DENTISTRY PROCEDURE A ( RM 4401 - RM 4800 ) PROCEDURE B ( RM 3601 - RM 4400 ) 1 Fixed appliances Treatment package (both arches) package 3 2 Provision of fixed appliance Upper/Lower full package 3 3 Osteotomy maxillofacial Midface Le Fort 3 with bone graft 4 Reconstruction of bony maxillofacial defect with free flap PROCEDURE C ( RM 2801 - RM 3600 ) 5 Fixed appliances Treatment package (both arches) package 2 6 Provision of fixed appliance Upper/Lower full package 2 7 Osteotomy maxillofacial Midface Le Fort 3 PROCEDURE D ( RM 2201 - RM 2800 ) 8 Fixed appliances Treatment package (single arch) package 3 9 Fixed appliances Treatment package (both arches) package 1 10 Provision of fixed appliance Upper/Lower full, metal (per arch) package 3 11 Provision of fixed appliance Upper/Lower full package 1 12 Excision of parotid gland total 13 Maxillectomy extended with reconstruction 14 Temporomandibular joint (TMJ) Joint reconstruction autograft 15 Open reduction and internal fixation Maxillofacial panfacial/multiple bones PROCEDURE E ( RM 1801 - RM 2200 )
16 Fixed appliance Treatment package (single arch) package 2 17 Provision of fixed appliance Upper/Lower full, metal (per arch) package 2 18 Excision of parotid gland partial/superficial 19 Mandibulectomy segmental with reconstruction autograft 20 Maxillectomy total 21 Temporomandibular joint (TMJ) Joint reconstruction non autograft 22 Osteotomy maxillofacial Midface Le Fort 2 with bone graft 23 Reconstruction of bony maxillofacial defect with autograft PROCEDURE F ( RM 1501 - RM 1800 ) 24 Excision lesion soft tissue oral with reconstruction autograft 25 Mandibulectomy segmental with reconstruction allograft 26 Maxillectomy partial external 27 Alveolar bone graft 28 Temporomandibular joint (TMJ) Open surgery 29 Osteotomy maxillofacial Mandible ramus/body 30 Osteotomy maxillofacial Midface segmental 31 Osteotomy maxillofacial Midface Le Fort 1 with bone graft 32 Osteotomy maxillofacial Midface Le Fort 2 33 Augmentation maxillofacial (per jaw/region) chin /zygomatic bone bone graft 34 Surgical exposure of tooth (per tooth) without placement of attachment PROCEDURE G ( RM 1001 - RM 1500 ) 35 Provision of removable appliance per arch Treatment package 2 complex 36 Enucleation lesion maxillofacial with reconstruction autograft 37 Mandibulectomy segmental 38 Mandibulectomy marginal with reconstruction autograft 39 Maxillectomy partial intraoral 40 Distraction osteogenesis maxillofacial midfacial bone/ mandible 41 Osteotomy maxillofacial Mandible genioplasty 42 Osteotomy maxillofacial Mandible segmental 43 Osteotomy maxillofacial Midface Le Fort 1
44 Reconstruction of bony maxillofacial defect with allograft 45 Augmentation maxillofacial (per jaw/region) chin/zygomatic bone allograft PROCEDURE H ( RM 751 - RM 1000 ) 46 Provision of removable appliance per arch Treatment package 1 simple 47 Excision submandibular gland 48 Excision lesion soft tissue oral with reconstruction allograft 49 Mandibulectomy marginal with reconstruction allograft 50 Salivary duct repair/reposition 51 Temporomandibular joint (TMJ) Arthroscopic surgery 52 TMJ coronoidectomy 53 Open reduction and internal fixation maxillofacial midfacial/mandible 54 Distraction osteogenesis maxillofacial alveolar bone 55 Augmentation maxillofacial (per jaw/region) alveolar bone autograft bone graft 56 Antralplasty maxillary (sinus lift) with autograft bone graft 57 Apicectomy (per tooth) posterior tooth with retrograde filling 58 Surgical removal of impacted/unerupted tooth (per tooth) complicated 59 Closure oro-antral fistula PROCEDURE I ( RM 601 - RM 750 ) i) Oral surgery 60 Excision sublingual gland 61 Excision lesion maxillofacial with reconstruction allograft 62 Enucleation lesion maxillofacial More than 4 cm 63 Enucleation lesion maxillofacial With reconstruction allograft 64 Mandibulectomy marginal 65 Closure salivary gland fistula 66 Elevation maxillofacial zygomatic arch/complex 67 Augmentation maxillofacial (per jaw/region) alveolar bone more than 4cm allograft 68 Vestibuloplasty oral (per arch) 69 Apicectomy (per tooth) posterior tooth 70 Transplantation tooth PROCEDURE J ( RM 401 - RM 600 ) i) Periodontic
