Internal Bleaching / Tooth

External Bleaching Full Mouth

Endodontic Treatment for Anterior teeth / Tooth
Endodontic Treatment For Premolar / Tooth
Endodontic Treatment for molar / Tooth
Re-treatment of Root Canal / Per 1 Canal
Exploration of Calcified Canal or a Ledge, Additional charge of
treatment
Removal of Broken Instrument / Additional Charge of Treatment
Repair of Perforation
Retrograde filling with MTA
Partial Pulpotomy (Permanent Tooth)
Enamel Micro Abrasion / Tooth
Inlay / Onlay - Porcelain
Inlay / Onlay - Precious Metal
Inlay / Onlay - Composite
Porcelain Laminate Veneer /Tooth
Metal Free Ceramic Crown / Tooth
Metal - Ceramic Crown (Non Precious Metal) / Unit
Metal - Ceramic Crown (Precious metal) / Unit
Metal Crown (Non Precious - Metal) / Unit
Metal Crown (Precious - Metal) / Unit
Anterior Casted Post & Core (Non Precious - Metal)
Anterior Casted Post & Core (Precious - Metal)
Posterior Casted Post & Core (Non Precious - Metal)
Posterior Casted Post & Core (Precious - Metal)
Ready Made Post
Non Metal Post

/
/
/

30.00
120.00
30.00
60.00
90.00
35.00

0.00
0.00
0.00
0.00
0.00
0.00

5.00
50.00
5.00
10.00
15.00
10.00

0.00
0.00
0.00
0.00
0.00
0.00

/
/

MTA



/

/
/
/
/
/
/
/
/
/
/

20.00
20.00
50.00
30.00
20.00
20.00
90.00
100.00
40.00
100.00
150.00
110.00
170.00
80.00
120.00
50.00
120.00
50.00
150.00
50.00
60.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
10.00
0.00
10.00
0.00
5.00
0.00
5.00
0.00
5.00
0.00

5.00
5.00
15.00
10.00
5.00
5.00
40.00
50.00
15.00
40.00
60.00
30.00
60.00
15.00
50.00
15.00
50.00
15.00
50.00
10.00
10.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
4.00
6.00
8.00
5.00
8.00
5.00
8.00
5.00
10.00
50.00
3.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.00
0.00
0.00

30.00
60.00
30.00
0.00
0.00
0.00
0.00
0.00
0.00
150.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
1.00
1.00
0.00
2.00
5.00
5.00
0.00
0.00
0.00

10.00
0.00
5.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5.00
5.00
0.00
0.00
0.00

110.00
170.00
80.00
10.00
20.00
15.00
30.00
20.00
10.00
300.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5.00
8.00
4.00
3.00
5.00
10.00
10.00
10.00
0.00
0.00

/
/
/






/


3

Metal - Ceramic Bridge (Non Precious Metal) / Unit

Metal - Ceramic Bridge (Precious Metal) / Unit
Resin Bonded Bridge / Unit
Crown Removel / One Crown
)Crown Removal / Crown (By Sectioning
Bridge Removal
)Bridge Removal (By Sectioning
Post - Crown Removal
Temporary Crown
Dental Implant / Prosthetics Per Unit
Class I Amalgam
Class II Amalgam
Amalgam MOD
Posterior Composite Class I
Posterior Composite Class II
Class III Composite
Class IV Composite
Class V Composite
Endodontic Treatment With G/P Filling for One Canal
Metal - Ceramic Crown (Non Precious Metal) / Unit
Emergency Visit
Examination & Diagnosis
Diagnosis and Oral Medicine Treatment
Review Oral Medicine Treatment within one month
P.A. X-ray
Occlusal X-ray
Panoramic X-ray
Cephalometric X-ray
Emergency Clinic
Sandplast
Mounting

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00
0.00
0.00
0.00
3.00
4.00
4.00
5.00
5.00
5.00
5.00
1.00
5.00
3.00
4.00
5.00
6.00
4.00
5.00
5.00
7.00
3.00
5.00
5.00
7.00
4.00
5.00
6.00
15.00
50.00
100.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5.00
20.00
20.00

0.00
0.00
0.00
15.00
12.00
15.00
15.00
20.00
25.00
25.00
25.00
5.00
20.00
10.00
20.00
25.00
30.00
15.00
25.00
20.00
30.00
10.00
20.00
15.00
35.00
10.00
15.00
20.00
30.00
250.00
250.00

