| Diagnostic |
|
|
|
|
|
| Type of Service |
Code |
Price LVL |
| Primary examination, personal data collection , teeth formula estimation, |
|
|
| hygiene index estimation, treatment planning |
D001 |
15,00 |
| Qualified specialist consultation with treatment planning |
D002 |
25,00 |
| Primary X - ray examination |
D003 |
3,50 |
| Additional X - ray examination |
D004 |
1,00 |
| Diagnostic models casting |
D005 |
11,00 |
| Diagnostic models analysis |
D006 |
8,00 |
| Panoramic radiography or tomography analysis |
D007 |
6,00 |
| Front, smile or profile photographs |
D008 |
10,00 |
|
|
|
| Oral Cavity Hygiene |
|
|
|
|
|
| Type of Service |
Code |
Price LVL |
| Full professional oral cavity hygiene |
H000 |
35,00 |
| Plaque cleaning from all teeth |
H001 |
3,00 |
| Calculus cleaning and tooth polishing per one tooth |
H002 |
2,00 |
| Application of caries and inflammation prevention drugs |
H003 |
3,00 |
| One tooth coverage: |
|
|
| a) with Varnish |
H004 |
2,00 |
| b) with Fluoride protector |
H005 |
4,00 |
| b) with Sealant |
H006 |
4,00 |
| Plaque cleaning with Air-Flow system application per tooth |
H007 |
1,50 |
| Professional teeth whitening |
H008 |
70,00 |
| Individual tray for teeth whitening (per one tray) |
H009 |
50,00 |
| Dental jewel bonding |
H010 |
15,00 |
| Laser treatment in oral cavity |
H011 |
10,00 |
|
|
|
|
|
|
| Therapeutic Dentistry |
|
|
|
|
|
|
|
|
| Type of Service |
Code |
Price LVL |
| Cariotic masses removal and filling the cavity with |
|
|
| quality temporary material |
T001 |
8,00 |
| Liners: |
|
|
| 1) chemically cured |
T002 |
4,00 |
| 2) light cured |
T003 |
5,00 |
| 3) bonding system for Amalgam filling |
T004 |
6,00 |
| Silver Amalgam restorations |
|
|
| 1) one surface |
T005 |
15,00 |
| 2) two surfaces |
T006 |
20,00 |
| 3) three surfaces |
T007 |
25,00 |
| Chemically cured composite restorations |
|
|
| 1) one surface |
T008 |
10,00 |
| 2) two surfaces |
T009 |
12,00 |
| 3) three surfaces |
T010 |
15,00 |
| Light cured composite restorations |
|
|
| 1) one surface |
T011 |
25,00 |
| 2) two surfaces |
T012 |
30,00 |
| 3) three surfaces |
T013 |
40,00 |
| 4) composite veneer |
T014 |
50,00 |
| 5) tooth angle restoration |
T015 |
60,00 |
| Old filling removal |
T016 |
6,00 |
| Whole tooth remodeling with light cured composite |
|
|
| 1) 1-st degree of complexity |
T017 |
60,00 |
| 2) 2-nd degree of complexity |
T018 |
80,00 |
| 3) 3-rd degree of complexity |
T019 |
110,00 |
| Whole tooth remodeling with siver amalgam |
T020 |
50,00 |
| Pulp devitalisation, temporary filling |
T021 |
10,00 |
| Pulp amputation, toxavit application, temporary filling |
T022 |
10,00 |
| Pulp extirpation for one canal |
T023 |
8,00 |
| Root canal system preparation (per one canal) |
T024 |
5,00 |
| Mechanical and chemical canal preparation |
T025 |
5,00 |
| Root canal system filling per canal |
|
|
| 1) with AH-plus paste |
T026 |
8,00 |
| 2) with gutta-percha |
T027 |
12,00 |
| 3) temporary canal filling with Ca(OH)2 |
T028 |
5,00 |
| Intracanal post (screw) |
T029 |
15,00 |
| Root canal filling removal |
|
|
| (paste or gutta-percha) |
T030 |
10,00 |
| Root canal filling removal (cement) |
T031 |
20,00 |
| Laser treatment or rehabilitation (per one appointment) |
T032 |
15,00 |
|
|
|
|
|
|
|
|
|
| Dental Surgery |
|
|
|
|
|
|
|
|
|
|
|
| Type of Service |
Code |
Prise LVL |
| Topical anesthesia |
Ķ001 |
2,00 |
| Infiltration anesthesia |
