 nulJ (Band)
- i4ufl i1lJUil tI
- i4UflmiddotS1l1
6 Inlay Onlay
7 Labial Veneer
- Direct
- Indirect
~UtGlGlDUor
1 fl1i~fl131A~ ))1 fli4U
- i4lJU1
- i4Ufl1lJUil tI 1 1fl
- i4Ufl1lJUiltl 2 1fl
- i4Ufli1lJ
ApexificationRecalcification
3
2 Wilflli4u (Non-vital Bleaching)
4 L~ULGlGl iluchJ11rGl~flLaU i4UU1- i4Ufl1lJUiltl
L~ULGlGl iluchi11rGl~flLaU i4uflnlJ5
tAtiuGlill U 1 GlUU1~1t1 ~)111fl (illJllGli4u)
Root PlaningCurettage
3
2 Flap Operation
~ 130
18041 20041 22041
llil) 300
41 120
120~
70041
Ift 240 Ift 500
1 600
41 600
100041 en 1800
A~) 120
A~) 120
~ 150 Ift 200
~)111fl 120
Qualdant 150 Gi1LLU) 250
allI UnlS 4 5 6
Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
- FGG LLA~ Stent
7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
LLtiL11 n11igttil~u~GItIn
- LltilW1~Gi1LLVIti
- ~ItI1n
11 fntt1 inn11L~tl1~ULGI tI n11Vl1 tl1
MUCAntJuziw 1 A1tlU~U (Crown)
2 Cantilever Bridge
3 ~tW1U~U (Fixed Bridge)
- 3 -5 FJ1lGl
- lJ1nn11 5 FJ1lGl
4 Etched Bridge
5 L tl tli4u (Post amp Core)
- Amalgam Core
- Composite Core
- Pin R1L~~~1lJU Amalgam Core
- Pin R1L~l~1lJ1J Composite Core
- Coping I pin LVI1t1
A1tllJi4ui(1 A)11 (n1dlqn L~U)6 7 tl~~W1U~U1tlA1tllJi4U1tlLtltl (LltilW1~ Abutment)
Recementation A)tl1Ji4UVItl~~W1Ui4U8 9 lftllJ Porcelain LGltltll Composite
10 i4utlAtllJ~tI1n ~1UtlA~n n1dl 1 flu
- fllJWGl1t1 polysulfide
11 i4utlAtllJ~ItI1n ~1UtlA~n n1dl 2 flu
- fllJWGl1t1 polysulfide
1amp)u i 350911 LLVIti
25041
350611 LLVIti
350 400
911 LLVIti
2009i1LLVIti
40A~
60Af
200Af
3041
90041 900flu
650 FJUGl
FJ1lGl
700 ffu 500
25041 25041 30041 300~
41 350 FJ1lGl 200
200 100
~ flu
A~ 150911 LLVIti
flu 650
1200FJ I
ihiu 5on15 I htl 12 ~uL~~~u1um1ua~~~1ulA~~ (Metallic Partial Denture)
- 1-5 41 ffu - ~1nni1 541 ffu
13 ~~v1u~Ua~GlGl (Removable Bridge) ilu 14 f1uLO~~u1um1ua~~1Glg1u~Fl~n( TP )
-1-2 ~ ilu - 3-5 ~ ilu - 6-9 ~ ilu
-10-15fl ilu
- 16 41 ~ul1 ilu 15 Hard acrylic occlusal splint Gi1LLwuu 16 Adjust Occlusal splint Fl~u
17 Mouth guard Night GuardSoft splint ilu 18 Speech Aid ilu 19 11~u~Sl1v~ULO~~G1~ Tissue Conditioner
- Single denture Flu - RPDAPD (chairside) Fl~u
20 L~~i1U~UL~~~ (Reline)
- Single denture (chairside) ilu
- RPDAPD (chairside) ffu - Laboratory ilu
21 Rebase full dentures ilu 22 Repair denture
- Chairside ilu - Laboratory ilu
MUGln55SJ~(lwU
1 ~1J Consult Gln~L14~11uLLNu~~fJu Fl~u
2 X-rayvi1tJ~i~A~WtJ1nci1~ltJ Cephampmodel analy Fl~u
11uLLNUn1~n~1 flu~lh~
3 tmLFl~JSj ~~~f1Uliil~~~LLtiu (tNuf1UUULLA~A1J) 1~
tm face mask head gear chin cup
4 n16JLLAFl~uGifl11 tJ~u LtJ~~UA1~ Fl~u
(1J~~1m 18-24 FlJ)
iGl5
600 700 350
300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
i
I
nunl~ei1U 1i1UlU 5 ClelGlLA1ih1fi eltGli4Uti1lGlGGl LLtiu 300
1a retainer ClelGl1Gi 300 1ft retainer GGlutiu 400
6 iRecheck AJ 50
7 300 8
1ftLA1elJfi eltillGl CI elGl61 ilu
50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
