| Temporary restoration | ₹150 | ₹102 | DP026 |
| Intraoral Periapical | ₹200 | ₹136 | DI001 |
| Intraoral Occlusal/Bite Wing X-Ray | ₹300 | ₹204 | DI002 |
| Alveoloplasty - Per Tooth | ₹300 | ₹204 | DP017 |
| Tissue Conditioning, Maxillary/Mandibular | ₹300 | ₹204 | DP040 |
| Removable Partial Denture - Cast Metal | ₹300 | ₹204 | DP063 |
| Removable Partial Denture - Tooth Addition | ₹300 | ₹204 | DP065 |
| Curettage and Root Planning - Per Tooth | ₹350 | ₹238 | DP003 |
| Extraction - Normal Tooth | ₹400 | ₹272 | DP010 |
| Add Tooth to existing Partial Denture | ₹400 | ₹272 | DP067 |
| Flap Surgery- Per Tooth | ₹450 | ₹306 | DP007 |
| Digital OPG with X ray film/ CD | ₹500 | ₹340 | DI003 |
| Application of Desensitizing Medicament | ₹500 | ₹340 | DP024 |
| Composite - Occlusal Pit/Class I | ₹500 | ₹340 | DP028 |
| Medication -intracanal medicament | ₹500 | ₹340 | DP034 |
| Crown lengthening - Per Tooth | ₹500 | ₹340 | DP042 |
| Crown - Removal | ₹500 | ₹340 | DP047 |
| Odontoplasty /Enameloplasty | ₹500 | ₹340 | DP048 |
| Occlusion Analysis | ₹500 | ₹340 | DP055 |
| Add Clasp to existing Partial Denture | ₹500 | ₹340 | DP066 |
| Glass ionomer Cement Restoration | ₹600 | ₹408 | DP027 |
| Crown - Recementation | ₹600 | ₹408 | DP046 |
| Surgical - Apicectomy | ₹700 | ₹476 | DP039 |
| Extraction - Orthodontic Extraction | ₹750 | ₹510 | DP014 |
| Complicated Extraction per tooth under LA | ₹800 | ₹544 | DP011 |
| Scaling | ₹1,000 | ₹680 | DP002 |
| Gingivoplasty - Per Quadrant | ₹1,000 | ₹680 | DP005 |
| Fluoride Application for Children | ₹1,000 | ₹680 | DP025 |
| Composite -Class I with buccal extension | ₹1,000 | ₹680 | DP029 |
| Crown - PMMA Crown | ₹1,000 | ₹680 | DP043 |
| Pulpotomy | ₹1,000 | ₹680 | DP051 |
| Biopsy of Oral tissue- Soft | ₹1,200 | ₹816 | DI004 |
| Gingivectomy - Per Quadrant | ₹1,200 | ₹816 | DP006 |
| Alveoloplasty - Per Quadrant | ₹1,200 | ₹816 | DP018 |
| Excision of hyperplastic tissue - per arch | ₹1,200 | ₹816 | DP020 |
| Abscess - Drainage-Dental | ₹1,500 | ₹1,020 | DP001 |
| Core build-up | ₹1,500 | ₹1,020 | DP041 |
| Tooth Splinting -General | ₹1,500 | ₹1,020 | DP056 |
| Splinting - Periodontally weak teeth | ₹1,800 | ₹1,224 | DP057 |
| Biopsy of Oral tissue - Hard (bone, tooth) | ₹2,000 | ₹1,360 | DI005 |
| Curettage and Root Planning - Per Arch | ₹2,000 | ₹1,360 | DP004 |
| Flap Surgery- Per Quadrant | ₹2,000 | ₹1,360 | DP008 |
| Extraction Impacted - Soft tissue | ₹2,000 | ₹1,360 | DP012 |
| Operculectomy- Pericoronal flap excision | ₹2,000 | ₹1,360 | DP015 |
| Bone replacement graft for ridge preservation… | ₹2,000 | ₹1,360 | DP022 |
| Minor oral surgery, cyst, granuloma, residual… | ₹2,000 | ₹1,360 | DP023 |
| RCT-Single Rooted tooth | ₹2,000 | ₹1,360 | DP030 |
| Apicectomy-Single tooth | ₹2,000 | ₹1,360 | DP035 |
| Apexification with any bio-compatible material | ₹2,000 | ₹1,360 | DP037 |
| Crown - All Metal-Nickel Free | ₹2,000 | ₹1,360 | DP044 |
| Pulpectomy (Anterior Tooth) | ₹2,000 | ₹1,360 | DP049 |
| Night Guard | ₹2,000 | ₹1,360 | DP058 |
| Bridge/ Fixed Partial denture (per missing (DP059) | ₹2,000 | ₹1,360 | DP059 |
| Removable Partial Denture - Acrylic Up to 3… | ₹2,000 | ₹1,360 | DP064 |
| Sialolithotomy | ₹2,000 | ₹1,360 | DP081 |
| Partial Ostectomy | ₹2,000 | ₹1,360 | DP085 |
| Frenectomy | ₹2,500 | ₹1,700 | DP019 |
| Re-RCT - Anterior | ₹2,500 | ₹1,700 | DP032 |
| Removable orthodontic appliance | ₹2,500 | ₹1,700 | DP070 |
| Minor Treatment to Control Habits-Removable… | ₹2,500 | ₹1,700 | DP073 |
| Flap Surgery and Bone Graft per quadrant | ₹3,000 | ₹2,040 | DP009 |
