| |
Crystal |
Opal |
Pearl |
Diamond |
|
| Annual maximum benefit :
|
£800 |
£1000 |
£1500 |
£2000 |
| Normal Examination |
£6.10 |
£20.30 |
£34.50 |
£46.00 |
| Extensive Examination |
£9.00 |
£23.80 |
£38.50 |
£55.00 |
| Full Case Assessment |
£18.90 |
£31.90 |
£45.00 |
£65.00 |
| Bitewing X-Rays |
£4.00 |
£5.90 |
£7.70 |
£9.40 |
| Intra Oral X-Rays |
£6.20 |
£8.60 |
£11.00 |
£17.60 |
| O.P.G. X-Rays |
£9.20 |
£15.60 |
£22.00 |
£35.00 |
| Polishing & Scaling |
£9.50 |
£24.00 |
£38.50 |
£49.50 |
| Fissure Sealant |
£8.40 |
£10.20 |
£12.00 |
£17.00 |
| Topical Fluoride Application |
£4.90 |
£12.50 |
£20.00 |
£30.00 |
| Occlusal Splint |
£66.20 |
£104.40 |
£142.50 |
£165.00 |
| One Surface Amalgam Filling |
£9.90 |
£20.70 |
£31.50 |
£44.10 |
| Two Surface Amalgam Filling |
£13.00 |
£27.50 |
£42.00 |
£57.80 |
| Three+ Surface Amalgam Filling |
£19.20 |
£35.90 |
£52.50 |
£73.50 |
| One Surface Composite Anterior Filling |
£16.00 |
£29.00 |
£42.00 |
£63.00 |
| Two+ Surface Composite Anterior Filling |
£22.80 |
£45.60 |
£68.30 |
£102.40 |
| One Surface Composite Posterior Filling |
£17.10 |
£34.80 |
£52.50 |
£68.30 |
| Two+ Surface Composite Posterior Filling |
£22.80 |
£48.20 |
£73.50 |
£102.40 |
| Additional Charge use of pin |
£5.10 |
£9.40 |
£13.70 |
£17.90 |
| Upper & Lower Anterior Root Treatment (1 root) |
£26.50 |
£57.30 |
£115.00 |
£195.00 |
| Upper Premolar Root Treatment (2 roots) |
£39.10 |
£96.60 |
£180.00 |
£240.00 |
| Lower Premolar (1 root) |
£32.70 |
£63.10 |
£135.00 |
£220.00 |
| Molars - Root Canal Treatment (3 roots) |
£64.40 |
£123.00 |
£235.00 |
£305.00 |
| Single Extraction |
£10.80 |
£26.00 |
£50.00 |
£65.00 |
| Extraction per additional tooth |
£6.00 |
£15.90 |
£35.00 |
£50.00 |
| Extractions - Post op Care |
£12.10 |
£16.40 |
£20.60 |
£30.90 |
| Extraction/Removal Bone Debris |
£28.20 |
£47.60 |
£67.00 |
£100.50 |
| Extraction - soft tissue involved |
£16.60 |
£33.10 |
£49.50 |
£74.20 |
| Apicectomy |
£46.30 |
£95.30 |
£144.20 |
£175.10 |
| Relative Analgesia/Nitrous Oxide |
£18.80 |
£30.00 |
£41.20 |
£61.80 |
| IV Valium |
£18.80 |
£35.20 |
£51.50 |
£77.30 |
| Occasional Treatment - Dressings |
£6.20 |
£10.90 |
£15.50 |
£23.20 |
| Incising an Abscess |
£7.00 |
£14.90 |
£22.70 |
£30.90 |
| Open Root Canal for Drainage |
£6.80 |
£16.30 |
£35.00 |
£55.00 |
| Recementing Crowns/Bridges |
£12.00 |
£18.90 |
£25.80 |
£36.10 |
| Abnormal Haemorrhaging |
£18.80 |
£30.00 |
£41.20 |
£61.80 |
| Remember, all treatments in the
following section must be pre-authorised by CIGNA.
Please call 01475 492351 |
| Prolonged Periodontal Treatment (per quadrant) |
£35.20 |
£40.80 |
£46.40 |
£67.00 |
| Splinting |
£17.80 |
£34.70 |
£51.50 |
£77.30 |
| Gingivectomy |
£16.20 |
£22.60 |
£28.90 |
£43.80 |
| Mucoperio, Flap Bone Surgery |
£35.60 |
£59.00 |
£82.40 |
£123.60 |
| Partial/Full Upper or Lower Acrylic Denture |
£81.30 |
£161.70 |
£242.10 |
£252.40 |
| Partial/Full Upper and Lower Acrylic Denture |
£130.30 |
£281.50 |
£432.60 |
£618.00 |
| Partial Metal Denture |
£144.20 |
£265.30 |
£386.30 |
£463.50 |
| Full Upper or Lower Metal Denture |
£161.70 |
£274.00 |
£386.30 |
£463.50 |
| Additional Tooth to Denture |
£20.40 |
£29.80 |
£39.20 |
£58.80 |
| Addition of Clasp to Denture |
£22.60 |
£26.60 |
£30.90 |
£46.40 |
| Denture Repair |
£15.40 |
£20.60 |
£25.80 |
£38.70 |
| Veneers (per tooth) |
£76.60 |
£128.50 |
£180.30 |
£270.40 |
| Adhesive Bridges (per unit) |
£47.00 |
£100.80 |
£154.50 |
£180.30 |
| Conventional Bridgework (per unit) |
£93.10 |
£193.40 |
£293.60 |
£440.40 |
| Standard Post & Core |
£13.90 |
£27.60 |
£50.00 |
£70.00 |
| Gold Post & Core |
£27.20 |
£44.50 |
£70.00 |
£95.00 |
| Bonded Precious Crown |
£95.10 |
£198.10 |
£330.00 |
£425.00 |
| Bonded Non-Precious Crown |
£87.40 |
£183.50 |
£290.00 |
£380.00 |
| Full Cast Crown |
£82.90 |
£181.20 |
£320.00 |
£425.00 |
| Porcelain Crown |
£62.50 |
£160.30 |
£325.00 |
£410.00 |
| Precious Inlay |
£93.10 |
£149.60 |
£295.00 |
£380.00 |
| Non-Precious Inlay |
£93.10 |
£131.60 |
£280.00 |
£360.00 |
| Porcelain Inlay |
£93.10 |
£162.50 |
£310.00 |
£400.00 |
| Additional Cover For Accident & Emergency Pain
Relief |
£500.00 |
£500.00 |
£500.00 |
£800.00 |
| |
| Band 1 - Maintenance |
£16.20 |
£16.20 |
£16.20 |
£16.20 |
| Band 2 - Simple Treatment |
£44.60 |
£44.60 |
£44.60 |
£44.60 |
| Band 3 - Complex Treatment |
£198.00 |
£198.00 |
£198.00 |
£198.00 |
| Band 4 - Urgent Treatment |
£16.20 |
£16.20 |
£16.20 |
£16.20 |