Ķ002 |
3,50 |
| Block anesthesia |
Ķ003 |
5,00 |
| Movable tooth extraction |
Ķ004 |
6,00 |
| Single rooted tooth extraction |
|
|
| 1) 1-st degree of complexity |
Ķ005 |
10,00 |
| 2) 2-nd degree of complexity |
Ķ006 |
15,00 |
| Multi rooted tooth extraction |
|
|
| 1) 1-st degree of complexity |
Ķ007 |
20,00 |
| 2) 2-nd degree of complexity |
Ķ008 |
30,00 |
| 3) 1-st degree of complexity |
Ķ009 |
40,00 |
| 4) 4-nd degree of complexity |
Ķ010 |
80,00 |
| Tooth extraction with osteothomy: |
|
|
| single rooted |
Ķ011 |
55,00 |
| multi rooted |
Ķ012 |
90,00 |
| Alveolitis treatment (per one appointment) |
Ķ013 |
10,00 |
| Surgical treatment of inflammation of the oral cavity and jaws |
Ķ014 |
10,00 |
| Injuries management |
Ķ015 |
10,00 |
| Bone irregularities surgical planning, sutures, tamponade or etc. |
|
|
| of one jaw side or frontal jaw region |
Ķ016 |
60,00 |
| Retained or impacted tooth opening for orthodontic regulation |
Ķ017 |
70,00 |
| Hemisection of multi rooted tooth |
Ķ018 |
50,00 |
| Sinus communication surgical closure |
Ķ019 |
55,00 |
| Apicoectomy |
Ķ020 |
70,00 |
| Apicoectomy of every next neighboring tooth |
Ķ021 |
35,00 |
| Retrograde root canal filling |
Ķ022 |
15,00 |
| Cystectomy |
Ķ023 |
45,00 |
| Surgical opening of localized mucosal abscess |
Ķ024 |
25,00 |
| Surgical curettage of inflamed alveoli (postextractional) |
Ķ025 |
20,00 |
| Small size mucous membrane irregularities incision |
Ķ026 |
25,00 |
| Big size mucous membrane irregularities incision |
Ķ027 |
35,00 |
| Alveolar bone irregularities resection |
Ķ028 |
65,00 |
| Mucous membrane cyst management |
Ķ029 |
50,00 |
| Surgical opening of localized subperiosteal or submucosal abscess |
Ķ030 |
35,00 |
| Extirpation of periapical cyst without apicoectomy (until 2 cm in size) |
Ķ031 |
30,00 |
| Extirpation of periapical cyst without apicoectomy (larger than 2 cm in size) |
Ķ032 |
40,00 |
| Lips frenulum surgical plastic |
Ķ033 |
60,00 |
| Tongue frenulum surgical plastic |
Ķ034 |
80,00 |
| Implantation (per one implant) |
|
|
| 1) 1-st degree of complexity |
Ķ035 |
350,00 |
| 2) 2-nd degree of complexity |
Ķ036 |
400,00 |
| Application of artificial bone (per one implant) |
Ķ037 |
100,00 |
| Closed sinus-lift (per one operation) |
|
|
| 1) 1-st degree of complexity |
Ķ038 |
350,00 |
| 2) 2-nd degree of complexity |
Ķ039 |
400,00 |
| Implant opening (per one implant): |
|
|
| 1) 1-st degree of complexity |
Ķ040 |
50,00 |
| 2) 2-nd degree of complexity |
Ķ041 |
70,00 |
| Root-replica operation (one tooth region) |
Ķ042 |
140,00 |
| Physiotherapeutical rehabilitation after surgical treatment (per one appointment) |
Ķ043 |
15,00 |
|
|
|
| Treatment of Periodontal Diseases |
|
|
|
|
|
| Type of Service |
Code |
Price LVL |
| Application of artificial bone in periodontal treatment (per one tooth) |
P001 |
140,00 |
| Sublingval abscess opening |
P002 |
10,00 |
| Periodontal pocket curettage (3 tooth region) |
P003 |
20,00 |
| Periodontal dressing application (4-5 tooth region) |
P004 |
10,00 |
| Temporary teeth splinting (with surgical thread or strand) |
P005 |
20,00 |
| Teeth splinting with: |
|
|
| a) composite material 3-4 teeth region |
P006 |
30,00 |
| b) light cured composite material 3-4 teeth region |
P007 |
40,00 |
| Gingivectomy 3 tooth region |
P008 |
40,00 |
| Gingivectomy 6-7 tooth region |
P009 |
60,00 |
| Periodontal pockets management by medicines application |
