Aux praticiens en soins dentaires du Nouveau Brunswick inscrits au Programme des SSNA

Le 1 er mars, 2009 Aux praticiens en soins dentaires du Nouveau Brunswick inscrits au Programme des SSNA Cher praticien, Veuillez trouver ci-joint la Grille régionale des soins dentaires des SSNA du Nouveau Brunswick pour les dentistes généralistes et les spécialistes. La grille régionale des soins dentaires des SSNA du Nouveau Brunswick sera en vigueur à compter du 1 er mars, 2009. Le Système de traitement des renseignements et des demandes de paiement pour services de santé (STRDPSS) a été modifié de façon à refléter les nouveaux tarifs indiqués sur la grille. Si vous avez des questions, veuillez communiquer avec le Centre d information à numéro sans frais sur les SSNA de First Canadian Health au 1-888-471-1111. Veuillez agréer, cher praticien, mes sentiments les meilleurs. Dr. Gregory W. Jones DDS Agent dentaire du région de l Atlantique Services de santé non-assurés c.c. Société des praticiens dentaires du Nouveau Brunswick Also available in English at 1-888-471-1111

RÉGION DE L ATLANTIQUE GRILLE RÉGIONALE DES SOINS DENTAIRES DU PROGRAMME DES SSNA Dentistes généralistes et Spécialistes DATE D ENTRÉE EN VIGUEUR 1 er mars, 2009 Les soins dentaires couverts par le Programme des SSNA seront remboursés en vertu des termes et conditions énumérés du programme. Une approbation après traitement sera considérée sauf pour les exceptions mentionnées dans la Trousse d information pour le praticien en soins dentaires des SSNA. Tous les actes de l'annexe B nécessitent une prédétermination. Lignes directrices relatives au programme de soins dentaires de la DGSPNI (liste non-exhaustive) sont inclus pour votre information.

Examen buccodentaire complet et diagnostic Examen limité/de rappel Examen d'urgence/spécifique Examen fait par un spécialiste et diagnostic Radiographies Intraorales Lignes directrices relatives au programme de soins dentaires de la DGSPNI* * Avertissement : Les renseignements fournis dans cette liste ne sont offerts qu'à titre d'information générale. Il s'agit d'une liste non-exhaustive. Pour des informations supplémentaires s'il vous plaît voir le "Cadre de travail sur les soins dentaires". Lignes directrices - L' échéance est basé sur une année de Services roulement eg; 12 mois représente une période de 12 mois quelconques. Examens Maximum d'examens éligibles: 17 ans et plus : max.3/12 mois; moins de 17 ans : max. 4/12 mois. Tous les codes de procedure compris dans la section de diagnostique compte contre le maximum alloué. 1/60 mois - un examen complet remplace l examen de rappel pour la période visée. 17 ans et plus : 1/12 mois; moins de 17 ans : 2/12 mois 1/12 mois 1/12 mois (sur recommandation d'un dentiste généraliste) 6/12 mois Radiographies - série complète Panoramiques Services préventifs Polissage Détartrage Application topique de fluorure Scellants et résines préventives Meulage interproximal des dents Services de restauration Caries/traumatisme et contrôle de la douleur Restaurations amalgame/composite; couronnes préfabriquées Pivots/corps Enlèvement d'un pivot Couronnes Réparations de couronnes Recimentation de couronnes Enlèvement de couronnes Endodontie - Prédétermination requise Traitement de canal Parodontie Surfaçage radiculaire Appareils parodontaux Appareils parodontaux - entretien Prothèses amovibles Prothèses complètes/partielles/immédiates Réparations et ajouts Regarnissage ou rebasage Garnissage temporaire thérapeutique Chirurgie buccale et maxillofaciale Extractions simples Extractions complexes Orthodontie - Prédétermination requise Traitement d'interception Traitement complet Services généraux complémentaires - Prédétermination requise Anesthésie générale/'installations 1/60 mois 1/120 mois; 2/à vie 17 ans et plus : 1/12 mois; moins de 17 ans : 2/12 mois - Le paiement d'une séance de polissage se limitera au coût d'une demi-unité. 12 ans et plus : 4 unités/12 mois combiné avec un surfaçage radiculaire. Moins de 12 ans: 1 unité/12 mois combiné avec un surfaçage radiculaire. Moins de 17 ans : 2/12 mois Moins de 14 ans : molaire permanente (éruption récente) où la surface occlusale n a pas été restaurée et la surface linguale des incisives du maxillaire supérieur. 1/12 mois - Le paiement d'une séance de meulage se limitera au coût d'une demiunité. Max. 2 dents/à vie, urgence Les dents incisives primaires ne sont admissibles que pour les moins de 5 ans. 1/36 mois (dent permanente) - Prédétermination requise 1/à vie (dent permanente) La politique sur les couronnes s applique - Prédétermination requise 1/couronne/à vie 1/couronne/à vie 1/couronne/à vie La politique endodontique s applique - Prédétermination non requise pour les dents anterieures permanentes (13-23, 33-43). 12 ans et plus: 4 unités/12 mois combiné avec un détartrage; moins de 12 ans: 1unité/12 mois combiné avec un détartrage. 1/36 mois - Prédétermination requise 3/36 mois - Prédétermination requise 1/arcade/96 mois - Prédétermination requise 1/prothèse/12 mois 1/prothèse/24 mois 1/prothèse/24 mois Prédétermination non requise Prédétermination requise La politique concernant l'orthodontie s'applique. La politique concernant l'orthodontie s'applique. Moins de 12 ans

