KODE TARIF KETERANGAN KELAS

RJ.MLT.0001 PIT & FISSURE / GIGI POLI GIGI

RJ.MLT.0002 PULP CAPPING / GIGI POLI GIGI
RJ.MLT.0003 SEMI PERMANENT FILLING / GIGI POLI GIGI
RJ.MLT.0004 TAMBALAN SEMENTARA / GIGI POLI GIGI
RJ.MLT.0005 PENGISIAN SALURAN AKAR TUNGGAL POLI GIGI
RJ.MLT.0006 PERAWATAN ENDODONSI / VISIT POLI GIGI
RJ.MLT.0007 PULPOTOMY ANTERIOR / VISIT POLI GIGI
RJ.MLT.0008 PULPOTOMY POSTERIOR / VISIT POLI GIGI
RJ.MLT.0009 GLASIONOMER SIMPLE POLI GIGI
RJ.MLT.0010 GLASIONOMER COMPLEX POLI GIGI
RJ.MLT.00100 GIGI TIRUAN SEBAGIAN + 6 GIGI POLI GIGI
RJ.MLT.00101 GIGI TIRUAN SEBAGIAN + 7 GIGI POLI GIGI
RJ.MLT.00102 GIGI TIRUAN SEBAGIAN + 8 GIGI POLI GIGI
RJ.MLT.00103 GIGI TIRUAN SEBAGIAN + 9 GIGI POLI GIGI
RJ.MLT.00104 GIGI TIRUAN SEBAGIAN + 10 GIGI POLI GIGI
RJ.MLT.00105 GIGI TIRUAN SEBAGIAN + 10 - 12 POLI GIGI
RJ.MLT.00106 MAHKOTA AKRILIK / GIGI POLI GIGI
RJ.MLT.00107 MAHKOTA ALL PORSELEN / GIGI POLI GIGI
RJ.MLT.00108 MAHKOTA KOMPOSIT IN DIRECT / G POLI GIGI
RJ.MLT.00109 MAHKOTA METAL PORSELEN / GIGI POLI GIGI
RJ.MLT.0011 KOMPOSIT SIMPLE POLI GIGI
RJ.MLT.00110 MAHKOTA SEMENTARA / GIGI POLI GIGI
RJ.MLT.00111 MAHKOTA ZICORNIA / GIGI POLI GIGI
RJ.MLT.00112 REBASING POLI GIGI
RJ.MLT.00113 RELINING POLI GIGI
RJ.MLT.00114 REPARASI RINGAN POLI GIGI
RJ.MLT.00115 REPARASI BERAT POLI GIGI
RJ.MLT.00116 SENDOK CETAK PERORANGAN POLI GIGI
RJ.MLT.00117 VEENER KOMPOSIT DIRECT POLI GIGI
RJ.MLT.00118 VEENER KOMPOSIT INDIRECT POLI GIGI
RJ.MLT.00119 REBONDING BRACKET POLI GIGI
RJ.MLT.0012 KOMPOSIT COMPLEX POLI GIGI
RJ.MLT.00120 DEBONDING BRACKET POLI GIGI
RJ.MLT.00121 EXO ANTERIOR: INJEKSI (GR / GO POLI GIGI
RJ.MLT.00122 EXO ANTERIOR: INJEKSI (GP/ UT POLI GIGI
RJ.MLT.00123 EXO POSTERIOR: INJEKSI (GR / G POLI GIGI
RJ.MLT.00124 GIGI TIRUAN SEBAGIAN + 2 GIGI POLI GIGI
RJ.MLT.0013 POLISHING / GIGI POLI GIGI
RJ.MLT.0014 RESEMENTASI / GIGI POLI GIGI
RJ.MLT.0015 CABUT GIGI ANTERIOR DGN INJEKSI (GANGRPOLI GIGI
RJ.MLT.0016 CABUT GIGI ANTERIOR DGN INJEKSI (GANGREPOLI GIGI
RJ.MLT.0017 CABUT GIGI POSTERIOR DGN INJEKSI (GANGPOLI GIGI
RJ.MLT.0018 CABUT GIGI POSTERIOR DGN INJEKSI (GANGRPOLI GIGI
RJ.MLT.0019 KONTROL / BUKA JAHITAN POLI GIGI
RJ.MLT.0020 PERAWATAN DRY SOCKET POLI GIGI
RJ.MLT.0021 PENGOBATAN ABSCES / GIGI POLI GIGI
RJ.MLT.0022 PERAWATAN POCKET GINGIVA / GIG POLI GIGI
RJ.MLT.0023 ROOT PLANING / GIGI POLI GIGI
RJ.MLT.0024 SCALLING / RAHANG GRADE 1 POLI GIGI
