| No | Nama Layanan | Tarif | Jenis Pemeriksaan |
|---|---|---|---|
| 2581 | Alveolectomi | Rp3.125.000 | Prosedur Non Bedah |
| 2582 | Apek Reseksi (Gigi) | Rp3.125.000 | Prosedur Non Bedah |
| 2583 | Enucleatie Kista | Rp3.125.000 | Prosedur Non Bedah |
| 2584 | Excohliasi | Rp3.125.000 | Prosedur Non Bedah |
| 2585 | Extirpasi Tumor | Rp3.125.000 | Prosedur Non Bedah |
| 2586 | Fistulectomi | Rp3.125.000 | Prosedur Non Bedah |
| 2587 | Insisi Mucocele | Rp3.125.000 | Prosedur Non Bedah |
| 2588 | Marsupialisasi Ranula | Rp3.125.000 | Prosedur Non Bedah |
| 2589 | Odentectomy >2 Elemen dengan Narkose | Rp3.125.000 | Prosedur Non Bedah |
| 2590 | Pencabutan gigi dan dengan komplikasi | Rp3.125.000 | Prosedur Non Bedah |
