Non-Covered Medical Fee Schedule
| Resin | Cervical abrasion | 70,000 |
|---|
| Simple cavity | 100,000 |
| Fracture (incisal edge) | 150,000 |
| Diastema (per space) | 150,000 |
| High Strength Resin | Cervical abrasion | 150,000 |
|---|
| Occlusal wear | 150,000 |
| Inlay | Pediatric metal inlay | 100,000 |
|---|
| Gold inlay | 600,000 |
| Ceramic inlay | 400,000 |
| Crown | Gold crown | 800,000 |
|---|
| PFM | 450,000 |
| All ceramic (anterior) | 600,000 |
| Zirconia (posterior) | 500,000 |
| Esthetic Prosthetics | Laminate veneer (taxable) | 550,000 |
|---|
| Laminate veneer (tax-free) | 500,000 |
| Denture | R.P.D (partial denture) | 1,500,000 |
|---|
| Full denture | 1,500,000 |
| Post | Direct method | 100,000 |
|---|
| Indirect method | 200,000 |
| Core | Simple | 50,000 |
|---|
| Complex | 100,000 |
| Pediatric Crown | Prefabricated | 100,000 |
|---|
| Custom | 150,000 |
| Orthodontic Space Maintainer | | 200,000 |
|---|
| Bruxism Device & Splint | | 500,000 |
|---|
| Implant | Biotem implant | 1,000,000 |
|---|
| UV Top implant | 1,100,000 |
| Osstem implant | 1,200,000 |
| Custom prosthesis additional fee | +100,000 |
| Implant Prosthesis | PFM | 400,000 |
|---|
| Zirconia | 500,000 |
| Sinus Lift | Simple | from 700,000 |
|---|
| Complex | from 1,000,000 |
| Bone Graft | | From 200,000 |
|---|
| Teeth Whitening | Professional whitening | 220,000 |
|---|
| Retouch (per session) | 50,000 |
| Discolored tooth (per tooth) | 100,000 |
| TMJ (Botox) | Masseter | 150,000 |
|---|
| Masseter & temporalis | 300,000 |
| Extracorporeal Shockwave Therapy (per session) | | 30,000 |
|---|
| Orthodontic Diagnostic Fee | | 100,000 |
|---|
| Orthodontics | Osstem bracket orthodontics (including monthly fee) | 6,000,000 |
|---|
| Pediatric growth orthodontics | 2,500,000 |
| Orthodontic screw (per unit) | 100,000 |
| Clear aligner orthodontics (per arch) | basic 300,000 + 150,000 per visit |
| Invisalign (full mouth) | 5,000,000 ~ 7,000,000 |
| Scaling / Sealant (Non-covered) | Full mouth / Per tooth | |
|---|
| Hemostatic Agent Qutanplast | General | 10,000 (per tooth) |
|---|
| Impacted tooth surgery | 20,000 (per tooth) |
| Snoring Device | Sleep apnea | 700,000 |
|---|
Certificate Issuance Fees
| General medical certificate |
10,000 |
| Surgery certificate |
10,000 |
| Injury certificate (under 3 weeks) |
50,000 |
| Injury certificate (3 weeks or more) |
100,000 |