Cavitas dental Insurance procedures to be indemnified

CodeTreatment descriptionBRONZE SILVER GOLD
Annual Sum Insured 7.500 DKKAnnual Sum Insured 20.000 DKKAnnual Sum Insured 30.000 DKK
DIAGNOSTIC & X-RAY500 DKK750 DKK1.000 DKK
1415Periodontal examination and diagnostics479,61 DKK479,61 DKK479,61 DKK
1150Bitewing x-ray212,36 DKK212,36 DKK212,36 DKK
1300X-ray recording151,85 DKK151,85 DKK151,85 DKK
9944Panoramic X-Ray600,00 DKK600,00 DKK600,00 DKK
ROUTINE TREATMENT1.500 DKK3.250 DKK5.000 DKK
9945Local anaesthetic, nitrous oxide anaesthesia150,00 DKK150,00 DKK150,00 DKK
1501Filling. Single, silver amalgam / stepwise excavation205,76 DKK205,76 DKK205,76 DKK
1502Filling. Combined, silver amalgam / stepwise excavation280,95 DKK280,95 DKK280,95 DKK
1503Filling. Double combined, silver amalgam / stepwise excavation512,38 DKK512,38 DKK512,38 DKK
1504Filling. Single-faced, where the occlusion is affected by wear988,00 DKK988,00 DKK988,00 DKK
1505Filling. Plastic, single-faced / stepwise excavation426,70 DKK426,70 DKK426,70 DKK
1506Filling. Plastic, multi-level / stepwise excavation765,00 DKK765,00 DKK765,00 DKK
1507Filling. Under glass, single-faced / stepwise excavation426,70 DKK426,70 DKK426,70 DKK
1509Filling multi-level, wherein the occlusion is affected by wear1.025,00 DKK1.025,00 DKK1.025,00 DKK
1556Filling. Plastics, multi-level / stepwise excavation765,00 DKK765,00 DKK765,00 DKK
1558Glass ionomer filling492,00 DKK492,00 DKK492,00 DKK
1600Root canal treatment (pulp tissue removal)202,38 DKK202,38 DKK202,38 DKK
1601Root canal treatment (amputation coronal)234,96 DKK234,96 DKK234,96 DKK
1605Root canal treatment (acute thermal decomposition)234,96 DKK234,96 DKK234,96 DKK
1606Root canal treatment (root canal filling and apical amputation per canal)1.025,00 DKK1.025,00 DKK1.025,00 DKK
1701Tooth extraction per tooth334,99 DKK334,99 DKK334,99 DKK
1705Stopping the bleeding associated with tooth extraction116,66 DKK116,66 DKK116,66 DKK
ADVANCED TREATMENT5.500 DKK8.000 DKK12.000 DKK
1801Surgical removal of teeth1.100,00 DKK1.100,00 DKK1.100,00 DKK
9905Cast core3.300,00 DKK3.300,00 DKK3.300,00 DKK
9906Gold and porcelain inlays3.400,00 DKK3.400,00 DKK3.400,00 DKK
9907Crown - gold, ceramic or zircon3.400,00 DKK3.400,00 DKK3.400,00 DKK
9910Partial crown3.400,00 DKK3.400,00 DKK3.400,00 DKK
9912Root cap with retention2.500,00 DKK2.500,00 DKK2.500,00 DKK
9913Attachment1.250,00 DKK1.250,00 DKK1.250,00 DKK
9914Bridgework in gold, ceramics and the like per piece5.800,00 DKK5.800,00 DKK5.800,00 DKK
9919.1Retrograde root filling or root tip amputation one root3.000,00 DKK3.000,00 DKK3.000,00 DKK
9919.2Retrograde root canal filling or root tip amputation multi-tooth3.000,00 DKK3.000,00 DKK3.000,00 DKK
9937BSoft splint / mouth guard1.450,00 DKK1.450,00 DKK1.450,00 DKK
9937HHard splint / mouth guard2.700,00 DKK2.700,00 DKK2.700,00 DKK
9949Re-cementing475,00 DKK475,00 DKK475,00 DKK
9955Plastic Core with post1.250,00 DKK1.250,00 DKK1.250,00 DKK
9956Full denture (upper jaw or lower jaw)6.000,00 DKK6.000,00 DKK6.000,00 DKK
9958Full prosthesis (upper and lower jaw)11.500,00 DKK11.500,00 DKK11.500,00 DKK
9959Metal Based Partial Denture9.600,00 DKK9.600,00 DKK9.600,00 DKK
9960Mucosa supported acrylic partial denture3.500,00 DKK3.500,00 DKK3.500,00 DKK
1431Cleaning of the root of the tooth107,70 DKK107,70 DKK107,70 DKK
1440Surgical periodontal treatment (per 1-6 teeth)1.608,00 DKK1.608,00 DKK1.608,00 DKK
9944CCone beam recording2.200,00 DKK2.200,00 DKK2.200,00 DKK
9944TTomography1.300,00 DKK1.300,00 DKK1.300,00 DKK
IMPLANTS LIMITS8.000 DKK12.000 DKK
9901.1Implant, single tooth total price (operation implant, fixture, abutment and crown)-9.500,00 DKK9.500,00 DKK
9901.2Implant placement-3.000,00 DKK3.000,00 DKK
9901.3Implant Based bridge per tooth-3.000,00 DKK3.000,00 DKK
9919.3Bone augmentation before implant treatment-2.650,00 DKK2.650,00 DKK
9919.4Sinus lift before implant treatment-1850,00 DKK1850,00 DKK
9911Long term temporization of implant dentistry-3.000,00 DKK3.000,00 DKK