LAsectellJVS~IJ-elJi4u (Pit and Fissure Sealant) I 41 50 3 100Preventive Resin Restoration (PRR) 41
MUniiJJd~u ttl n 1 170Pulpotomy 41 2 iPulpectomy
300 - i4uvs~J
- i4UVSU1 ~
400 3
4t 1ftAlelllfJULvs~n 1~ilIJlJlfUtfJUU1UIJ 200
4 4t
200 5
411ftAlellJfJUelA~ nlJl fUtfJUU1UIJ
200 6
1fJLA1elJpoundlelf(uV1 ( Space Maintainer) LLlJllClelGl161 ilu
1fJLA1elJfielf(uV1 ( Space Maintainer) LLlJlJGGl LLtiu
- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
hiu 5lllnl5 lU1U
7 ~h rAGl LU=UiI cnJ~1pound111 ntlu (Retrog rade )
- tlUVlU1 41 - tlUVllaquoJ 41
8 Root AmputationBicuspidizationHemisection 41 9 Tooth Reimplantation andor Stabilization of ~
Accidentay Avulsed or Displaced Tooth (112J Splinting Gl1t1
Composite wire or Arch Bar)
10 Tooth Transplantation (11lJC1ilutluSplintingstabilizc ~
11 Marsupiafization (under local anesthesia) Gl1LLVlUJ
12 Oroantral Fistula Closure (1li11lJFllvi1 Soft Tissue ( Gl1LLVlUJ
under local anesthesia
13 Surgical Exposure of Unerupted Tooth For Orthod( 41 (lli11lJFl1Lfil~ilJfj ilIKUGln11lJ~Gltlu)
14 Excision of Pericoronal Gingiva ~
15 Biopsy of Oral Tissue (HardSoft) Gl1LLVlUJ
16 Debridement and Suturing LL~~tutlilJlhn A-rJ
Surgical Preparation of Ridge For Denture
17 tI ~1JLL~~LL6iJ n1~GJn L14 iltatlu (AlveolectomyAlveolop Gl1LLVlUJ
18 Vestibuloplasty Gl1LLVlUJ
19 L~lJlun1~GJn (Ridge Augmentation) Gl1LLVlUJ
20 LLtlltl Epulis Fibrous Alveolar Ridge Gl1LLVlUJ
Excision of Bone Tissue
21 Torectomy OstectomY1Ju arch
22 Torectomy Ostectomy ~1J arch
Removal of Tumors Cysts Neoplasms
23 ~J1rAGlL~1~llU1 lJVlUilJtIU1GH~n laquo15cm) Gl1LLVlUJ
24 N1rAlLA1~lJtl1 lJVlUilJtIU1ltVltY (gt15cm) Gl1LLVlUJ
25 N1rAlLllilJilntutlilJlhntlU1GlL~n laquo15cm) Gl1LLVlUJ
26 N1rAGlLllillilntutlilJlhntlU1GltVltY (gt15cm) Gl1LLVlUJ
Surgical Incision
151
300
400
400
200
400
240
240
240
70
120
120
200
250
300
180
300
200
200
250
200
250
hlll 1flnl 1J)u a 27 LOll~QIUilllllutulfih1thnltBt drain GllLLUI 150 28 LOll~QIUilllllUUil nlfilllh n (Illut61 tJl1ilLQWl~) GllLLUI 200 29 Sequestrectomy (lllut61Ul1ilLQWlt~) GllLLUI 200 30 Maxillary Sinusotomy For Removal of Tooth Fragment
or Foreign Body (Cald Well Luc)
- IllUt61tJl1ilLQWlt AI 450
Treatment of Fractures
31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
- Closed Reduction (lllUt61tJl1ilLQWl~) AI 800 33 Fracture Maxilla
- Closed Reduction (lllUt61Ul1ilLQWl~VI) A~I 800 34 Alveolar Fracture
- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
I
I
- IlltJt61Ul1ilLQWlt AI 250 38 Frenectomy Frenoplasty GllLLUI 140 39 Sialol ithotomy (Illut61 tJl1il LnWl~) AI 200
Miscellaneous Procedures 40 Gln1tlLLampgtIA (Curettage) GllLLUI 50 41 Stop Bleeding GllLLUI 40 42 GlGl1J ~l1LLampgtIAtulfilllhn AI 30 43 tBttJln1tl Dry Socket AI 30
MUtA n53I n 1 ~Gli4UtY1AS11pulp capping ft 60 2 IlGli4U611tJiRG Amalgam
- 6l1ULliu1 ft 100
