KODE BPJS LENGKAP POLI GIGI UPT.

PUSKESMAS
SELATBARU

Diagnosa Kode Diagnosa

1 Supernumerary/paramolar/mesiodens K.00.1
2 Persistensi gigi/perforasi radix K.00.6
3 Embedded/gigi terbenam bukan karena gigi lain K.01.0
4 Impacted/gigi terbenam karena terhalang gigi lain K.01.1
5 Karies email K.02.0
6 Karies dentin K.02.1
7 Karies Sementum K.02.2
8 Atrisi Gigi K.03.0
9 Abrasi Gigi K.03.1
1 Granuloma gigi/resorbsi patologis K.03.3
0
1 Hipersementosis K.03.4
1
1 Kalkulus subgingiva/supragingiva K.03.6
2
1 Pulpitis Rersibel/Irreversibel K.04.0
3
1 Gangren Pulpa/Gangren Radix/Gigi nonvital K.04.1
4
1 Apikal Periodontitis Akut K.04.4
5
1 Apikal Periodontitis Kronis K.04.5
6
1 Abses periapikal dengan sinus K.04.6
7
1 Abses periapikal tanpa melibatkan sinus K.04.7
8
1 Kista radikular K.04.8
9
2 Gingivitis Akut K.05.0
0
2 Gingivitis Kronis K.05.1
1
2 Periodontitis Akut/Perikoronitids Akut K.05.2
2
2 Periodontitis Akut/Perikoronitids Akut K.05.3
3
2 Periodontitis karena kalkulus K.05.6
4
2 Resesi Gingival K.06.0
5
2 Pembengkakan Gingival K.06.1
6
2 Epulis/kelainan pada gingival K.06.8
7
2 Creowding/diastema/malposisi gigi K.07.3
8
2 Kelainan sendi temporomandibula K.07.6
9
3 Akar yang tertinggal/retained dental root K.08.3
0
3 Dry Socket K.10.3
1

Prosedur di Pcare BPJS

No. Kode Prosedur prosedur
1. 23.01 Extraction of deciduous tooth
2. 23.09 Extraction of other tooth
3. 23.11 Removal of residual tooth
4. 23.19 Other surgical extraction of tooth
5. 23.2 Restoration of tooth by filling
6. 23.3 Restoration of tooth by filling inlay
7. 23.41 Application of crown
8. 23.49 Other dental restoration
9. 23.70 Root canal, not otherwise specified
10. 24.0 Incision of gum or alveolarbone
11. 24.7 Application of orthodontics appliance
12. 24.99 Other dental operations
13. 87.11 Full mouth x-ray of teeth
14. 87.12 Other dental x-ray
15. 89.31 Dental examination
16. 96.54 Dental scalling,polishing, and
debridement
17. 99.97 Fitting of denture