RJ.MLT.0025 SCALLING / RAHANG GRADE II POLI GIGI
RJ.MLT.0026 SCALLING RAHANG GRADE III POLI GIGI
RJ.MLT.0027 BLEACHING IN OFFICE POLI GIGI
RJ.MLT.0028 TOPICAL FLUORIDASI / RAHANG POLI GIGI
RJ.MLT.0029 CORE BUILT UP / ELEMENT POLI GIGI
RJ.MLT.0030 KONSULTASI DOKTER SPESIALIS POLI GIGI
RJ.MLT.0031 KONSULTASI DOKTER UMUM POLI GIGI
RJ.MLT.0032 DIGITAL CEPHALOPANORMIC POLI GIGI
RJ.MLT.0033 DENTAL OPG POLI GIGI
RJ.MLT.0034 DENTAL PHOTO PERIAPIKAL POLI GIGI
RJ.MLT.0035 PENGISISAN SALURAN AKAR GANDA POLI GIGI
RJ.MLT.0036 PERAWATAN ENDODONSI / VISIT POLI GIGI
RJ.MLT.0037 PULPOTOMY ANTERIOR /VISIT POLI GIGI
RJ.MLT.0038 PULPOTOMY POSTERIOR / VISIT POLI GIGI
RJ.MLT.0039 CABUT GIGI TANPA INJEKSI / GIGI TOPICAL A POLI GIGI
RJ.MLT.0040 CUSTOM DOWEL POLI GIGI
RJ.MLT.0041 CORE BUILT UP POLI GIGI
RJ.MLT.0042 INDIRECT VENEER / ELEMEN POLI GIGI
RJ.MLT.0043 DIRECT VENEER / ELEMEN POLI GIGI
RJ.MLT.0044 CABUT GIGI ANTERIOR DGN KOMPLI POLI GIGI
RJ.MLT.0045 CABUT GIGI POSTERIOR DGN KOMPL POLI GIGI
RJ.MLT.0046 MAHKOTA PORCELAIN POLI GIGI
RJ.MLT.0047 MAHKOTA INDIRECT COMPOSITE POLI GIGI
RJ.MLT.0048 INDIRECT ONLAY / ELEMEN POLI GIGI
RJ.MLT.0049 DIRECT ONLAY, INLAY /ELEMEN POLI GIGI
RJ.MLT.0050 DIRECT BRIDGE PENGUAT FIBER / POLI GIGI
RJ.MLT.0051 BLEACHING INTRA KORONAL / ELEM POLI GIGI
RJ.MLT.0052 RESEKSI APEX, APIKOEKTOMY ELEM POLI GIGI
RJ.MLT.0053 CROWN LENGHTENING / ELEMEN POLI GIGI
RJ.MLT.0054 BICUSPIDISASI (TIDAK TERMASUK POLI GIGI
RJ.MLT.0055 GLASIONOMER SIMPLE POLI GIGI
RJ.MLT.0056 GLASIONOMER COMPLEX POLI GIGI
RJ.MLT.0057 KOMPOSIT SIMPLE (RESTORASI) POLI GIGI
RJ.MLT.0059 KOMPOSIT COMPLEX (RESTORASI) POLI GIGI
RJ.MLT.0060 EKSISI KOMPLEKS POLI GIGI
RJ.MLT.0061 EKSISI SEDERHANA POLI GIGI
RJ.MLT.0062 ENUKLEASI KISTA KOMPLEKS POLI GIGI
RJ.MLT.0063 ENUKLEASI KISTA SEDERHANA POLI GIGI
RJ.MLT.0064 FIKSASI GIGI /ELEMENT POLI GIGI
RJ.MLT.0065 FISTULEKTOMI POLI GIGI
RJ.MLT.0066 FRENEKTOMI POLI GIGI
RJ.MLT.0067 GINGIVEKTOMI / SEGMENT POLI GIGI
RJ.MLT.0068 IMPLANT DENTAL INTRA OSSEOUS POLI GIGI
RJ.MLT.0069 IMPLANT MINISCREW ORTODONSI / POLI GIGI
RJ.MLT.0070 INSISI KOMPLEKS POLI GIGI
RJ.MLT.0071 INSISI SEDERHANA POLI GIGI
RJ.MLT.0073 ODONTECTOMI KOMPLEKS POLI GIGI
RJ.MLT.0074 ODONTECTOMI SEDERHANA POLI GIGI
RJ.MLT.0075 OPERKULEKTOMI POLI GIGI
RJ.MLT.0076 PENUTUPAN OROANTRAL FISTULA POLI GIGI
RJ.MLT.0077 RESEKSI APEX POLI GIGI
RJ.MLT.0078 INTERMAXILLARY WIRING (FIKSASI POLI GIGI
RJ.MLT.0079 ALVEOLEKTOMI POLI GIGI