hclu -sIInl-s MU11J i 15041- 2 Gi1u
170- 3 Gi1U ~ 1 180- fiuGi 4 Gi1uiiu11hil Amalgam overlay
3 ~GlNuGiltl~mG)~hvdjilui4u (compositeGIFlowable composite)
- G11ULGltll
- 2 Gi1U
- 3 Gi1U
- fi)UGi 4 Gl1uiiu111il Composite onlay (dire 4 ~GlrJGlllil)i1)t11)i4U (Spacing)
5 JrutNULGlpoundltl1ufUlL esfl1 nulJ (Band)
- i4ufl i1lJUil tI
- i4UflmiddotS1l1
6 Inlay Onlay
7 Labial Veneer
- Direct
- Indirect
~UtGlGlDUor
1 fl1i~fl131A~ ))1 fli4U
- i4lJU1
- i4Ufl1lJUil tI 1 1fl
- i4Ufl1lJUiltl 2 1fl
- i4Ufli1lJ
ApexificationRecalcification
3
2 Wilflli4u (Non-vital Bleaching)
4 L~ULGlGl iluchJ11rGl~flLaU i4UU1- i4Ufl1lJUiltl
L~ULGlGl iluchi11rGl~flLaU i4uflnlJ5
tAtiuGlill U 1 GlUU1~1t1 ~)111fl (illJllGli4u)
Root PlaningCurettage
3
2 Flap Operation
~ 130
18041 20041 22041
llil) 300
41 120
120~
70041
Ift 240 Ift 500
1 600
41 600
100041 en 1800
A~) 120
A~) 120
~ 150 Ift 200
~)111fl 120
Qualdant 150 Gi1LLU) 250
allI UnlS 4 5 6
Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
- FGG LLA~ Stent
7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
LLtiL11 n11igttil~u~GItIn
- LltilW1~Gi1LLVIti
- ~ItI1n
11 fntt1 inn11L~tl1~ULGI tI n11Vl1 tl1
MUCAntJuziw 1 A1tlU~U (Crown)
2 Cantilever Bridge
3 ~tW1U~U (Fixed Bridge)
- 3 -5 FJ1lGl
- lJ1nn11 5 FJ1lGl
4 Etched Bridge
5 L tl tli4u (Post amp Core)
- Amalgam Core
- Composite Core
- Pin R1L~~~1lJU Amalgam Core
- Pin R1L~l~1lJ1J Composite Core
- Coping I pin LVI1t1
A1tllJi4ui(1 A)11 (n1dlqn L~U)6 7 tl~~W1U~U1tlA1tllJi4U1tlLtltl (LltilW1~ Abutment)
Recementation A)tl1Ji4UVItl~~W1Ui4U8 9 lftllJ Porcelain LGltltll Composite
10 i4utlAtllJ~tI1n ~1UtlA~n n1dl 1 flu
- fllJWGl1t1 polysulfide
11 i4utlAtllJ~ItI1n ~1UtlA~n n1dl 2 flu
- fllJWGl1t1 polysulfide
1amp)u i 350911 LLVIti
25041
350611 LLVIti
350 400
911 LLVIti
2009i1LLVIti
40A~
60Af
200Af
3041
90041 900flu
650 FJUGl
FJ1lGl
700 ffu 500
25041 25041 30041 300~
41 350 FJ1lGl 200
200 100
~ flu
A~ 150911 LLVIti
flu 650
1200FJ I
ihiu 5on15 I htl 12 ~uL~~~u1um1ua~~~1ulA~~ (Metallic Partial Denture)
- 1-5 41 ffu - ~1nni1 541 ffu
13 ~~v1u~Ua~GlGl (Removable Bridge) ilu 14 f1uLO~~u1um1ua~~1Glg1u~Fl~n( TP )
-1-2 ~ ilu - 3-5 ~ ilu - 6-9 ~ ilu
-10-15fl ilu
- 16 41 ~ul1 ilu 15 Hard acrylic occlusal splint Gi1LLwuu 16 Adjust Occlusal splint Fl~u
17 Mouth guard Night GuardSoft splint ilu 18 Speech Aid ilu 19 11~u~Sl1v~ULO~~G1~ Tissue Conditioner
- Single denture Flu - RPDAPD (chairside) Fl~u
20 L~~i1U~UL~~~ (Reline)
- Single denture (chairside) ilu
- RPDAPD (chairside) ffu - Laboratory ilu
21 Rebase full dentures ilu 22 Repair denture
- Chairside ilu - Laboratory ilu
MUGln55SJ~(lwU
1 ~1J Consult Gln~L14~11uLLNu~~fJu Fl~u
2 X-rayvi1tJ~i~A~WtJ1nci1~ltJ Cephampmodel analy Fl~u
11uLLNUn1~n~1 flu~lh~
3 tmLFl~JSj ~~~f1Uliil~~~LLtiu (tNuf1UUULLA~A1J) 1~
tm face mask head gear chin cup
4 n16JLLAFl~uGifl11 tJ~u LtJ~~UA1~ Fl~u
(1J~~1m 18-24 FlJ)