NOUVEAU-BRUNSWICK, GRILLE RÉGIONALE DES SOINS DENTAIRES DU PROGRAMME DES SSNA DENTISTES GÉNÉRALISTES ET SPÉCIALISTES *NOMENCLATURE A* Acte L DG Endo Chirur. B Ortho Pédo Paro Radio Prostho Path B. 0.1 - Diagnostic 01101 $47.16 $58.63 01102 $64.19 $80.75 01103 $79.94 $106.82 01201 $31.45 $54.73 $54.73 01202 $28.28 $43.43 01204 $31.45 $46.89 $46.89 $46.89 $46.89 01205 $31.45 $46.89 $46.89 $46.89 $46.89 01402 $122.47 01502 $80.24 01602 $57.33 01702 $48.21 01802 $57.33 0.2 - Radiographies 02101 $78.60 $97.71 $97.71 $97.71 $97.71 02102 $85.17 $105.52 $105.52 $105.52 $105.52 02111 $17.03 $20.84 $20.84 $20.84 $20.84 $20.84 02112 $23.59 $28.66 $28.66 $28.66 $28.66 $28.66 02113 $28.83 $35.19 $35.19 $35.19 $35.19 $35.19 02114 $34.06 $42.97 $42.97 $42.97 $42.97 $42.97 02115 $38.21 $46.89 $46.89 $46.89 $46.89 $46.89 02116 $41.94 $52.10 $52.10 $52.10 $52.10 $52.10 02117 $45.85 $57.33 $57.33 $57.33 $57.33 02118 $49.77 $62.54 $62.54 $62.54 $62.54 02119 $53.71 $67.75 $67.75 $67.75 $67.75 02120 $57.64 $72.93 $72.93 $72.93 $72.93 02121 $61.57 $78.18 $78.18 $78.18 $78.18 02122 $65.52 $83.38 $83.38 $83.38 $83.38 02123 $69.44 $88.57 $88.57 $88.57 $88.57 02124 $73.40 $93.80 $93.80 $93.80 $93.80 02125 $77.29 $99.00 $99.00 $99.00 $99.00 02131 $22.27 $27.35 $27.35 $27.35 $27.35 02132 $34.06 $42.98 $42.98 $42.98 $42.98 02133 $45.85 $57.32 $57.32 $57.32 $57.32 02134 $57.64 $71.63 $71.63 $71.63 $71.63 02135 $69.45 $85.95 $85.95 $85.95 $85.95 02136 $81.25 $100.31 $100.31 $100.31 $100.31 02141 $17.03 $20.84 $20.84 $20.84 $20.84 02142 $23.59 $28.66 $28.66 $28.66 $28.66 02143 $28.83 $35.19 $35.19 $35.19 $35.19 02144 $34.06 $41.69 $41.69 $41.69 $41.69 02145 $38.00 $46.89 $46.89 $46.89 $46.89 02146 $41.90 $52.10 $52.10 $52.10 $52.10 02601 $51.10 $75.12 $75.12 $75.12 $75.12 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE A 1

