Scribd Logo
Upload

Welcome to Scribd!

  • Rumah Sakit "DENISA" JL. Dr. Wahidin Sudirohusodo 736 Gresik 61161

    Uploaded by

    Trirezika Dianingrum
    11 views5 pages
    The document contains a list of dental procedures and services provided by Rumah Sakit "DENISA" along with their codes and fees. Services range from checkups and cleanings to root canals, crowns, bridges and orthodontics. Fees vary depending on the specific procedure and materials used, with more complex treatments like dental implants or full orthodontic treatment costing upwards of millions of rupiah. The document provides a comprehensive listing of treatment options and associated costs for patients of the dental hospital.

    Original Description:

    wsdw

    Original Title

    Tarif Gigi 2017

    Copyright

    © © All Rights Reserved

    Available Formats

    DOC, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The document contains a list of dental procedures and services provided by Rumah Sakit "DENISA" along with their codes and fees. Services range from checkups and cleanings to root canals, crowns, bridges and orthodontics. Fees vary depending on the specific procedure and materials used, with more complex treatments like dental implants or full orthodontic treatment costing upwards of millions of rupiah. The document provides a comprehensive listing of treatment options and associated costs for patients of the dental hospital.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    11 views5 pages

    Rumah Sakit "DENISA" JL. Dr. Wahidin Sudirohusodo 736 Gresik 61161

    Uploaded by

    Trirezika Dianingrum
    The document contains a list of dental procedures and services provided by Rumah Sakit "DENISA" along with their codes and fees. Services range from checkups and cleanings to root canals, crowns, bridges and orthodontics. Fees vary depending on the specific procedure and materials used, with more complex treatments like dental implants or full orthodontic treatment costing upwards of millions of rupiah. The document provides a comprehensive listing of treatment options and associated costs for patients of the dental hospital.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 5

    Rumah Sakit “DENISA”

    JL. Dr. Wahidin Sudirohusodo 736


    Gresik 61161
    KODE KETERANGAN TARIF KODE KETERANGAN TARIF
    D9001 LOKET 15.000 D9044 PRWT DG MAHKOTA PFM 850.000
    D9001A PERIKSA GIGI 30.000 D9045 PRWT DG MAHKOTA 1.250.000
    D9002 KONSULTASI 75.000 PORSELEN
    D9003 MEDIKAMENTOSA 75.000 D9046 INLAY/ONLAY 800.000
    D9004 EMERGENSI 75.000 D9047 PASAK ULIR 200.000
    D9004A EMERGENSI OPEN BUR 75.000 D9051 BLEACHING 1.875.000
    D9004B EMERGENSI DEVITALISASI 75.000 D9052 GTL PER 1 RAHANG 2.500.000
    D9004C EMERGENSI STERILISASI 75.000 D9053 GTSL PLAT AKRILIK DAN 850.000
    D9004D EMERGENSI APLIKASI 75.000 GIGI I PRHG
    EUGENOL+CHKM D9054 GTSL TAMBAHAN AKRILIK 125.000
    D9004E EMERGENSI TUMPAT 75.000 D9055 GTSL PLAT VALPLAST DG 1.100.000
    SEMENTARA GIGI I PRHG
    D9004F EMERGENSI SELECTIVE 75.000 D9056 GTSL TAMBAHAN 125.000
    GRINDING VALPLAST
    D9004I E. LOKAL ANESTESI 60.000 D9057 GTSL METAL FRM & GIGI 1.300.000
    D9005 MAHKOTA SMTR AKRILIK 125.000 D9061 KONTROL GT+APL 125.000
    D9011 EXO DITUNDA 100.000 PARADONTAX
    D9012 EXO GIGI SULUNG 80.000 D9062 REPARASI GTL 300.000
    CHLORETHYL D9063 REBASING GT PER 500.000
    D9013 EXO GIGI SULUNG 135.000 RAHANG
    CITOJECT D9064 RELINING GIGI TIRUAN 300.000
    D9014 EXO GIGI PERMANEN 165.000 D9065 REPARASI GTSL 300.000
    D9015 EXO GIGI PERMANEN 220.000 D9071 GIGI JEMB FCAST CROWN 3 2.000.000
    JAHITAN UNIT
    D9016 EXO GIGI PERMANEN 275.000 D9072 GIGI JEMB PFM 3 UNIT 3.000.000
    KOMPLIKASI / FRAKTUR D9073 KONTROL GIGI JEMBATAN 125.000
    D9021 BUKA JAHITAN 75.000 D9074 PRWT ORTODONSI 1.000.000
    D9022 INSISI / EKSISI 125.000 LEPASAN PER RAHANG
    D9023 ALVEOLEKTOMI 375.000 D9075 KONTROL ORTODONSI 110.000
    D9024 ODONTEKTOMI 1.000.000 LEPASAN
    D9025 SCALING 1 RAHANG DG 165.000 D9076 PRWT ORTODONSI CEKAT 5.000.000
    ULTRASONIC FULL RAHANG
    D9026 SCALING 2 RAHANG DG 210.000 D9076A PRWT ORTODONSI CEKAT 3.000.000
    ULTRASONIC PER RAHANG
    D9027 KTRL SCALING+APLKSI 90.000 D9077 KONTROL ORTODONSI 165.000
    ANTIPLAK CEKAT
    D9031 UPPERCULECTOMY 500.000 D9078 RETAINER AKRILIK PER 500.000
    D9032 CURRETAGE PER REGIO 500.000 RAHANG
    D9081 APLKSI ALVOGYL PD DRY 125.000
    D9033 TUMPAT KOMPOSIT 210.000
    SOCKET
    D9034 TUMPAT GIC 165.000
    D9082 DIRECT VENEER 440.000
    D9035 APLKSI TRIMIX+BASIS+GIC 330.000
    D9083 APLIKASI GARGLIN 25.000
    D9036 PULP CAPPING 125.000
    D9084 APLIKASI KENALOG 50.000
    D9041 PRWT SALURAN AKAR PER 165.000
    D9085 APLKS FLUORIDE / 50.000
    KUNJUNGAN
    SENSODYNE
    D9042A EKSISI POLIP ( kecil ) 500.000
    D9086 SPLINTING/FIKSASI 250.000
    D9042B EKSISI POLIP (besar ) 750.000 FRAKTUR
    D9043 PRWT DG MAHKOTA 625.000
    AKRILIK
    Rumah Sakit “DENISA”
    JL. Dr. Wahidin Sudirohusodo 736
    Gresik 61161

    KODE KETERANGAN TARIF


    D9094
    KODE PLAT ACRYLIC JUMPING
    KETERANGAN 350.000
    TARIF
    D9088 CETAK ALGINATE 70.000 BITE PLANT
    D9089 CETAK DOUBLE 125.000 D9095 KONTROL ACRYLIC 165.000
    IMPRESSION Perkuadran JUMPING BITE PLANT
    D9090 PEMBUATAN MOLAR BAND 200.000 D9096 INCLINASI BITE PLANT 1.000.000
    di LUAR PAKET ORTHO
    D9091 PEMAKAIAN BAHAN 125.000
    TUMPATAN OVER X di D9096 A KONTROL INCLINASI BITE 110.000
    LUAR TUMPATAN PLANT
    COMPOCITE D9097 MUMIVIKASI 75.000
    D9092 PEMASANGAN BRACKET 125.000
    BARU PENGGANTI
    D9093 PEMBUATAN PENINGGIAN 180.000 D9098 INDIVIDUAL TRAY 300.000
    GIGIT

    You might also like