Page 17 - TARIF BPJS (Update Nov 2017)

8 G I C Filling / element 62,100 110,400 172,500
9 Komposit resin besar 74,520 132,480 207,000
10 Komposit resin komplek + pin 64,800 115,200 180,000
11 Komposit resin sedang 62,100 110,400 172,500
12 Labial Veneering - - -
13 Polishing / element 37,260 66,240 103,500
14 Single light cure filling 57,600 102,400 160,000
V SEMI PROSTHODONSI
1 Complex inlay / uplay / onlay - - -
2 Resementasi / element 41,400 73,600 115,000
3 Simple inlay / element - - -
VI PENCABUTAN
1 Cabut gigi anterior dengan injeksi 72,000 128,000 200,000
2 Cabut gigi posterior dengan injeksi 72,000 128,000 200,000
3 Cabut gigi tanpa injeksi / gigi (topical anesthesi) 54,000 96,000 150,000
4 Kontrol / buka jahitan 43,200 76,800 120,000
5 Perawatan dry socket 43,200 76,800 120,000
VII PERAWATAN PERIODONTAL
1 Detatrol / Oco treatment / Rahang 41,400 73,600 115,000
2 Kontrol dengan resep dokter 28,980 51,520 80,500
3 Occlusal ajusment 41,400 73,600 115,000
4 Pengobatan absces 43,200 76,800 120,000
5 Pengobatan priodontal 36,000 64,000 100,000
6 Perawatan pocket gingiva / elemen 48,600 86,400 135,000
7 Root planing / element 41,400 73,600 115,000
8 Scalling / rahang 51,840 92,160 144,000
9 Scalling kelas III / Rahang 62,100 110,400 172,500
VIII TINDAKAN SPESIFIK
1 Intra pulpa bleaching / element 45,540 80,960 126,500
2 Superficial bleaching / element 45,540 80,960 126,500
3 Topical fluoridasi / rahang 57,960 103,040 161,000
4 Bleaching - - -
IX DIAGNOSTIK
1 Check up / tanpa perawatan 27,000 48,000 75,000
2 Chepalometric Radiography 54,000 96,000 150,000
3 Dental Photo 30,600 54,400 85,000
4 Panoramic Photo 54,000 96,000 150,000

Catatan :
Biaya belum termasuk Obat-obatan dan Medical Supply

LABORATORIUM TEKNIK GIGI
I Porcelain :
1 Jacket Crown Porcelain / Unit 216,000
2 Marylan Porcelain 264,000
3 Inlay Porcelain 144,000
II Frame (Steel Denture) :
1 Steel denture bilateral, per rahang 420,000
2 Steel denture sadle, per rahang 360,000
3 Pemasangan gigi pertama 96,000
4 Pemasangan gigi selanjutnya 36,000
III Acrylic :
1 Full dentuire / rahang 420,000
2 Plat acrylic + 1 gigi pertama 96,000
3 Pemasangan gigi selanjutny 36,000
4 Klammer C 12,000
5 Klammer 2 jari 18,000