RJ.MLT.0080 CETAK / RAHANG POLI GIGI
RJ.MLT.0081 KONTROL ALAT ORTHODONSI CEKAT POLI GIGI
RJ.MLT.0082 KONTROL ALAT ORTHODONSI LEPASA POLI GIGI
RJ.MLT.0083 PASANG MOLAR BAND / GIGI POLI GIGI
RJ.MLT.0084 PASANG MOLAR TUBE GIGI POLI GIGI
RJ.MLT.0085 PERAWATAN ORTHODONSI CEKAT / R POLI GIGI
RJ.MLT.0086 PERAWATAN ORTHODONSI LEPASAN / POLI GIGI
RJ.MLT.0087 POLISH GIGI / RAHANG POLI GIGI
RJ.MLT.0088 POSTERIOR / ANTERIOR BITE TRAC POLI GIGI
RJ.MLT.0089 SEPARASI / GIGI POLI GIGI
RJ.MLT.0090 KONTROL PROTHESA POLI GIGI
RJ.MLT.0091 SPACE MAINTENAIR / REGAINER POLI GIGI
RJ.MLT.0092 RETENSI LINGUAL-PALATAL ORTO / POLI GIGI
RJ.MLT.0093 RETENSI REMOVABLE ORTO / RAHAN POLI GIGI
RJ.MLT.0094 RETAINER ORTHODONSI POLI GIGI
RJ.MLT.0095 GIGI TIRUAN PENUH / RAHANG RES POLI GIGI
RJ.MLT.0096 GIGI TIRUAN SEBAGIAN + 1 GIGI POLI GIGI
RJ.MLT.0097 GIGI TIRUAN SEBAGIAN + 3 GIGI POLI GIGI
RJ.MLT.0098 GIGI TIRUAN SEBAGIAN + 4 GIGI POLI GIGI
RJ.MLT.0099 GIGI TIRUAN SEBAGIAN + 5 GIGI POLI GIGI
JUMLAH JASA DOKTER JASA SARANA JASA RUMAH SAKIBHAP
150,000 75,000 0 75,000 0
150,000 75,000 0 75,000 0
60,000 30,000 0 30,000 0
100,000 50,000 0 50,000 0
300,000 150,000 0 150,000 0
120,000 60,000 0 60,000 0
250,000 125,000 0 125,000 0
250,000 125,000 0 125,000 0
150,000 75,000 0 75,000 0
250,000 125,000 0 125,000 0
1,800,000 900,000 0 900,000 0
2,000,000 1,000,000 0 1,000,000 0
2,200,000 1,100,000 0 1,100,000 0
2,400,000 1,200,000 0 1,200,000 0
2,600,000 1,300,000 0 1,300,000 0
2,800,000 1,400,000 0 1,400,000 0
300,000 150,000 0 150,000 0
2,500,000 1,250,000 0 1,250,000 0
1,500,000 750,000 0 750,000 0
2,000,000 1,000,000 0 1,000,000 0
250,000 125,000 0 125,000 0
300,000 150,000 0 150,000 0
4,000,000 2,000,000 0 2,000,000 0
500,000 250,000 0 250,000 0
500,000 250,000 0 250,000 0
100,000 50,000 0 50,000 0
200,000 100,000 0 100,000 0
200,000 100,000 0 100,000 0
600,000 300,000 0 300,000 0
3,500,000 1,750,000 0 1,750,000 0
100,000 50,000 0 50,000 0
500,000 250,000 0 250,000 0
300,000 150,000 0 150,000 0
150,000 75,000 0 75,000 0
200,000 100,000 0 100,000 0
250,000 125,000 0 125,000 0
1,300,000 650,000 0 650,000 0
50,000 25,000 0 25,000 0
150,000 75,000 0 75,000 0
150,000 75,000 0 75,000 0
200,000 100,000 0 100,000 0
200,000 100,000 0 100,000 0
250,000 125,000 0 125,000 0
100,000 50,000 0 50,000 0
100,000 50,000 0 50,000 0
150,000 75,000 0 75,000 0
 100,000 50,000 0 50,000 0