) )
) )
) )
) )
3








)(
)(
)(
)(
)(
)(

Duplications
Study Cast
Diagnostic Wax Up
Cytological Smear or Swab
)Class I Amalgam (simple
)Class I Amalgam (Extensive
)Class II Amalgam (simple
)Class II Amalgam (Extensive
Amalgam MOD
Amalgam Restorations (complex amalgam)-Build up of Missing Wall
)Amalgam Restorations (Direct or Indirect Pulp Capping
Temporary Filling
Pin-Retained Amalgam
Endodontic Post
Class I Posterior Composite
Class II Posterior Composite
Posterior Composite MOD
)Class III Composite (simple
)Class III Composites (Extensive
)Class IV Composite (Simple
)Class IV Composite (Extensive
)Class V Composite (Simple
)Class V Composite (Extensive
)Composite PRR (CAR
Composites Facing
Class I Glass Ionomer Restoration
Class II Glass Ionomer Restoration
Glass Ionomer Restoration MOD
Assessment of Orthodontic Case Including Models
Upper Removable Appliance
Expansion Screw RME

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

50.00
50.00
100.00
100.00
100.00
200.00
300.00
400.00
30.00
2.50
7.50
1.50
2.50
7.50
7.50
10.00
3.50
6.00
7.50
7.50
10.00
12.50
7.50
10.00
5.00
12.50

20.00
20.00
20.00
50.00
50.00
0.00
0.00
0.00
20.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

250.00
200.00
400.00
250.00
200.00
500.00
700.00
900.00
50.00
5.00
15.00
3.00
5.00
15.00
15.00
20.00
12.00
12.00
15.00
15.00
20.00
25.00
15.00
20.00
10.00
25.00

0.00
0.00
0.00
0.00

5.00
7.50
10.00
7.50

0.00
0.00
0.00
1.00

10.00
15.00
20.00
15.00

/
) )
) )
) )
/


/





3






/
/

/
/
/

Quad - Helix
Habit Breaker
Functional Appliance
Head gear Treatment
Sectional 2*4
Fixed Appliance / 1 Jaw
Fixed Appliance / Moderate Case
Fixed Appliance / Major Case
Retainer / 1 Jaw
Behavior Management / Visit
Fluoride Application
Extraction of Deciduous Tooth
Fissure Sealent / Tooth
)PRR I (Conservative Adhesive Restoration - CAR
)PRR II (Conservative Adhasive Restoration - CAR
)PRR III (Conservative Adhesive Restoration - CAR
Class I Amalgam Deciduous Tooth
Class II Amalgam Deciduous Tooth
Amalgam MOD Deciduous Tooth
Class I Posterior Composite Deciduous Tooth
Class II Posterior Deciduous Tooth
Posterior Composite MOD Deciduous Tooth
Class III Composite Deciduous Tooth
Class IV Composite Deciduous Tooth
Class V Composite Deciduous Tooth
Composite Facing Deciduous Tooth
Class I Glass Ionomer Restoration Deciduous Tooth
Class II Glass Ionomer Restoration Deciduous Tooth
Glass Ionomer Restoration MOD Deciduous Tooth
Stainless Steel Crown / Deciduous Tooth

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

12.50
12.50
4.00
7.50
2.50
12.50
30.00
7.50
15.00
60.00
12.50
7.50
2.00
1.00
5.00
2.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
30.00
5.00
5.00
0.00
10.00
10.00
15.00
0.00

1.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
2.00
2.00
5.00
0.00

25.00
25.00
8.00
15.00
5.00
25.00
60.00
15.00
30.00
120.00
25.00
15.00
20.00
15.00
25.00
50.00
15.00
15.00
30.00
80.00
30.00
50.00
25.00
75.00
70.00
35.00
5.00
20.00
50.00
30.00
5.00

/



/

/






/
6
/






) (D

) (C


/
/

Stainless Steel Crown / Permanen Tooth

Strip Crown
Pulpotomy - Deciduous Tooth
PULPECTOMY - Deciduous tooth
Intrim Dressing / Endo or Apexification / visit
Splinting of Traumatized Teeth
Space Maintainer / One Jaw
Treatment Under Sedation / Additional Charge
Unilateral Space Maintainer
Fixed Replacement of Anterior teeth for Children
Endodontic Treatment with G/P filling / One Canal
Apexification
Removal of Epulis
Scaling & Polishing / 1 Jaw
Root Planning / Quadrant
Crown Lengthening / Tooth
Gingivectomy / tooth
Gingivoplasty / tooth
Periodontal Flap
Gingival Graft (FGG or CTG) / One Tooth
Hemisection or Resection Tooth
Bone Graft / Tooth
Splinting of Periodontally Compromised Teeth By Composite
Splinting of Teeth by Metal Plates Up 6 Teeth
Guided Tissue Regeneration
Root Preparation / Conditioning
Desensitization
Night Guard / Soft
Night Guard / Hard
Acrylic RPD with One Tooth
Additional Charge For Each Additional Tooth On RPD