71 Flap surgery with osseous surgery 72 Flap surgery with autograft 73 Flap surgery with allograft 74 Guided tissue regeneration with autograft 75 Mucogingival surgery with autograft 76 Crown lengthening with ostectomy 77 Tooth hemisection 78 Excision lesion maxillofacial with reconstruction autograft bone graft 79 Suture/ revision soft tissue oro facial complicated 80 Reduction and fixation bony maxillofacial closed PROCEDURE K ( RM 301 - RM 400 ) i) Periodontic 81 Root planning of tooth 82 Incision and drainage (I&D) of periodontal abscess 83 Flap surgery 84 Wedge surgery 85 Guided tissue regeneration 86 Mucogingival surgery With allograft 87 Mucogingival surgery With tissue substitute 88 Mucogingival surgery With synthetic substitute 89 Furcationplasty Tunnelling 90 Furcationplasty Grooveplasty 91 Crown lengthening without ostectomy 92 Periapical surgery 93 Root resection 93 Excision lesion soft tissue oral more than 2cm 94 Removal salivary duct calculus open 95 Temporomandibular joint (TMJ) Arthrocentesis 96 Temporomandibular joint (TMJ) Non arthroscopy therapeutic lavage and lysis 97 Antralplasty maxillary (sinus lift) with allograft 98 Repositioning and/or stabilisation tooth surgical 99 Surgical removal Tooth/Root (per tooth) 100 Surgical removal Displaced tooth/root (per tooth) 101 Surgical removal Impacted/Unerupted tooth (per tooth) simple 102 Implant dental (per implant) first stage surgery
103 Implant maxillofacial (per implant) first stage surgery 104 Trigeminal nerve repositioning 105 Removal foreign body orofacial complicated PROCEDURE L ( RM 201 - RM 300 ) i) Periodontic 106 Gingivectomy with laser i 107 Fixed maxillary/mandibular expansion appliance replacement i 108 Enucleation lesion maxillofacial 4 cm or less 109 Augmentation maxillofacial (per jaw/region) alveolar bone 4 cm or less allograft 110 Apicectomy (per tooth) anterior tooth with retrograde filling 111 Surgical exposure of tooth (per tooth) with placement of attachment 112 Trigeminal nerve cryotherapy/sectioning 113 Biopsy lymph node open facial/neck 114 Removal dental/maxillofacial implants complicated 115 Removal internal fixation maxillofacial PROCEDURE M ( RM 121 - RM 200 ) 116 Root canal treatment multiple root ii) Periodontic 117 Subgingival scaling Fine with polishing upper arch 118 Subgingival scaling Fine with polishing lower arch 119 Splinting teeth ii 120 Provision of functional appliance fixed 121 Fixed expansion appliance per arch provision iv) Oral surgery 122 Ablation oral mucosal lesion
123 Excision lesion maxillofacial 124 Excision lesion soft tissue oral with laser 125 Marsupialisation lesion bony maxillofacial 126 Salivary duct Dilation 127 Salivary duct Ligation 128 Meatoplasty salivary duct orifice 129 Temporomandibular joint (TMJ) Reduction closed 130 Frenotomy/Frenectomy with laser 131 Frenoplasty 132 Reimplantation tooth 133 Repositioning and/or stabilisation tooth non surgical 134 Antral washout caldwell Luc (per side) 135 Biopsy bony maxillofacial PROCEDURE N ( RM 76 - RM 120 ) 136 Inlay/Onlay per tooth 137 Crown per unit (inclusive of temporary crown) 138 Bridge per abutment/pontic (inclusive of temporary bridge) 139 Provision of full denture (acrylic) upper jaw (maxilla) 140 Provision of full denture (acrylic) lower jaw (mandible) 141 Arrest of tooth resorption 142 Apexification per tooth ii) Periodontic 143 Gingivectomy 144 Gingivoplasty with laser 145 Supragingival scaling Fine with polishing upper arch 146 Supragingival scaling Fine with polishing lower arch 147 Subgingival scaling Gross with polishing upper arch 148 Subgingival scaling Gross with polishing lower arch 149 Pericision of periodontal ligament 150 Veneer gingival labial 151 Modification of tooth morphology 152 Recontouring of pre-existing restoration ii 153 Provision of active removable appliances per arch 154 Provision of functional appliance removable 155 Replacement of functional appliance removable 156 Removal of fixed appliance components (debond) per arch upper/lower 157 Provision of fixed retainers per arch (upper/lower)
158 Replacement of fixed retainers per arch (upper/lower) 159 Accesory palatal/lingual arch Provision 160 Accesory palatal/lingual arch Replacement 161 Placement of traction device (onplant) per device Upper arch 162 Placement of traction device (onplant) per device Lower arch iv) Oral surgery 163 Excision lesion soft tissue oral 2 cm or less 164 Marsupialisation lesion soft tissue oral 165 Suture/ revision soft tissue orofacial simple 166 Incision and drainage orofacial abscess 167 Sequestrectomy maxillofacial 168 Vestibuloplasty oral (per arch) 169 Alveolectomy/alveoloplasty maxillofacial (per jaw) maxilla/mandible more than 4 cm 170 Frenotomy/frenectomy 171 Apicectomy (per tooth) anterior tooth 172 Biopsy soft tissue oral 173 Removal foreign body orofacial simple 174 Examination/exploration oro-maxillofacial PROCEDURE O ( RM 51 - RM 75 ) 175 Provision of chrome cobalt denture upper plate/lower plate with a single tooth Placement of restoration permanent tooth multiple surface/with pin retention per 176 tooth 177 Root canal treatment single root 178 Pulpotomy per tooth 179 Retrieval of separated/broken instrument 180 Tooth bleaching (external) per arch ii) Periodontic 181 Fixed maxillary/mandibular expansion appliance per arch repair ii 182 Gingivoplasty 183 Supragingival scaling gross with polishing Upper arch 184 Supragingival scaling gross with polishing Lower arch 185 Guided tissue regeneration - second surgery 186 Occlusal adjustment
