| A | B | C | FB | FD | FF | |
|---|---|---|---|---|---|---|
1 | AZUL-BLANCO-CELESTE-ADV-CORPORATE-FAMILY CARE-MC INTEGRA-MC INTEGRA 2-INTEGRA 3 | MS1 (SIN COPAGO) | MS2 (SIN COPAGO) | |||
2 | ||||||
3 | Círculo Odontológico de Bariloche - E178115 | |||||
4 | CODIGOS | CODIGOS MEDICUS | LISTA E178115 | jun-26 | jun-26 | jun-26 |
5 | 01.01 | 040101 | CONSULTA FICHADO | $ 28,340.00 | $ 28,340.00 | $ 28,340.00 |
6 | 01.04 | 040104 | CONSULTA DE URGENCIA | $ 26,160.00 | $ 26,160.00 | $ 26,160.00 |
7 | 02.01 | 040201 | AMALGAMA SIMPLE Y COMPUESTA | $ 46,434.00 | $ 46,434.00 | $ 46,434.00 |
8 | 02.01.01 | 14020101 | Restauracion complementaria | $ 34,880.00 | $ 34,880.00 | $ 34,880.00 |
9 | 02.02 | 040202 | OBTURACION AMALGAMA | $ 46,434.00 | $ 46,434.00 | $ 46,434.00 |
10 | 02.04 | 040204 | OBTURACION CON TORNILLO EN CONDUCTO | $ 46,434.00 | $ 46,434.00 | $ 46,434.00 |
11 | 02.08 | 040208 | OBTURACION AUTOCURADO | $ 34,880.00 | $ 34,880.00 | $ 34,880.00 |
12 | 02.09 | 040209 | OBTURACION RECONST. ANGULO | $ 51,775.00 | $ 51,775.00 | $ 51,775.00 |
13 | 02.15 | 14020702 | OBTURACION LH ANTERIOR | $ 51,775.00 | $ 51,775.00 | $ 51,775.00 |
14 | 02.16 | 14020704 | OBTURACION LH POSTERIOR | $ 51,775.00 | $ 51,775.00 | $ 51,775.00 |
15 | 03.01 | 040301 | ENDODONCIA UNIRRADICULARES | $ 207,100.00 | $ 207,100.00 | $ 207,100.00 |
16 | 03.02 | 040302 | ENDODONCIA MULTIRRADICULARES | $ 223,450.00 | $ 223,450.00 | $ 223,450.00 |
17 | 03.05 | 040305 | BIOPULPECTOMIA PARCIAL | $ 92,650.00 | $ 92,650.00 | $ 92,650.00 |
18 | 03.06 | 040306 | NECROPULPECTOMIA PARCIAL | $ 92,650.00 | $ 92,650.00 | $ 92,650.00 |
19 | 03.07 | 140301 | DESOBTURACION DE CONDUCTO | $ 81,750.00 | $ 81,750.00 | $ 81,750.00 |
20 | 05.01 | 040501 | TARTRECTOMIA Y CEPILLADO MECANICO | $ 28,340.00 | $ 28,340.00 | $ 28,340.00 |
21 | 05.02 | 040502 | TOPICACION DE FLUOR | $ 28,340.00 | $ 28,340.00 | $ 28,340.00 |
22 | 05.05 | 040505 | SELLADORES | $ 28,340.00 | $ 28,340.00 | $ 28,340.00 |
23 | 07.01 | 040701 | CONSULTA Y MOTIVACION | $ 40,330.00 | $ 40,330.00 | $ 40,330.00 |
24 | 07.02 | 040702 | MANTENEDOR ESPACIO FIJO | $ 152,600.00 | $ 152,600.00 | $ 152,600.00 |
25 | 07.03 | 040703 | Reduccion de luxacion con inmovilizacion dentaria | $ 65,400.00 | $ 65,400.00 | $ 65,400.00 |
26 | 07.04 | 040704 | FORMOCRESOL | $ 76,300.00 | $ 76,300.00 | $ 76,300.00 |
27 | 07.05 | 040705 | CORONA DE ACERO PROVISORIA POR DESTRUCCION COR | $ 81,750.00 | $ 81,750.00 | $ 81,750.00 |
28 | 07.06 | 04070602 | REIMPLANTE DENTARIO E INMOVILIZACION POR LUXAC | $ 41,420.00 | $ 41,420.00 | $ 41,420.00 |