02801 $23.59 $29.32 $29.32 $29.32 $29.32 $29.32 02802 $23.59 $29.32 $29.32 $29.32 $29.32 $29.32 0.4 - Tests et examens de laboratoire divers 04101 L $32.74 $44.31 $44.31 04311 L $76.01 $93.80 $93.80 04312 L $76.01 $93.80 $93.80 04313 L $76.01 $93.80 $93.80 04321 L $132.35 $164.16 $164.16 04322 L $132.35 $164.16 $164.16 04323 L $132.35 $164.16 $164.16 04401 L $34.06 $45.60 $45.60 1.0 - Prévention 11101 $10.62 $13.27 $13.27 $13.27 11102 $10.62 $13.27 $13.27 $13.27 11107 $10.62 $13.27 $13.27 $13.27 11111 $44.20 $55.25 $55.25 $55.25 11112 $88.43 $110.52 $110.52 $110.52 11113 $132.61 $165.77 $165.77 $165.77 11114 $176.81 $221.03 $221.03 $221.03 11117 $22.10 $27.64 $27.64 $27.64 12101 $19.23 $24.26 $24.26 $24.26 12102 $14.11 $17.97 $17.97 $17.97 13401 $21.79 $26.81 $26.81 13409 $12.84 $15.34 $15.34 13411 $39.48 $49.37 $49.37 13419 $27.14 $33.95 $33.95 16201 $43.63 $53.65 16511 $27.12 $33.91 $33.91 $33.91 16517 $27.12 2.0 - Restauration 20111 $55.95 $69.97 $69.97 20119 $42.95 $58.30 $58.30 20121 $67.68 $84.20 $84.20 20129 $67.68 $84.20 $84.20 20131 $22.11 $27.21 $27.21 20139 $18.22 $22.02 $22.02 21111 $44.71 $55.72 $55.72 21112 $65.08 $80.32 $80.32 21113 $75.49 $102.35 $102.35 21114 $109.34 $136.03 $136.03 21115 $119.75 $148.99 $148.99 21121 $44.71 $55.72 $55.72 21122 $65.08 $80.32 $80.32 21123 $75.49 $102.35 $102.35 21124 $109.34 $136.03 $136.03 21125 $119.75 $148.99 $148.99 21211 $45.58 $57.01 $57.01 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE A 2

21212 $71.60 $89.39 $89.39 21213 $89.83 $111.43 $111.43 21214 $124.95 $155.46 $155.46 21215 $140.59 $174.90 $174.90 21221 $58.58 $72.54 $72.54 21222 $88.52 $110.12 $110.12 21223 $105.44 $130.84 $130.84 21224 $145.80 $161.94 $161.94 21225 $158.81 $196.91 $196.91 21231 $45.58 $57.01 $57.01 21232 $71.60 $89.39 $89.39 21233 $89.83 $111.43 $111.43 21234 $124.95 $155.46 $155.46 21235 $140.59 $174.90 $174.90 21241 $58.58 $72.54 $72.54 21242 $88.52 $110.12 $110.12 21243 $105.44 $130.84 $130.84 21244 $145.80 $161.94 $161.94 21245 $158.81 $196.91 $196.91 21401 $16.92 $20.73 $20.73 21402 $27.33 $33.68 $33.68 21403 $37.76 $46.64 $46.64 21404 $45.58 $59.60 $59.60 21405 $53.35 $73.84 $73.84 22201 $119.75 $148.99 $148.99 22211 $126.27 $156.75 $156.75 22301 $119.75 $148.99 $148.99 22302 $171.01 $171.01 22311 $126.27 $156.75 $156.75 22312 $171.01 $171.01 22401 $113.27 $141.21 $141.21 22411 $143.91 $143.91 22501 $124.95 $152.87 $152.87 22511 $124.95 $152.87 $152.87 23101 $59.86 $73.84 $73.84 23102 $76.80 $95.86 $95.86 23103 $100.22 $124.49 $124.49 23104 $115.87 $143.80 $143.80 23105 $140.59 $174.91 $174.91 23111 $75.49 $93.27 $93.27 23112 $91.88 $115.30 $115.30 23113 $121.06 $142.50 $142.50 23114 $156.22 $190.43 $190.43 23115 $199.18 $242.25 $242.25 23211 $56.49 $70.61 $70.61 23212 $82.05 $102.18 $102.18 23213 $96.25 $120.30 $120.30 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE A 3

