TABEL 1.

1 REKAPITULASI DATA PASIEN

PRAKTIKUM PEMBIAYA
NO NAMA JENIS KELAMIN PEKERJAAN KEADAAN KLINIS

1 SITI P Perawat Karies dentin gigi 24 bagian proksimal distal

2 BAGUS L Karyawan Swasta Sisa akar gigi 1.6

3 FIAN P Pengusaha Gingivitis kronis seluruh regio

4 ANDIKA L Karyawan Swasta Karies superfisialis

5 DENDI L Pelajar Abses periapikal tanpa sinus gigi 36

6 NEVA P Karyawati Impaksi kelas 1 gigi 4.8

7 ASEP L Buruh Atrisi gigi etcausa kebiasaan menggerutu

8 AGUS L Guru Dry Socket

9 ENIH P Traveler Stomatitis Apthous Reccurent

M PEMBIAYAAN KESEHATAN
KODE ICD 10 TREATMEN/PLAN BARANG UNIT COST JUMLAH UC

K02.1 Restorasi Komposit Handscoon Rp 900.00

masker Rp 800.00
diamond bur Rp 16,000.00
komposit Rp 14,063.00
polishing bur Rp 11,800.00
bonding Rp 2,000.00
Rp 79,363.00
etching Rp 1,200.00
microaplicator Rp 600.00
matriks seksional Rp 20,000.00
wedges Rp 8,000.00
pasta polishing Rp 500.00
cotton roll Rp 3,500.00
K08.3 Ekstraksi handscoon Rp 900.00
masker Rp 800.00
tampon Rp 3,500.00 Rp 16,530.00
Pehacain Rp 11,200.00
spuit 3ml Rp 130.00
K05.1 Scaling-Rootplanning Handscoon Rp 900.00
masker Rp 800.00
brush Rp 12,000.00 Rp 26,000.00
polishing bur Rp 11,800.00
pasta polishing Rp 500.00
K02.0 observasi Handscoon Rp 900.00
Rp 1,700.00
Masker Rp 800.00
K04.7 Trepanasi handscoon Rp 900.00
masker Rp 800.00
tampon Rp 3,500.00
Pehacain Rp 11,200.00
spuit 3ml Rp 130.00
komposit Rp 14,063.00 Rp 97,343.00
bonding Rp 2,000.00
etching Rp 1,200.00
polishing bur Rp 11,800.00
articulating pad Rp 3,750.00
Accses bur Rp 48,000.00
K01.1 Odontektomi handscoon Rp 900.00
masker Rp 500.00
Nacl Rp 667.00
Spuit 3ml Rp 130.00
Rp 111,230.00
 Tampon Rp 3,500.00 Rp 111,230.00
Pehacain Rp 11,200.00
Benang hecting Rp 17,000.00
Blade Rp 4,000.00
Bur Tulang Rp 73,333.00
K03.0 Pembuatan Night Guard Handscoon Rp 900.00
masker Rp 800.00
alginat Rp 13,750.00 Rp 269,200.00
articulating pad Rp 3,750.00
night guard Rp 250,000.00
K10.3 Irigasi Handscoon Rp 900.00
Masker Rp 800.00
Alvogyl Rp 10,000.00
Rp 15,997.00
Nacl Rp 667.00
cotton roll Rp 3,500.00
spuit 3ml Rp 130.00
K12.0 Obat Triamnicolon acetonide Rp 58,000.00
handscoon Rp 900.00 Rp 59,400.00
masker Rp 500.00
PERKIRAAN TARIF

Rp 476,178.00

Rp 99,180.00

Rp 156,000.00

Rp 10,200.00

Rp 584,058.00

Rp 667,380.00
Rp 667,380.00

Rp 1,615,200.00

Rp 95,982.00

Rp 356,400.00
Tabel 1.2 Unit cost bahan habis pakai dan obat-obatan
Bahan dan Obat2an Isi Bahan yang digunakan/1 x pemakaian
Komposit 4000 125
Bonding 5 0.02
Miccroapplicator 50 1
Etching 3 0.02
Wedge 10 1
Diamond Bur 5 1
Polishing Bur 10 1
Matriks Miller Kelas 3 50 1
Acces Bur 5 1
Bur Batu Merah 15 1
Bur Batu Hijau 15 1
Tampon 50 5
Pehacaine 10 1
Spuit 3 ml 100 1
Triamcinolone Acetonide 1 1
Benang Hetching 500 10
Blade 20 1
Alvogyl 10 0.25
Night Guard Custome Lab 1
Bur Tulang 3 1
Articulating Pad 20 1
Alginat 1000 125
Nacl 180 6
Lilin merah 10 2
Gips moldano 1000 125
Brush 1 1
Handscoon 50 1
Masker 50 1
Retraction Cord 100 5
Pasta Polishing 35 0.5
Matriks Sectional Set 50 1
Cotton Roll 100 5
Povidon Iodine 1000 5
 Harga Harga 1 kali pakai
Rp 450,000 Rp 14,063
Rp 500,000 Rp 2,000
Rp 30,000 Rp 600
Rp 180,000 Rp 1,200
Rp 80,000 Rp 8,000
Rp 80,000 Rp 16,000
Rp 118,000 Rp 11,800
Rp 100,000 Rp 2,000
Rp 240,000 Rp 48,000
Rp 40,000 Rp 2,667
Rp 40,000 Rp 2,667
Rp 35,000 Rp 3,500
Rp 112,000 Rp 11,200
Rp 13,000 Rp 130
Rp 58,000 Rp 58,000
Rp 850,000 Rp 17,000
Rp 80,000 Rp 4,000
Rp 400,000 Rp 10,000
Rp 250,000 -
Rp 220,000 Rp 73,333
Rp 75,000 Rp 3,750
Rp 110,000 Rp 13,750
Rp 20,000 Rp 667
Rp 65,000 Rp 13,000
Rp 55,000 Rp 6,875
Rp 12,000 Rp 12,000
Rp 45,000 Rp 900
Rp 40,000 Rp 800
Rp 280,000 Rp 14,000
Rp 35,000 Rp 500
Rp 1,000,000 Rp 20,000
Rp 70,000 Rp 3,500
Rp 65,000 Rp 325