100,000 50,000 0 50,000 0
150,000 75,000 0 75,000 0
200,000 100,000 0 100,000 0
250,000 125,000 0 125,000 0
3,000,000 1,500,000 0 1,500,000 0
250,000 125,000 0 125,000 0
350,000 175,000 0 175,000 0
100,000 50,000 0 50,000 0
60,000 30,000 0 30,000 0
225,000 112,500 0 112,500 0
200,000 100,000 0 100,000 0
100,000 50,000 0 50,000 0
600,000 300,000 0 300,000 0
350,000 175,000 0 175,000 0
500,000 250,000 0 250,000 0
500,000 250,000 0 250,000 0
100,000 50,000 0 50,000 0
500,000 250,000 0 250,000 0
350,000 175,000 0 175,000 0
3,500,000 1,750,000 0 1,750,000 0
1,000,000 500,000 0 500,000 0
500,000 250,000 0 250,000 0
1,000,000 500,000 0 500,000 0
3,500,000 1,750,000 0 1,750,000 0
1,500,000 750,000 0 750,000 0
1,500,000 750,000 0 750,000 0
500,000 250,000 0 250,000 0
750,000 375,000 0 375,000 0
600,000 300,000 0 300,000 0
1,500,000 750,000 0 750,000 0
1,000,000 500,000 0 500,000 0
1,500,000 750,000 0 750,000 0
200,000 100,000 0 100,000 0
300,000 150,000 0 150,000 0
350,000 175,000 0 175,000 0
500,000 250,000 0 250,000 0
350,000 175,000 0 175,000 0
275,000 137,500 0 137,500 0
690,000 345,000 0 345,000 0
480,000 240,000 0 240,000 0
140,000 70,000 0 70,000 0
200,000 100,000 0 100,000 0
275,000 137,500 0 137,500 0
300,000 150,000 0 150,000 0
15,000,000 7,500,000 0 7,500,000 0
750,000 375,000 0 375,000 0
 350,000 175,000 0 175,000 0
200,000 100,000 0 100,000 0
2,500,000 1,250,000 0 1,250,000 0
1,500,000 750,000 0 750,000 0
750,000 375,000 0 375,000 0
2,500,000 1,250,000 0 1,250,000 0
1,500,000 750,000 0 750,000 0
800,000 400,000 0 400,000 0
750,000 375,000 0 375,000 0
75,000 37,500 0 37,500 0
100,000 50,000 0 50,000 0
60,000 30,000 0 30,000 0
100,000 50,000 0 50,000 0
100,000 50,000 0 50,000 0
3,250,000 1,625,000 0 1,625,000 0
1,500,000 750,000 0 750,000 0
150,000 75,000 0 75,000 0
250,000 125,000 0 125,000 0
80,000 40,000 0 40,000 0
100,000 50,000 0 50,000 0
500,000 250,000 0 250,000 0
300,000 150,000 0 150,000 0
300,000 150,000 0 150,000 0
1,500,000 750,000 0 750,000 0
3,000,000 1,500,000 0 1,500,000 0
1,000,000 500,000 0 500,000 0
1,200,000 600,000 0 600,000 0
1,400,000 700,000 0 700,000 0
1,600,000 800,000 0 800,000 0
JASA ANASTESI
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0
0
0
0
0
0
0
0
0
0
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0
0
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0
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