Acrylic Complete Denture / 2 Jaw

Cr - Co RPD / 1 Jaw
Cr - Co / 2 Jaw
Relining for Denture
Rebase for One Denture
Repairing Acrylic Denture Complete or PD
Prosthetic Precision Attachment / Unit
Obturator
Arylic Complete Denture / 1 Jaw
Simple Extraction
Extraction With Root Separation
Simple Extraction of A Remaining root
Surgical Extraction of A Remaining Root
Extraction of A Soft Tissue Impacted Tooth
Extraction of Half Bony Impacted Tooth
Extraction of Full Bony Impacted Tooth
Surgical Exposure of A Soft Tissue Impacted Tooth
Surgical Exposure of Bony Impacted Tooth
Simple Alveoplasty
Complex Alveoplasty / Quadrant
Maxillary Tubeosity Reduction
Mylohyoid Ridge Reduction / Side
Genial Tubercle Reduction
Removal of Maxillary Tori
Removal of Mandibular Tori
Reduction of Hypermobile Soft Tissue
Labial Frenectomy
Lingual Frenectomy
Jaw Augmentation With Bone Graft / 1 Jaw
Jaw Augmentation With Alloplastic Material
Sulcus Deepening / Quadrant

/
/



/ C












/

/






/

/

200.00
200.00
400.00
50.00
50.00
10.00
100.00
350.00
100.00
10.00
20.00
25.00
50.00
50.00
75.00
100.00
40.00
60.00
40.00
50.00
50.00
75.00
75.00
75.00
75.00
50.00
50.00
75.00
150.00
120.00
80.00

10.00
10.00
0.00
0.00
0.00
1.00
0.00
0.00
10.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

50.00
50.00
100.00
5.00
10.00
2.00
20.00
70.00
25.00
0.00
0.00
0.00
5.00
5.00
8.00
10.00
5.00
8.00
0.00
5.00
5.00
0.00
0.00
5.00
5.00
5.00
5.00
5.00
0.00
0.00
0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

Indirect Sinus Lift / side

Direct Sinus Lift / Side
Intraoral Incision And Drainage
Simple Extraoral Incision And Drainage
Apicectomy of Anterior Tooth
Apicectomy of Posterior Tooth
Surgical Treatment of Osteomyelitis
Closure of Oro-Antral Fistula
Cald Well Luc Approach
Removal of A Stone From Salivary Gland Duct
Excision of Sublingual Gland / Ranula
Excision of A Mucocele
Closed Reduction of TMJ Dislocation
Closed Reduction & Fixation of A Fractured Jaw
Interdental Wiring
Removal of Interdental Wiring
Intermaxillary Fixation (IMF)
Removal of IMF
Suturing of Minor Facial Lacerations
Soft Tissue Biopsy
Bone Biopsy
Fine Needle Aspiration
Excision With Primary Closure / Small Lession
Excision With Primary Closure / Large Lession
First Stage Implant Surgery Per IMPLANT
Second Stage Implant Surgery Per IMPLANT
Ridge Augmentation Without A Membrane
Ridge Augmentation With A Membrane
Jaw Cyst Enucleation / Up to 3 cm
Jaw Cyst Enucleation / More than 3 cm
Excision of Sebaceous Cyst

) )
) )






) )



















3
3

100.00
300.00
30.00
50.00
80.00
100.00
150.00
120.00
150.00
80.00
100.00
40.00
30.00
200.00
70.00
30.00
150.00
50.00
100.00
30.00
70.00
60.00
50.00
100.00
300.00
50.00
100.00
150.00
100.00
150.00
90.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00
0.00
0.00
5.00
5.00
10.00
0.00
15.00
0.00
10.00
0.00
5.00
3.00
0.00
10.00
5.00
15.00
5.00
5.00
5.00
0.00
0.00
0.00
0.00
150.00
25.00
0.00
0.00
15.00
0.00
0.00

0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00

0.00

2.00

0.00

20.00

Operculectomy