iGl5
600 700 350
300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
i
I
nunl~ei1U 1i1UlU 5 ClelGlLA1ih1fi eltGli4Uti1lGlGGl LLtiu 300
1a retainer ClelGl1Gi 300 1ft retainer GGlutiu 400
6 iRecheck AJ 50
7 300 8
1ftLA1elJfi eltillGl CI elGl61 ilu
50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
LAsectellJVS~IJ-elJi4u (Pit and Fissure Sealant) I 41 50 3 100Preventive Resin Restoration (PRR) 41
MUniiJJd~u ttl n 1 170Pulpotomy 41 2 iPulpectomy
300 - i4uvs~J
- i4UVSU1 ~
400 3
4t 1ftAlelllfJULvs~n 1~ilIJlJlfUtfJUU1UIJ 200
4 4t
200 5
411ftAlellJfJUelA~ nlJl fUtfJUU1UIJ
200 6
1fJLA1elJpoundlelf(uV1 ( Space Maintainer) LLlJllClelGl161 ilu
1fJLA1elJfielf(uV1 ( Space Maintainer) LLlJlJGGl LLtiu
- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
hlll 1flnl 1J)u a 27 LOll~QIUilllllutulfih1thnltBt drain GllLLUI 150 28 LOll~QIUilllllUUil nlfilllh n (Illut61 tJl1ilLQWl~) GllLLUI 200 29 Sequestrectomy (lllut61Ul1ilLQWlt~) GllLLUI 200 30 Maxillary Sinusotomy For Removal of Tooth Fragment
or Foreign Body (Cald Well Luc)
- IllUt61tJl1ilLQWlt AI 450
Treatment of Fractures
31 L111LJJiln~u (Intra Arch) Gl1uArchbar I A1Gl compos A~I 300 32 Fracture Mandible
- Closed Reduction (lllUt61tJl1ilLQWl~) AI 800 33 Fracture Maxilla
- Closed Reduction (lllUt61Ul1ilLQWl~VI) A~I 800 34 Alveolar Fracture
- Closed Reduction (lllUt61tJl1ilLQWlt) arch 350 35 Off Arch Bar AI 120 36 Removal Suspension Wire AI 150 37 Plate and ScrewlWire Removal
I
I
- IlltJt61Ul1ilLQWlt AI 250 38 Frenectomy Frenoplasty GllLLUI 140 39 Sialol ithotomy (Illut61 tJl1il LnWl~) AI 200
Miscellaneous Procedures 40 Gln1tlLLampgtIA (Curettage) GllLLUI 50 41 Stop Bleeding GllLLUI 40 42 GlGl1J ~l1LLampgtIAtulfilllhn AI 30 43 tBttJln1tl Dry Socket AI 30
MUtA n53I n 1 ~Gli4UtY1AS11pulp capping ft 60 2 IlGli4U611tJiRG Amalgam
- 6l1ULliu1 ft 100
hclu -sIInl-s MU11J i 15041- 2 Gi1u
170- 3 Gi1U ~ 1 180- fiuGi 4 Gi1uiiu11hil Amalgam overlay
3 ~GlNuGiltl~mG)~hvdjilui4u (compositeGIFlowable composite)
- G11ULGltll
- 2 Gi1U
- 3 Gi1U
- fi)UGi 4 Gl1uiiu111il Composite onlay (dire 4 ~GlrJGlllil)i1)t11)i4U (Spacing)
5 JrutNULGlpoundltl1ufUlL esfl1 nulJ (Band)
- i4ufl i1lJUil tI
- i4UflmiddotS1l1
6 Inlay Onlay
7 Labial Veneer
- Direct
- Indirect
~UtGlGlDUor
1 fl1i~fl131A~ ))1 fli4U
- i4lJU1
- i4Ufl1lJUil tI 1 1fl
- i4Ufl1lJUiltl 2 1fl
- i4Ufli1lJ
ApexificationRecalcification
3
2 Wilflli4u (Non-vital Bleaching)
4 L~ULGlGl iluchJ11rGl~flLaU i4UU1- i4Ufl1lJUiltl
L~ULGlGl iluchi11rGl~flLaU i4uflnlJ5
tAtiuGlill U 1 GlUU1~1t1 ~)111fl (illJllGli4u)
Root PlaningCurettage
3
2 Flap Operation
~ 130
18041 20041 22041
llil) 300
41 120
120~
70041
Ift 240 Ift 500
1 600
41 600
100041 en 1800
A~) 120
A~) 120
~ 150 Ift 200
~)111fl 120
Qualdant 150 Gi1LLU) 250
allI UnlS 4 5 6
Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
- FGG LLA~ Stent