29 | 07.07 | 140308 | PROTECCION PULPAR DIRECTA. INCLUYE RX. POST - | $ 26,160.00 | $ 26,160.00 | $ 26,160.00 |
30 | 08.01 | 040801 | CONSULTA DE PERIODONCIA | $ 30,520.00 | $ 30,520.00 | $ 30,520.00 |
31 | 08.02 | 040802 | TRATAMIENTO DE GINGIVITIS MARGINAL CRONICA | $ 29,430.00 | $ 29,430.00 | $ 29,430.00 |
32 | 08.03 | 040803 | TRATAMIENTO DE PERIODONTITIS LEVE O MODERADA | $ 8,720.00 | $ 8,720.00 | $ 8,720.00 |
33 | 08.04 | 040804 | TRAT. DE PERIODONTITIS DESTRUCT. SEVERA | $ 25,070.00 | $ 25,070.00 | $ 25,070.00 |
34 | 08.05 | 040805 | DESGASTE SEECTIVO-ARMONIZACION OCLUSAL | $ 14,170.00 | $ 14,170.00 | $ 14,170.00 |
35 | 09.01.01 | 04090101 | PERIAPICAL | $ 8,175.00 | $ 8,175.00 | $ 8,175.00 |
36 | 09.01.03 | 04090103 | OCLUSAL | $ 13,516.00 | $ 13,516.00 | $ 13,516.00 |
37 | 09.01.04 | 04090104 | MEDIA SERIADA - 7 PELICULAS | $ 20,928.00 | $ 20,928.00 | $ 20,928.00 |
38 | 09.01.05 | 04090105 | SERIADA COMPLETA - 14 PELICULAS | $ 34,444.00 | $ 34,444.00 | $ 34,444.00 |
39 | 09.02.04 | 04090204 | RADIOGRAFIA PANORAMICA | $ 35,316.00 | $ 35,316.00 | $ 35,316.00 |
40 | 09.02.05 | 04090205 | TELERRADIOGRAFIA CEFALOMETRICA | $ 29,866.00 | $ 29,866.00 | $ 29,866.00 |
41 | 10.01 | 041001 | EXODONCIA SIMPLE | $ 55,590.00 | $ 55,590.00 | $ 55,590.00 |
42 | 10.02 | 041002 | PLASTICA DE COMUNICACION BUCOSINUSAL | $ 41,420.00 | $ 41,420.00 | $ 41,420.00 |
43 | 10.03 | 041003 | BIOPSIA | $ 32,700.00 | $ 32,700.00 | $ 32,700.00 |
44 | 10.04 | 041004 | ALVEOLECTOMIA ESTABILIZADORA | $ 50,140.00 | $ 50,140.00 | $ 50,140.00 |
45 | 10.05 | 041005 | REIMPLANTE DENTARIO | $ 40,657.00 | $ 40,657.00 | $ 40,657.00 |
46 | 10.06 | 041006 | INCISION Y DRENAJE | $ 23,980.00 | $ 23,980.00 | $ 23,980.00 |
47 | 10.09 | 041009 | EXTRACCION DE DIENTE CON RETENCION OSEA | $ 261,600.00 | $ 261,600.00 | $ 261,600.00 |
48 | 10.09.01 | 141021 | EXTRACCION DE DIENTE CON RETENCION MUCOSA | $ 218,000.00 | $ 218,000.00 | $ 218,000.00 |
49 | 10.10 | 041010 | GERMECTOMIA | $ 209,280.00 | $ 209,280.00 | $ 209,280.00 |
50 | 10.11 | 041011 | LIBERACION DE DIENTE RETENIDO | $ 152,600.00 | $ 152,600.00 | $ 152,600.00 |
51 | 10.12 | 041012 | APICECTOMIA | $ 152,600.00 | $ 152,600.00 | $ 152,600.00 |
52 | 10.13 | 041013 | TRATAMIENTO DE LA OSTEOMIELITIS | $ 65,400.00 | $ 65,400.00 | $ 65,400.00 |
53 | 10.14 | 041014 | EXTRACCION DE CUERPO EXTRAðO | $ 54,500.00 | $ 54,500.00 | $ 54,500.00 |
54 | 10.15 | 041015 | ALVEOLECTOMIA CORRECTIVA | $ 46,216.00 | $ 46,216.00 | $ 46,216.00 |
55 | 10.16 | 141023 | Frenectomia | $ 41,420.00 | $ 41,420.00 | $ 41,420.00 |
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