23214 $121.24 $151.55 $151.55 23215 $139.05 $173.81 $173.81 23221 $60.23 $75.29 $75.29 23222 $89.69 $112.11 $112.11 23223 $103.13 $129.38 $129.38 23224 $130.13 $162.66 $162.66 23225 $149.56 $186.97 $186.97 23311 $74.30 $85.49 $85.49 23312 $107.19 $130.84 $130.84 23313 $127.94 $155.21 $155.21 23314 $159.72 $187.84 $187.84 23315 $189.70 $233.19 $233.19 23321 $77.15 $90.68 $90.68 23322 $116.71 $142.50 $142.50 23323 $141.10 $167.12 $167.12 23324 $175.76 $218.93 $218.93 23325 $206.98 $257.81 $257.81 23401 $54.67 $67.37 $67.37 23402 $71.89 $90.68 $90.68 23403 $96.34 $119.18 $119.18 23404 $111.96 $138.63 $138.63 23405 $113.27 $141.21 $141.21 23411 $66.40 $82.92 $82.92 23412 $80.69 $99.74 $99.74 23413 $110.66 $137.32 $137.32 23414 $113.27 $141.21 $141.21 23415 $113.27 $141.21 $141.21 23501 $52.44 $63.30 $63.30 23502 $79.11 $98.89 $98.89 23503 $88.24 $110.52 $110.52 23504 $111.62 $139.53 $139.53 23505 $126.27 $143.91 $143.91 23511 $69.72 $73.84 $73.84 23512 $94.47 $89.39 $89.39 23513 $109.09 $104.94 $104.94 23514 $126.27 $124.37 $124.37 23515 $126.27 $136.03 $136.03 25781 $55.11 $58.88 $58.88 25782 $110.21 $117.77 $117.77 27711 $84.12 $104.65 $104.65 27721 $94.67 $117.77 $117.77 27722 L $94.67 $117.77 $117.77 29101 $55.11 $68.90 $68.90 29301 $55.11 $68.90 $68.90 3.0 - Endodontie 32221 $85.45 $105.97 $105.97 32222 $122.26 $151.79 $151.79 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE A 4

32231 $76.23 $94.19 $94.19 32232 $55.21 $68.04 $68.04 32311 $110.42 $137.37 $137.37 32312 $138.03 $183.18 $183.18 32313 $177.48 $235.49 $235.49 32314 $216.92 $287.82 $287.82 32321 $85.45 $105.97 $105.97 32322 $93.33 $116.47 $116.47 33111 $357.61 $444.84 $444.84 39201 $42.06 $58.88 $58.88 39202 $48.65 $71.96 $71.96 4.0 - Parodontie 42831 $55.11 $68.90 $68.90 43421 $47.32 $59.18 $59.18 43422 $94.66 $118.33 $118.33 43423 $141.96 $177.48 $177.48 43424 $189.31 $236.63 $236.63 43427 $23.66 $35.23 $35.23 5.0 - Prothèses amovibles 54201 $55.11 $58.88 $58.88 54202 $110.21 $117.77 $117.77 54209 $55.11 $58.88 $58.88 55101 L $44.69 $54.96 $54.96 55102 L $44.69 $54.96 $54.96 55201 L $73.62 $99.46 $99.46 55202 L $73.62 $99.46 $99.46 55203 L $75.35 $204.54 $204.54 55301 L $44.69 $66.74 $66.74 55302 L $44.69 $66.74 $66.74 55401 L $86.76 $107.28 $107.28 55402 L $86.76 $107.28 $107.28 55403 L $163.62 $204.54 $204.54 56211 $136.74 $176.62 $176.62 56212 $136.74 $176.62 $176.62 56213 $259.27 56221 $128.84 $175.30 $175.30 56222 $128.84 $175.30 $175.30 56223 $244.55 56231 L $160.39 $198.85 $198.85 56232 L $180.11 $223.72 $223.72 56233 L $323.04 56241 L $145.94 $181.85 $181.85 56242 L $145.94 $181.85 $181.85 56243 L $276.59 56251 L $203.78 $253.51 $253.51 56252 L $220.86 $274.76 $274.76 56253 L $402.80 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE A 5