7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
LLtiL11 n11igttil~u~GItIn
- LltilW1~Gi1LLVIti
- ~ItI1n
11 fntt1 inn11L~tl1~ULGI tI n11Vl1 tl1
MUCAntJuziw 1 A1tlU~U (Crown)
2 Cantilever Bridge
3 ~tW1U~U (Fixed Bridge)
- 3 -5 FJ1lGl
- lJ1nn11 5 FJ1lGl
4 Etched Bridge
5 L tl tli4u (Post amp Core)
- Amalgam Core
- Composite Core
- Pin R1L~~~1lJU Amalgam Core
- Pin R1L~l~1lJ1J Composite Core
- Coping I pin LVI1t1
A1tllJi4ui(1 A)11 (n1dlqn L~U)6 7 tl~~W1U~U1tlA1tllJi4U1tlLtltl (LltilW1~ Abutment)
Recementation A)tl1Ji4UVItl~~W1Ui4U8 9 lftllJ Porcelain LGltltll Composite
10 i4utlAtllJ~tI1n ~1UtlA~n n1dl 1 flu
- fllJWGl1t1 polysulfide
11 i4utlAtllJ~ItI1n ~1UtlA~n n1dl 2 flu
- fllJWGl1t1 polysulfide
1amp)u i 350911 LLVIti
25041
350611 LLVIti
350 400
911 LLVIti
2009i1LLVIti
40A~
60Af
200Af
3041
90041 900flu
650 FJUGl
FJ1lGl
700 ffu 500
25041 25041 30041 300~
41 350 FJ1lGl 200
200 100
~ flu
A~ 150911 LLVIti
flu 650
1200FJ I
ihiu 5on15 I htl 12 ~uL~~~u1um1ua~~~1ulA~~ (Metallic Partial Denture)
- 1-5 41 ffu - ~1nni1 541 ffu
13 ~~v1u~Ua~GlGl (Removable Bridge) ilu 14 f1uLO~~u1um1ua~~1Glg1u~Fl~n( TP )
-1-2 ~ ilu - 3-5 ~ ilu - 6-9 ~ ilu
-10-15fl ilu
- 16 41 ~ul1 ilu 15 Hard acrylic occlusal splint Gi1LLwuu 16 Adjust Occlusal splint Fl~u
17 Mouth guard Night GuardSoft splint ilu 18 Speech Aid ilu 19 11~u~Sl1v~ULO~~G1~ Tissue Conditioner
- Single denture Flu - RPDAPD (chairside) Fl~u
20 L~~i1U~UL~~~ (Reline)
- Single denture (chairside) ilu
- RPDAPD (chairside) ffu - Laboratory ilu
21 Rebase full dentures ilu 22 Repair denture
- Chairside ilu - Laboratory ilu
MUGln55SJ~(lwU
1 ~1J Consult Gln~L14~11uLLNu~~fJu Fl~u
2 X-rayvi1tJ~i~A~WtJ1nci1~ltJ Cephampmodel analy Fl~u
11uLLNUn1~n~1 flu~lh~
3 tmLFl~JSj ~~~f1Uliil~~~LLtiu (tNuf1UUULLA~A1J) 1~
tm face mask head gear chin cup
4 n16JLLAFl~uGifl11 tJ~u LtJ~~UA1~ Fl~u
(1J~~1m 18-24 FlJ)
iGl5
600 700 350
300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
i
I
nunl~ei1U 1i1UlU 5 ClelGlLA1ih1fi eltGli4Uti1lGlGGl LLtiu 300
1a retainer ClelGl1Gi 300 1ft retainer GGlutiu 400
6 iRecheck AJ 50
7 300 8
1ftLA1elJfi eltillGl CI elGl61 ilu
50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
LAsectellJVS~IJ-elJi4u (Pit and Fissure Sealant) I 41 50 3 100Preventive Resin Restoration (PRR) 41
MUniiJJd~u ttl n 1 170Pulpotomy 41 2 iPulpectomy
300 - i4uvs~J
- i4UVSU1 ~
400 3
4t 1ftAlelllfJULvs~n 1~ilIJlJlfUtfJUU1UIJ 200
4 4t
200 5
411ftAlellJfJUelA~ nlJl fUtfJUU1UIJ
200 6
1fJLA1elJpoundlelf(uV1 ( Space Maintainer) LLlJllClelGl161 ilu
1fJLA1elJfielf(uV1 ( Space Maintainer) LLlJlJGGl LLtiu
- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
hclu -sIInl-s MU11J i 15041- 2 Gi1u
170- 3 Gi1U ~ 1 180- fiuGi 4 Gi1uiiu11hil Amalgam overlay
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5 JrutNULGlpoundltl1ufUlL esfl1 nulJ (Band)
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6 Inlay Onlay
