Dental and Oral Hospital Universitas Sumatera Utara

Rates Service

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Name of Services	Action	Dentist Fees	Dentist Specialist Fees	General Practitioner(IGD)
Consultation	Consultation Services	IDR 80,000	IDR 250,000 – IDR 500,000	IDR 70,000
Denture Service	GTP Acrylic/ Jaws	IDR 1,800,000	-	-
	GTP Acrylic RA and RB	IDR 3,600,000	-	-
	GTSL Acrylic (1 plate+1 teeth)	IDR 800,000	-	-
	Flexible GTSL (1 plate+1 tooth)	IDR 1,200,000	-	-
	GTC PFM	IDR 2,000,000	-	-
Scaling	Adult Scaling	IDR 350,000	-	-
Scaling	Children Scaling	IDR 150,000	-	-
Pediatric Dental Services	Abscess trepanation	IDR 100,000	-	-
	Topical/Injectable Extraction of Primary Teeth	IDR 200,000	-	-
	GIC patch	IDR 250,000	-	-
	Composite Resin Patches	IDR 300,000	-	-
	Compomer Patch	IDR 250,000	-	-
	Fissure sealants	IDR 200,000	-	-
	Fluorine Topical Application	IDR 150,000	-	-
	Premedication	IDR 150,000	-	-
Oral Surgery Services	Tooth Extraction without Complications	IDR 250,000	-	-
	Tooth Extraction with Complications	IDR 500,000	-	-
	Class I Odontectomy	IDR 1,500,000	-	-
	Abscess treatment	IDR 200,000	-	-
	Alveolectomy by regio	IDR 300,000	-	-
Cavities Service	Fissure Sealant	IDR 250,000	-	-
	Composite Resin Filling	IDR 250,000	-	-
	MOD Composite Resin Fillings	IDR 300,000	-	-
	PSA of Anterior Teeth 3 Visits	IDR 1,250,000	-	-
	Posterior Tooth PSA Maximum 5 Visits	IDR 1,750,000	-	-
Oral Disease Services	Stomatic	IDR 200,000	-	-
	Denture stomatitis	IDR 200,000	-	-
	Angular cheilitis	IDR 200,000	-	-
	Tongue disorders	IDR 200,000	-	-
Radiology	Periapical	IDR 175,000	-	-
	Panoramic	IDR 350,000	-	-
	Cephalometry	IDR 450,000	-	-
	CBCT	IDR 1,000,000	-	-
Public Services	Dry Sockets	IDR 150,000	-	-
	Seam Control	IDR 70,000	-	-
	Pulp cap	IDR 600,000	-	-
	Crown porcelain fused metal luting GIC	IDR 1,200,000	-	-
	Crown All Porcelain Fused Metal Luting GIC	IDR 2,400,000	-	-
	Adult Premedication	IDR 150,000	-	-
	Children's pulpotomy	IDR 500,000	-	-
	Operculotomy	IDR 350,000	-	-
	Antigen Swabs	IDR 25,000	-	-
Emergency Room / General Practitioner	General Practitioner Consultation	IDR 70,000	-	-
	Consultation + Action of General Practitioner (Vital Sign + Prescription)	IDR 120,000	-	-
	Health Check (Health Letter)	IDR 70,000	-	-
	Sickness Certificate	IDR 10,000	-	-
	Wound Toilet + Heavy Band Change	IDR 200,000	-	-
	Wound Toilet + Medium Band Change	IDR 120,000	-	-
	Wound Toilet + Light Band Change	IDR 70,000	-	-
	Wound Suturing per Stitch	IDR 15,000	-	-
	Blood Sugar Level Check	IDR 30,000	-	-
	Cholesterol Level Check	IDR 40,000	-	-
	Uric Acid Screening	IDR 30,000	-	-
	ECG Examination	IDR 150,000	-	-
	Corpus Alienum of the Eye	IDR 100,000	-	-
	Corpus Alienum of the Nose	IDR 100,000	-	-
	Corpus Alienum of the Ear	IDR 30,000	-	-
	HB (Haemoglobin) Level Check	IDR 30,000	-	-
	Complete Examination Package (Including blood sugar, cholesterol, uric acid, and HB level)	IDR 115,000	-	-
	Circumcision	IDR 600,000	-	-
	TMJ (Temporomandibular Joint) Dislocation	IDR 120,000	-	-