56261 L $190.60 $236.82 $236.82 56262 L $197.21 $244.67 $244.67 56263 L $368.15 56311 L $160.39 $198.85 $198.85 56312 L $168.28 $209.32 $209.32 56313 L $308.95 $372.86 $372.86 56321 L $143.30 $177.93 $177.93 56322 L $143.30 $177.93 $177.93 56323 L $272.39 56511 $74.92 $92.89 $92.89 56512 $74.92 $92.89 $92.89 56513 $142.09 56521 $74.92 $92.89 $92.89 56522 $74.92 $92.89 $92.89 56531 $74.92 $92.89 $92.89 56532 $92.89 $92.89 56551 $74.92 $92.89 $92.89 56552 $74.92 $92.89 $92.89 56553 $142.09 7.0 - Chirurgie buccale 71101 $56.74 $70.92 $70.92 $70.92 71109 $42.55 $53.19 $53.19 $53.19 72311 $56.74 $70.92 $70.92 72319 $42.55 $53.19 $53.19 74111 $195.89 $243.34 $243.34 74112 $201.14 $374.16 $374.16 74121 $289.13 $289.13 74122 $529.86 $529.86 74211 $327.08 $327.08 74212 $541.66 $541.66 74221 $363.71 $363.71 74611 $195.89 $256.44 $256.44 74612 $211.68 $314.01 $314.01 74621 $408.17 $408.17 74631 $207.74 $257.74 $257.74 74632 $247.14 $312.70 $312.70 75111 $72.31 $103.35 $103.35 75112 $72.31 $103.35 $103.35 75113 $168.29 $158.30 $158.30 75121 $124.88 $176.62 $176.62 75122 $147.40 $183.63 $183.63 75123 $182.34 $183.63 $183.63 75211 $204.10 $204.10 75212 $350.62 $350.62 75221 $380.75 $380.75 75301 $350.62 $350.62 75302 $244.98 $616.21 $616.21 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE A 6

75303 $514.16 $514.16 76116 $281.30 $281.30 76141 $117.33 $117.33 76142 $242.05 $242.05 76911 $351.04 $436.96 $436.96 76912 $391.78 $486.69 $486.69 76921 $434.35 $434.35 76922 $565.17 $565.17 76931 $565.17 $565.17 76932 $680.33 $680.33 76941 $270.80 $336.23 $336.23 76949 $122.27 $151.79 $151.79 76951 $47.31 $58.88 $58.88 76952 $94.66 $117.77 $117.77 76961 $103.84 $129.54 $129.54 76962 $126.22 $156.99 $156.99 77801 $173.54 $218.50 $218.50 77802 $169.61 $218.50 $218.50 77803 $169.61 $218.50 $218.50 78102 $97.29 $147.83 $147.83 78107 $230.27 $230.27 79101 $162.23 $162.23 79402 $63.09 $117.77 $117.77 79403 $55.22 $98.13 $98.13 79404 $95.98 $136.05 $136.05 79601 $40.74 $51.03 $51.03 79602 $40.74 $54.96 $54.96 79603 $97.36 $108.21 79604 $140.04 $140.04 79605 $54.96 $54.96 79606 $54.96 $54.96 79701 $485.40 $485.40 79702 $255.12 $255.12 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE A 7