iv) Oral surgery 187 Debridement soft tissue orofacial 188 Wiring dental 189 Alveolectomy/Alveoloplasty maxillofacial (per jaw) maxilla/mandible 4 cm or less 190 Removal dental/maxillofacial implants simple 191 Control of haemorrhage post-surgery 192 Therapy soft laser orofacial 193 Therapy ultrasound oro-maxillofacial 194 Prosthesis Facial 195 Prosthesis Obturator PROCEDURE P ( RM 31 - RM 50 ) 196 Provision of mouth guard 197 Extraction of tooth permanent tooth 198 Provision of partial denture (acrylic) first tooth i 199 Impression taking for working model per arch (upper/lower) 200 Replacement of active removable appliance per arch 201 Provision of removable space maintainer per arch 202 Replacement of passive removable appliance (space maintainers) per arch 203 Provision of removable retainers per arch 204 Replacement of removable retainers per arch 205 Fixed expansion appliance per arch impression taking 206 Fixed maxillary/mandibular expansion appliance per arch adjustment 207 Fixed maxillary/mandibular expansion appliance Recemented 208 Fixed maxillary/mandibular expansion appliance Removal 209 Removal of fixed retainer per lower arch 210 Accessory Provision of headgear 211 Accessory Replacement of headgear 212 Accessory Removal 213 Lip bumper Provision 214 Lip bumper Replacement 215 Interdental stripping upper/lower arch i 216 Implant dental (per implant) second stage surgery 217 Implant maxillofacial (per implant) second stage surgery
218 Fine needle aspiration cytology orofacial 219 Control of haemorrhage lesion PROCEDURE Q ( RM 21 - RM 30 ) 220 Topical fluoride per arch 221 Extraction of tooth supernumerary/retained root 222 Placement of restoration Deciduous tooth per tooth 223 Placement of restoration Permanent tooth single surface per tooth 224 Stainless steel crown per unit 225 Repair perforated root 226 Tooth bleaching (internal) per tooth i 227 Orthodontic bands placement 228 Provision of fixed retainers per arch (upper/lower) repair 229 Accessory palatal/lingual arch adjustment 230 Placement of coil spring upper/lower arch 231 Placement of orthodontic auxiliaries 232 Provision of strapping appliances 233 Placement of traction chain impacted tooth 234 Repair of fixed retainers per arch (upper/lower) i 235 Operculectomy oral 236 Removal salivary duct calculus closed 237 Removal dental wires (per jaw) 238 Control of haemorrhage post-extraction 239 Injection of medication orofacial 240 Appliance Oral medicine 241 Appliance Oral surgery (per arch) 242 Splints PROCEDURE R ( RM 20 ) 243 Fissure sealant per tooth 244 Extraction of tooth deciduous tooth 245 Temporary dressing per tooth 246 Pulpectomy Deciduous tooth 247 Pulpectomy Permanent tooth
248 Provision of partial denture (acrylic) for additional tooth for each jaw 249 Provision of chrome cobalt denture for each additional tooth 250 Pulp capping (includes dressing) Direct 251 Pulp capping (includes dressing) Indirect 252 Denture repair denture plate 253 Denture repair replacement for each denture 254 Desensitisation per tooth 255 Treatment for dry socket 256 Arrest post extraction bleeding i 257 Impression taking for study model 258 Placement of orthodontic separator per arch 259 Adjustment of active removable appliance per arch (upper/lower) 260 Adjustment of passive removable appliance (space maintainers) per arch 261 Adjustment of removable retainers per arch 262 Repair of metal/acrylic component of removable appliance per arch 263 Adjustment of functional appliance removable 264 Repair of functional appliance removable 265 Orthodontic bands 266 Recemented 267 Removal (upper/lower) 268 Orthodontic brackets Placement partial bonding per tooth (metal/ceramics) 269 Orthodontic brackets Replacement per tooth (metal/ceramics) 270 Orthodontic wire Placement upper arch (multistrand) 271 Orthodontic wire Placement per arch upper/lower (Niti/ Cuniti/ SS/ TMA) 272 Orthodontic wire Adjustment 273 Orthodontic wire Replacement per arch upper/lower (Niti/Cuniti/ SS/TMA) 274 Accesory adjustment of headgear 275 Lip bumper adjustment Placement of fixed appliance accessories for minor tooth movement (traction chain) 276 one tooth i 277 Reduction and fixation bony maxillofacial temporary