Cavitas dental Insurance procedures to be indemnified
| Code | Treatment description | BRONZE | SILVER | GOLD |
|---|---|---|---|---|
| Annual Sum Insured 7.500 DKK | Annual Sum Insured 20.000 DKK | Annual Sum Insured 30.000 DKK | ||
| DIAGNOSTIC & X-RAY | 500 DKK | 750 DKK | 1.000 DKK | |
| 1415 | Periodontal examination and diagnostics | 479,61 DKK | 479,61 DKK | 479,61 DKK |
| 1150 | Bitewing x-ray | 212,36 DKK | 212,36 DKK | 212,36 DKK |
| 1300 | X-ray recording | 151,85 DKK | 151,85 DKK | 151,85 DKK |
| 9944 | Panoramic X-Ray | 600,00 DKK | 600,00 DKK | 600,00 DKK |
| ROUTINE TREATMENT | 1.500 DKK | 3.250 DKK | 5.000 DKK | |
| 9945 | Local anaesthetic, nitrous oxide anaesthesia | 150,00 DKK | 150,00 DKK | 150,00 DKK |
| 1501 | Filling. Single, silver amalgam / stepwise excavation | 205,76 DKK | 205,76 DKK | 205,76 DKK |
| 1502 | Filling. Combined, silver amalgam / stepwise excavation | 280,95 DKK | 280,95 DKK | 280,95 DKK |
| 1503 | Filling. Double combined, silver amalgam / stepwise excavation | 512,38 DKK | 512,38 DKK | 512,38 DKK |
| 1504 | Filling. Single-faced, where the occlusion is affected by wear | 988,00 DKK | 988,00 DKK | 988,00 DKK |
| 1505 | Filling. Plastic, single-faced / stepwise excavation | 426,70 DKK | 426,70 DKK | 426,70 DKK |
| 1506 | Filling. Plastic, multi-level / stepwise excavation | 765,00 DKK | 765,00 DKK | 765,00 DKK |
| 1507 | Filling. Under glass, single-faced / stepwise excavation | 426,70 DKK | 426,70 DKK | 426,70 DKK |
| 1509 | Filling multi-level, wherein the occlusion is affected by wear | 1.025,00 DKK | 1.025,00 DKK | 1.025,00 DKK |
| 1556 | Filling. Plastics, multi-level / stepwise excavation | 765,00 DKK | 765,00 DKK | 765,00 DKK |
| 1558 | Glass ionomer filling | 492,00 DKK | 492,00 DKK | 492,00 DKK |
| 1600 | Root canal treatment (pulp tissue removal) | 202,38 DKK | 202,38 DKK | 202,38 DKK |
| 1601 | Root canal treatment (amputation coronal) | 234,96 DKK | 234,96 DKK | 234,96 DKK |
| 1605 | Root canal treatment (acute thermal decomposition) | 234,96 DKK | 234,96 DKK | 234,96 DKK |
| 1606 | Root canal treatment (root canal filling and apical amputation per canal) | 1.025,00 DKK | 1.025,00 DKK | 1.025,00 DKK |
| 1701 | Tooth extraction per tooth | 334,99 DKK | 334,99 DKK | 334,99 DKK |
| 1705 | Stopping the bleeding associated with tooth extraction | 116,66 DKK | 116,66 DKK | 116,66 DKK |
| ADVANCED TREATMENT | 5.500 DKK | 8.000 DKK | 12.000 DKK | |
| 1801 | Surgical removal of teeth | 1.100,00 DKK | 1.100,00 DKK | 1.100,00 DKK |
| 9905 | Cast core | 3.300,00 DKK | 3.300,00 DKK | 3.300,00 DKK |
| 9906 | Gold and porcelain inlays | 3.400,00 DKK | 3.400,00 DKK | 3.400,00 DKK |
| 9907 | Crown - gold, ceramic or zircon | 3.400,00 DKK | 3.400,00 DKK | 3.400,00 DKK |
| 9910 | Partial crown | 3.400,00 DKK | 3.400,00 DKK | 3.400,00 DKK |
| 9912 | Root cap with retention | 2.500,00 DKK | 2.500,00 DKK | 2.500,00 DKK |
| 9913 | Attachment | 1.250,00 DKK | 1.250,00 DKK | 1.250,00 DKK |
| 9914 | Bridgework in gold, ceramics and the like per piece | 5.800,00 DKK | 5.800,00 DKK | 5.800,00 DKK |
| 9919.1 | Retrograde root filling or root tip amputation one root | 3.000,00 DKK | 3.000,00 DKK | 3.000,00 DKK |
| 9919.2 | Retrograde root canal filling or root tip amputation multi-tooth | 3.000,00 DKK | 3.000,00 DKK | 3.000,00 DKK |
| 9937B | Soft splint / mouth guard | 1.450,00 DKK | 1.450,00 DKK | 1.450,00 DKK |
| 9937H | Hard splint / mouth guard | 2.700,00 DKK | 2.700,00 DKK | 2.700,00 DKK |
| 9949 | Re-cementing | 475,00 DKK | 475,00 DKK | 475,00 DKK |
| 9955 | Plastic Core with post | 1.250,00 DKK | 1.250,00 DKK | 1.250,00 DKK |
| 9956 | Full denture (upper jaw or lower jaw) | 6.000,00 DKK | 6.000,00 DKK | 6.000,00 DKK |
| 9958 | Full prosthesis (upper and lower jaw) | 11.500,00 DKK | 11.500,00 DKK | 11.500,00 DKK |
| 9959 | Metal Based Partial Denture | 9.600,00 DKK | 9.600,00 DKK | 9.600,00 DKK |
| 9960 | Mucosa supported acrylic partial denture | 3.500,00 DKK | 3.500,00 DKK | 3.500,00 DKK |
| 1431 | Cleaning of the root of the tooth | 107,70 DKK | 107,70 DKK | 107,70 DKK |
| 1440 | Surgical periodontal treatment (per 1-6 teeth) | 1.608,00 DKK | 1.608,00 DKK | 1.608,00 DKK |
| 9944C | Cone beam recording | 2.200,00 DKK | 2.200,00 DKK | 2.200,00 DKK |
| 9944T | Tomography | 1.300,00 DKK | 1.300,00 DKK | 1.300,00 DKK |
| IMPLANTS LIMITS | 8.000 DKK | 12.000 DKK | ||
| 9901.1 | Implant, single tooth total price (operation implant, fixture, abutment and crown) | - | 9.500,00 DKK | 9.500,00 DKK |
| 9901.2 | Implant placement | - | 3.000,00 DKK | 3.000,00 DKK |
| 9901.3 | Implant Based bridge per tooth | - | 3.000,00 DKK | 3.000,00 DKK |
| 9919.3 | Bone augmentation before implant treatment | - | 2.650,00 DKK | 2.650,00 DKK |
| 9919.4 | Sinus lift before implant treatment | - | 1850,00 DKK | 1850,00 DKK |
| 9911 | Long term temporization of implant dentistry | - | 3.000,00 DKK | 3.000,00 DKK |