NOUVEAU-BRUNSWICK, GRILLE RÉGIONALE DES SOINS DENTAIRES DU PROGRAMME DES SSNA DENTISTES GÉNÉRALISTES ET SPÉCIALISTES *NOMENCLATURE B* Acte L DG Endo Chirur. B Ortho Pédo Paro Radio Prostho Path B. 0.1 - Diagnostic 01401 $115.95 01501 $122.47 01601 $115.95 01701 $72.93 01801 $115.95 01901 $290.51 $290.51 01902 $57.33 0.2 - Radiographies 02501 $30.13 $46.89 $46.89 $46.89 $46.89 02502 $48.49 $79.38 $79.38 $79.38 $79.38 02503 $65.52 $112.02 $112.02 $112.02 $112.02 02504 $85.17 $131.57 $131.57 $131.57 $131.57 02701 $49.78 $66.43 $66.43 $66.43 $66.43 02702 $68.15 $91.20 $91.20 $91.20 $91.20 02703 $86.49 $115.95 $115.95 $115.95 $115.95 02704 $104.83 $140.70 $140.70 $140.70 $140.70 02751 $47.17 $58.63 $58.63 $58.63 $58.63 02752 $94.36 $117.23 $117.23 $117.23 $117.23 02931 $42.98 $42.98 $42.98 02932 $76.86 $76.86 $76.86 02933 $110.71 $110.71 $110.71 02934 $144.60 $144.60 $144.60 04801 $15.71 $19.25 04802 $23.58 $28.66 04803 $31.45 $37.78 04809 $7.46 $9.12 04911 $43.23 $53.39 $53.39 $53.39 04931 L $62.89 $84.69 1.0 - Prévention 14611 L $221.32 $367.35 $367.35 14612 L $221.32 $367.35 $367.35 14621 L $54.24 $67.82 $67.82 14631 $98.36 $150.70 $150.70 2.0 - Restauration * Tous les actes de l'annexe B nécessitent une prédétermination.* 0.4 - Tests et examens de laboratoire divers 21301 $130.18 $161.94 $161.94 21302 $130.18 $161.94 $161.94 23601 $135.41 $168.42 $168.42 23602 $155.20 25731 $107.81 $133.44 $133.44 25732 $161.67 $201.47 $201.47 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE B 1

25733 $206.42 $256.44 $256.44 25751 $191.93 $238.10 $238.10 25752 $245.85 $306.13 $306.13 25753 $290.52 $361.10 $361.10 25754 $191.93 $238.10 $238.10 25755 $245.85 $306.13 $306.13 25756 $290.52 $354.01 $354.01 25761 $191.93 $238.10 $238.10 25762 $245.85 $306.13 $306.13 25763 $290.52 $361.10 $361.10 25764 $239.25 $287.12 $287.12 25765 $284.24 $341.09 $341.09 25766 $329.22 $395.07 $395.07 27211 L $545.59 $654.71 $654.71 27301 L $498.27 $620.14 $620.14 3.0 -Endodontie 33121 $486.43 $562.57 $562.57 33131 $629.76 $787.19 $787.19 33141 $740.17 $925.23 $925.23 33601 $178.80 $196.26 $196.26 33602 $227.45 $248.60 $248.60 33603 $323.42 $327.08 $327.08 33604 $432.52 $523.32 $523.32 33621 $357.61 $444.84 $444.84 33622 $450.05 $562.57 $562.57 33623 $629.76 $787.19 $787.19 33624 $740.17 $925.23 $925.23 34111 $227.45 $353.25 $353.25 34121 $204.77 $444.84 $444.84 34122 $335.22 $549.50 $549.50 34131 $272.12 $484.07 $484.07 34132 $347.08 $575.65 $575.65 34133 $379.91 $680.33 $680.33 34141 $240.58 $353.25 $353.25 34151 $264.26 $444.84 $444.84 34161 $285.30 $484.07 $484.07 34162 $360.23 $575.65 $575.65 34211 $64.41 $91.59 $91.59 34221 $72.31 $111.21 $111.21 34222 $88.07 $156.99 $156.99 34231 $88.07 $130.83 $130.83 34232 $97.29 $176.62 $176.62 34233 $127.52 $196.26 $196.26 34241 $64.41 $91.59 $91.59 34251 $72.31 $111.21 $111.21 34261 $88.07 $130.83 $130.83 34262 $176.62 $176.62 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE B 2