| RCT Multiple root and/ canal tooth | ₹3,000 | ₹2,040 | DP031 |
| Re-RCT - Posterior | ₹3,000 | ₹2,040 | DP033 |
| Apicectomy-Multiple tooth | ₹3,000 | ₹2,040 | DP036 |
| Root end resection and Retro grade filling | ₹3,000 | ₹2,040 | DP038 |
| Crown - Metal with Ceramic Facing | ₹3,000 | ₹2,040 | DP045 |
| Pulpectomy (Posterior Tooth) | ₹3,000 | ₹2,040 | DP050 |
| Veneer - Ceramic paediatric | ₹3,000 | ₹2,040 | DP052 |
| Bridge/ Fixed Partial denture (per missing (DP060) | ₹3,000 | ₹2,040 | DP060 |
| Removal of - Lateral Exostosis | ₹3,000 | ₹2,040 | DP080 |
| Osseous, Oste periosteal, or Cartilage graft… | ₹3,000 | ₹2,040 | DP090 |
| Surgical Augmentation | ₹3,500 | ₹2,380 | DP021 |
| Removable Partial Denture - Cast Metal Up… | ₹4,000 | ₹2,720 | DP062 |
| Space Maintainers - Fixed | ₹4,000 | ₹2,720 | DP072 |
| Minor Treatment to Control Habits-Fixed… | ₹4,000 | ₹2,720 | DP074 |
| Alveolus - Closed Reduction stabilization… | ₹4,000 | ₹2,720 | DP086 |
| Extraction Impacted - Bony | ₹5,000 | ₹3,400 | DP016 |
| Limited Orthodontic Treatment of the Primary… | ₹5,000 | ₹3,400 | DP054 |
| Feeding appliance for Cleft Palate | ₹5,000 | ₹3,400 | DP076 |
| Obturator Prosthesis - Surgical | ₹5,000 | ₹3,400 | DP079 |
| Facial Space Abscess | ₹5,000 | ₹3,400 | DP084 |
| Arch bar fixation | ₹5,000 | ₹3,400 | DP088 |
| Oroantral Fistula closure | ₹5,000 | ₹3,400 | DP089 |
| Cyst of Maxilla/mandible (DP096) | ₹5,000 | ₹3,400 | DP096 |
| Multiple Extraction and Treatment Procedures… | ₹6,000 | ₹4,080 | DP013 |
| Functional orthodontic appliance | ₹6,000 | ₹4,080 | DP075 |
| Alveolus - Open Reduction stabilization… | ₹6,000 | ₹4,080 | DP087 |
| Maxilla - Closed Reduction | ₹6,000 | ₹4,080 | DP092 |
| Mandible - Closed Reduction | ₹6,000 | ₹4,080 | DP094 |
| Cyst of Maxilla/mandible (DP097) | ₹6,000 | ₹4,080 | DP097 |
| Malar and/or Zygomatic arch - Closed Reduction | ₹6,000 | ₹4,080 | DP108 |
| Expansion plate | ₹6,500 | ₹4,420 | DP077 |
| Interceptive Orthodontic Treatment… | ₹7,000 | ₹4,760 | DP053 |
| Maxillofacial Prosthesis -Sal | ₹7,000 | ₹4,760 | DP078 |
| Removable Partial Denture - Flexible Per Arch | ₹7,500 | ₹5,100 | DP061 |
| Tooth Supported Overdenture Per Arch | ₹7,500 | ₹5,100 | DP068 |
| Complete Denture - Per Arch | ₹10,000 | ₹6,800 | DP069 |
| Maxilla - Open Reduction | ₹10,000 | ₹6,800 | DP093 |
| Mandible - Open Reduction | ₹10,000 | ₹6,800 | DP095 |
| Malar and/or Zygomatic arch - Open Reduction | ₹10,000 | ₹6,800 | DP109 |
| Fixed orthodontic per arch | ₹15,000 | ₹10,200 | DP071 |
| Excision of Salivary gland | ₹15,000 | ₹10,200 | DP082 |
| Release of fibrous bands & grafting in | ₹20,000 | ₹13,600 | DP083 |
| Temporomandibular | ₹20,000 | ₹13,600 | DP099 |
| Segmental | ₹20,000 | ₹13,600 | DP101 |
| Maxillectomy- partial without graft | ₹20,000 | ₹13,600 | DP107 |
| Cyst of Maxilla/mandible (DP098) | ₹25,000 | ₹17,000 | DP098 |
| Segmental / Hemi Mandibulectomy with graft | ₹25,000 | ₹17,000 | DP100 |
| Maxillectomy- partial with graft | ₹25,000 | ₹17,000 | DP106 |
| Osteoplasty - for Orthognathic deformities | ₹30,000 | ₹20,400 | DP091 |
| Sub-Total mandibulectomy without graft | ₹30,000 | ₹20,400 | DP103 |
| Maxillectomy/Mandibulectomy- Total without graft | ₹30,000 | ₹20,400 | DP105 |
| Distraction osteogenesis of mandible… | ₹30,000 | ₹20,400 | DP110 |
| Sub-Total mandibulectomy with graft | ₹35,000 | ₹23,800 | DP102 |
| Maxillectomy/Mandibulectomy- Total with graft | ₹35,000 | ₹23,800 | DP104 |
| Facial bones - Complicated Reduction… | ₹45,000 | ₹30,600 | DP111 |