P010 |
6,00 |
| Physiotherapeutical treatment of periodontitis (per one appointment) |
P011 |
15,00 |
| Mucous membrane disorders management by medicines application |
P012 |
7,00 |
| Microbiological analysis of oral cavity |
P013 |
20,00 |
|
|
|
|
|
|
| Prosthodontics |
|
|
|
|
|
| Type of Service |
Code |
Price LVL |
| Metal - Ceramic crown (per one crown): |
|
|
| 1) 1-st degree of complexity |
O001 |
150,00 |
| 2) 2-nd degree of complexity |
O002 |
175,00 |
| 3) 3-rd degree of complexity |
O003 |
200,00 |
| All - Ceramic crown (per one crown): |
|
|
| 1) 1-st degree of complexity |
O004 |
300,00 |
| 2) 2-nd degree of complexity |
O005 |
350,00 |
| Metal - Composite crown (per one crown): |
|
|
| 1) 1-st degree of complexity |
O006 |
150,00 |
| 2) 2-nd degree of complexity |
O007 |
170,00 |
| Full - Metal crown (per one crown): |
|
|
| 1) 1-st degree of complexity |
O008 |
70,00 |
| 2) 2-nd degree of complexity |
O009 |
100,00 |
| Stamped crown (per one crown): |
O010 |
60,00 |
| Stamped crown with acrylic veneer (per one crown): |
O011 |
80,00 |
| DurAcetal crown (per one crown): |
O012 |
85,00 |
| Acrylic crown (per one crown): |
|
|
| 1) 1-st degree of complexity |
O013 |
35,00 |
| 2) 2-nd degree of complexity |
O014 |
45,00 |
| 3) 3-rd degree of complexity |
O015 |
55,00 |
| Composite crown (per one crown): |
|
|
| 1) 1-st degree of complexity |
O016 |
85,00 |
| 2) 2-nd degree of complexity |
O017 |
95,00 |
| Acrylic Removable Partial Denture (primary price) |
O018 |
160,00 |
| Acrylic Total Denture (primary price) |
O019 |
190,00 |
| Metal Removable Partial Denture (primary price) |
O020 |
350,00 |
| Removable Denture of thermoplastic base material (unilateral): |
|
|
| 1) 1-st degree of complexity |
O021 |
190,00 |
| 2) 2-nd degree of complexity |
O022 |
235,00 |
| Removable Denture of thermoplastic base material (bilateral): |
|
|
| 1) 1-st degree of complexity |
O023 |
290,00 |
| 2) 2-nd degree of complexity |
O024 |
320,00 |
| Post & Core |
|
|
| 1) 1-st degree of complexity |
O025 |
70,00 |
| 2) 2-nd degree of complexity |
O026 |
100,00 |
| Ceramic veneer, onlay, inlay |
O027 |
250,00 |
| Composite veneer, onlay, inlay |
O028 |
100,00 |
| Acrylic Removable Partial Denture relining, rebasing or repair: |
|
|
| 1) 1-st degree of complexity |
O029 |
22,00 |
| 2) 2-nd degree of complexity |
O030 |
26,00 |
| 3) 3-rd degree of complexity |
O031 |
29,00 |
| 4) 4-th degree of complexity |
O032 |
42,00 |
| Crown removal |
O033 |
15,00 |
| Crown cementation |
O034 |
7,00 |
| Abutment on implant (per one crown) |
|
|
| 1) 1-st degree of complexity |
O034 |
150,00 |
| 2) 2-nd degree of complexity |
O035 |
200,00 |
| 3) 3-rd degree of complexity |
O036 |
250,00 |
|
|
|
|
|
|
| Orthodontics |
|
|
|
|
|
| Type of Service |
Code |
Price LVL |
| Removable appliances |
|
|
| 1) 1-st degree of complexity |
OR001 |
170,00 |
| 2) 2-nd degree of complexity |
OR002 |
350,00 |
| Brackets |
|
|
| 1) 1-st degree of complexity |
OR003 |
300,00 |
| 2) 2-nd degree of complexity |
OR004 |
400,00 |
| 3) 3-rd degree of complexity |
OR005 |
500,00 |
| 4) 4-th degree of complexity |
OR006 |
600,00 |
| Quad helix |
OR007 |
50,00 |
| Orthodontic appliances controle and correction |
|
|
| 1) 1-st degree of complexity |
OR008 |
5,00 |
| 2) 2-nd degree of complexity |
OR009 |
10,00 |
| 3) 3-rd degree of complexity |
OR010 |
15,00 |
| 4) 4-th degree of complexity |
OR011 |
20,00 |