7 Labial Veneer
- Direct
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~UtGlGlDUor
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- i4Ufli1lJ
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3
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L~ULGlGl iluchi11rGl~flLaU i4uflnlJ5
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Root PlaningCurettage
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18041 20041 22041
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120~
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1 600
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~ 150 Ift 200
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Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
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7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
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- ~ItI1n
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MUCAntJuziw 1 A1tlU~U (Crown)
2 Cantilever Bridge
3 ~tW1U~U (Fixed Bridge)
- 3 -5 FJ1lGl
- lJ1nn11 5 FJ1lGl
4 Etched Bridge
5 L tl tli4u (Post amp Core)
- Amalgam Core
- Composite Core
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- Pin R1L~l~1lJ1J Composite Core
- Coping I pin LVI1t1
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- fllJWGl1t1 polysulfide
11 i4utlAtllJ~ItI1n ~1UtlA~n n1dl 2 flu
- fllJWGl1t1 polysulfide
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25041
350611 LLVIti
350 400
911 LLVIti
2009i1LLVIti
40A~
60Af
200Af
3041
90041 900flu
650 FJUGl
FJ1lGl
700 ffu 500
25041 25041 30041 300~
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200 100
~ flu
A~ 150911 LLVIti
flu 650
1200FJ I
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-1-2 ~ ilu - 3-5 ~ ilu - 6-9 ~ ilu
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17 Mouth guard Night GuardSoft splint ilu 18 Speech Aid ilu 19 11~u~Sl1v~ULO~~G1~ Tissue Conditioner
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20 L~~i1U~UL~~~ (Reline)
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- Chairside ilu - Laboratory ilu
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tm face mask head gear chin cup
4 n16JLLAFl~uGifl11 tJ~u LtJ~~UA1~ Fl~u
(1J~~1m 18-24 FlJ)
iGl5
600 700 350
300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
i
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1a retainer ClelGl1Gi 300 1ft retainer GGlutiu 400
6 iRecheck AJ 50
7 300 8
1ftLA1elJfi eltillGl CI elGl61 ilu
50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
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300 - i4uvs~J
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4 4t
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200 6
1fJLA1elJpoundlelf(uV1 ( Space Maintainer) LLlJllClelGl161 ilu
1fJLA1elJfielf(uV1 ( Space Maintainer) LLlJlJGGl LLtiu
- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
allI UnlS 4 5 6
Osseous Surgery
Crown Lengthening
Mucogingival Surgery
- CPFPAPFP
- FGG LLA~ Stent
7 8 9 10
GTR (Membrane IBone Graft)
fn1tAL~tlni4u (Periodontal Splint)
LtJ~tlU Periodontal Dressing
LLtiL11 n11igttil~u~GItIn
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MUCAntJuziw 1 A1tlU~U (Crown)
2 Cantilever Bridge
3 ~tW1U~U (Fixed Bridge)
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4 Etched Bridge
5 L tl tli4u (Post amp Core)
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- Coping I pin LVI1t1
A1tllJi4ui(1 A)11 (n1dlqn L~U)6 7 tl~~W1U~U1tlA1tllJi4U1tlLtltl (LltilW1~ Abutment)
Recementation A)tl1Ji4UVItl~~W1Ui4U8 9 lftllJ Porcelain LGltltll Composite
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- fllJWGl1t1 polysulfide
11 i4utlAtllJ~ItI1n ~1UtlA~n n1dl 2 flu
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1amp)u i 350911 LLVIti
25041
350611 LLVIti
350 400
911 LLVIti
2009i1LLVIti
40A~
60Af
200Af
3041
90041 900flu
650 FJUGl
FJ1lGl
700 ffu 500
25041 25041 30041 300~
41 350 FJ1lGl 200
200 100
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A~ 150911 LLVIti
flu 650
1200FJ I
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13 ~~v1u~Ua~GlGl (Removable Bridge) ilu 14 f1uLO~~u1um1ua~~1Glg1u~Fl~n( TP )
-1-2 ~ ilu - 3-5 ~ ilu - 6-9 ~ ilu
-10-15fl ilu
- 16 41 ~ul1 ilu 15 Hard acrylic occlusal splint Gi1LLwuu 16 Adjust Occlusal splint Fl~u
17 Mouth guard Night GuardSoft splint ilu 18 Speech Aid ilu 19 11~u~Sl1v~ULO~~G1~ Tissue Conditioner
- Single denture Flu - RPDAPD (chairside) Fl~u
20 L~~i1U~UL~~~ (Reline)
- Single denture (chairside) ilu
- RPDAPD (chairside) ffu - Laboratory ilu
21 Rebase full dentures ilu 22 Repair denture
- Chairside ilu - Laboratory ilu
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2 X-rayvi1tJ~i~A~WtJ1nci1~ltJ Cephampmodel analy Fl~u
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3 tmLFl~JSj ~~~f1Uliil~~~LLtiu (tNuf1UUULLA~A1J) 1~
tm face mask head gear chin cup
4 n16JLLAFl~uGifl11 tJ~u LtJ~~UA1~ Fl~u
(1J~~1m 18-24 FlJ)
iGl5
600 700 350
300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
i
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1a retainer ClelGl1Gi 300 1ft retainer GGlutiu 400
6 iRecheck AJ 50
7 300 8
1ftLA1elJfi eltillGl CI elGl61 ilu
50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
LAsectellJVS~IJ-elJi4u (Pit and Fissure Sealant) I 41 50 3 100Preventive Resin Restoration (PRR) 41
MUniiJJd~u ttl n 1 170Pulpotomy 41 2 iPulpectomy
300 - i4uvs~J
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400 3
4t 1ftAlelllfJULvs~n 1~ilIJlJlfUtfJUU1UIJ 200
4 4t
200 5
411ftAlellJfJUelA~ nlJl fUtfJUU1UIJ
200 6
1fJLA1elJpoundlelf(uV1 ( Space Maintainer) LLlJllClelGl161 ilu
1fJLA1elJfielf(uV1 ( Space Maintainer) LLlJlJGGl LLtiu
- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
ihiu 5on15 I htl 12 ~uL~~~u1um1ua~~~1ulA~~ (Metallic Partial Denture)
- 1-5 41 ffu - ~1nni1 541 ffu
13 ~~v1u~Ua~GlGl (Removable Bridge) ilu 14 f1uLO~~u1um1ua~~1Glg1u~Fl~n( TP )
-1-2 ~ ilu - 3-5 ~ ilu - 6-9 ~ ilu
-10-15fl ilu
- 16 41 ~ul1 ilu 15 Hard acrylic occlusal splint Gi1LLwuu 16 Adjust Occlusal splint Fl~u
17 Mouth guard Night GuardSoft splint ilu 18 Speech Aid ilu 19 11~u~Sl1v~ULO~~G1~ Tissue Conditioner
- Single denture Flu - RPDAPD (chairside) Fl~u
20 L~~i1U~UL~~~ (Reline)
- Single denture (chairside) ilu
- RPDAPD (chairside) ffu - Laboratory ilu
21 Rebase full dentures ilu 22 Repair denture
- Chairside ilu - Laboratory ilu
MUGln55SJ~(lwU
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2 X-rayvi1tJ~i~A~WtJ1nci1~ltJ Cephampmodel analy Fl~u
11uLLNUn1~n~1 flu~lh~
3 tmLFl~JSj ~~~f1Uliil~~~LLtiu (tNuf1UUULLA~A1J) 1~
tm face mask head gear chin cup
4 n16JLLAFl~uGifl11 tJ~u LtJ~~UA1~ Fl~u
(1J~~1m 18-24 FlJ)
iGl5
600 700 350
300 400 500 600 650 250 100 250 300
120 120
200 200 200 300
150 150
50 300
3000 500 250
i
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nunl~ei1U 1i1UlU 5 ClelGlLA1ih1fi eltGli4Uti1lGlGGl LLtiu 300
1a retainer ClelGl1Gi 300 1ft retainer GGlutiu 400
6 iRecheck AJ 50
7 300 8
1ftLA1elJfi eltillGl CI elGl61 ilu
50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
LAsectellJVS~IJ-elJi4u (Pit and Fissure Sealant) I 41 50 3 100Preventive Resin Restoration (PRR) 41
MUniiJJd~u ttl n 1 170Pulpotomy 41 2 iPulpectomy
300 - i4uvs~J
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4t 1ftAlelllfJULvs~n 1~ilIJlJlfUtfJUU1UIJ 200
4 4t
200 5
411ftAlellJfJUelA~ nlJl fUtfJUU1UIJ
200 6
1fJLA1elJpoundlelf(uV1 ( Space Maintainer) LLlJllClelGl161 ilu
1fJLA1elJfielf(uV1 ( Space Maintainer) LLlJlJGGl LLtiu
- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
nunl~ei1U 1i1UlU 5 ClelGlLA1ih1fi eltGli4Uti1lGlGGl LLtiu 300
1a retainer ClelGl1Gi 300 1ft retainer GGlutiu 400
6 iRecheck AJ 50
7 300 8
1ftLA1elJfi eltillGl CI elGl61 ilu
50n1lGj LL~AJGl el1tljtllJ-nlel LLGlJ AJ 600
10 1ft Functional Appliances 9 ilu
100 11
n1lGjLL~AJGl el1tljtl-rlJ-nlel LLGlJ AJ c1 300~J Mini-Implant
MU niiJJua liu 1 60 2
LAsectelllW8el ellcl~Jtl1n A~J
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MUniiJJd~u ttl n 1 170Pulpotomy 41 2 iPulpectomy
300 - i4uvs~J
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400 3
4t 1ftAlelllfJULvs~n 1~ilIJlJlfUtfJUU1UIJ 200
4 4t
200 5
411ftAlellJfJUelA~ nlJl fUtfJUU1UIJ
200 6
1fJLA1elJpoundlelf(uV1 ( Space Maintainer) LLlJllClelGl161 ilu
1fJLA1elJfielf(uV1 ( Space Maintainer) LLlJlJGGl LLtiu
- Band and Loop 250ilu
250ilu- Distal shoe
500- Lingual holding arch ilu
ilu 500 7
- Nances Appliance
300Obtulator ~1VSilJ ~ibUtl1 nLLVSiJLWGl1uiwj ilu
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