| Operation | Charges(Income not more than Rs. 3500) | (Income between Rs 3501 to Rs. 7000) | Charges(Income greater than Rs. 7000) |
|---|---|---|---|
| Dressing and temporary filling | 05 | 10 | 15 |
| Permanent filling other than composites (per tooth) (silver filling) | 15 | 25 | 50 |
| Permanent filling with composites | 20 | 40 | 60 |
| Endodontic therapy (single rooted) | 25 | 50 | 75 |
| Endodontic therapy (multirooted-per tooth) | 40 | 80 | 120 |
| Bleaching, per tooth | 10 | 25 | 50 |
| Fluoride application | 05 | 25 | 50 |
| Extraction, per tooth | 05 | 15 | 20 |
| Surgical extraction, per tooth | 10 | 50 | 100 |
| Minor operation under LA | 15 | 60 | 100 |
| Major operation under LA | 75 | 100 | 200 |
| Major operation under GA | 100 | 150 | 250 |
| Prophylaxis/ Scaling & polisihing (Pyorrhoea alveolaris) | 20 | 50 | 100 |
| Subgingival curettage | 25 | 80 | 200 |
| Surgical periodontal treatment (per segment) | 30 | 100 | 250 |
| Occlusal equililbration | 20 | 40 | 75 |
| Splinting, per segment | 25 | 50 | 75 |
| Intraoral X-ray film (each) | 10 | 15 | 20 |
| Extraoral X-ray film (each) | 25 | 50 | 75 |
| Study costs | 10 | 20 | 50 |
| Composite filling with light cure | 30 | 50 | 100 |
| Prosthesis other than maxillofacial prosthesis | 75 | 175 | 350 |