4.0 - Services parodontaux 41211 $55.11 $68.90 $68.90 41221 $55.11 $68.90 $68.90 41231 $55.11 $68.90 $68.90 41301 $21.77 $27.22 $27.22 42201 $215.60 $340.16 $340.16 42311 $215.60 $346.72 $346.72 42321 $241.91 $366.32 $366.32 42331 $70.63 $70.63 42339 $45.78 $45.78 42521 $368.87 $461.10 $461.10 42531 $382.37 $477.95 $477.95 42551 $618.53 $618.53 42571 $618.53 $618.53 42821 $55.11 $68.90 $68.90 43511 $44.69 $59.18 $59.18 43519 $44.69 $59.18 $59.18 49101 $47.10 $58.88 $58.88 $58.88 49102 $94.19 $117.77 $117.77 $117.77 49109 $47.10 $58.88 $58.88 $58.88 5.0 -Prothèses amovibles 51101 L $507.47 $630.60 $630.60 51102 L $566.65 $703.88 $703.88 51103 L $1,014.94 $1,262.54 $1,262.54 51301 L $563.45 $630.60 $630.60 51302 L $622.94 $703.88 $703.88 51303 L $1,124.60 $1,262.54 $1,262.54 51711 L $637.65 $809.72 $809.72 51712 L $674.77 $809.72 $809.72 51713 L $1,186.46 $1,423.76 $1,423.76 51811 L $637.65 $765.19 $765.19 51812 L $674.77 $809.72 $809.72 51813 L $1,186.46 $1,423.76 $1,423.76 52101 L $173.54 $210.41 $210.41 52102 L $173.54 $210.41 $210.41 52103 L $308.96 $384.65 $384.65 52111 L $198.59 $247.03 $247.03 52112 L $198.59 $247.03 $247.03 52113 L $361.95 $450.27 $450.27 52201 L $302.14 $375.83 $375.83 52202 L $302.14 $375.83 $375.83 52203 L $550.64 $684.93 $684.93 52211 L $363.11 $451.69 $451.69 52212 L $363.11 $451.69 $451.69 52213 L $634.52 $790.00 $790.00 52301 L $332.61 $413.43 $413.43 52302 L $332.61 $413.43 $413.43 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE B 3

52303 L $623.17 $774.51 $774.51 52311 L $388.65 $483.43 $483.43 52312 L $388.65 $483.43 $483.43 52313 L $646.56 $804.24 $804.24 52401 L $351.03 $436.96 $436.96 52402 L $351.03 $436.96 $436.96 52403 L $645.52 $803.30 $803.30 52411 L $401.63 $499.64 52412 L $401.63 $499.64 52413 L $659.71 $820.63 52711 L $401.63 $481.97 $481.97 52712 L $401.63 $481.97 $481.97 52713 L $659.71 $791.66 $791.66 52811 L $419.14 $502.97 $502.97 52812 L $419.14 $502.97 $502.97 52813 L $725.81 $870.98 $870.98 53101 L $600.82 $747.05 $747.05 53102 L $600.82 $747.05 $747.05 53103 L $1,150.38 $1,431.29 $1,431.29 53104 L $63.40 $105.97 $105.97 53111 L $647.38 $805.30 $805.30 53112 L $647.38 $805.30 $805.30 53113 L $1,209.92 $1,505.03 $1,505.03 53201 L $554.81 $689.47 $689.47 53202 L $554.81 $689.47 $689.47 53203 L $1,067.54 $1,327.94 $1,327.94 53211 L $622.27 $774.04 $774.04 53212 L $622.27 $774.04 $774.04 53213 L $1,143.48 $1,422.38 $1,422.38 53711 L $587.69 $794.71 53712 L $587.69 $794.71 53713 L $1,114.87 $1,536.36 53714 L $75.35 $90.41 $90.41 53811 L $638.87 $705.22 $705.22 53812 L $638.87 $705.22 $705.22 53813 L $1,235.11 $1,482.12 $1,482.12 53814 $75.35 $90.41 $90.41 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE B 4

6.0 - Prothèses fixes (comme service équivalant à la prothèse amovible; approuvées â titre d'exception) - Maximum 950$ incluant les frais de laboratoire. 66111 L $55.11 $68.90 $68.90 66112 L $110.21 $137.77 $137.77 66113 L $165.32 $206.64 $206.64 66211 $55.11 $61.49 $61.49 66212 $110.21 $122.99 $122.99 66213 $165.32 $184.47 $184.47 66221 $55.11 $66.12 $66.12 66222 $110.21 $132.26 $132.26 66223 $165.32 $198.38 $198.38 66251 $55.11 $66.12 $66.12 66252 $110.21 $132.26 $132.26 66253 $165.32 $198.38 $198.38 66301 L $55.11 $68.90 $68.90 66302 L $110.21 $137.77 $137.77 66303 L $165.32 $206.64 $206.64 66711 $85.45 $105.97 $105.97 66719 $85.45 $105.97 $105.97 66721 L $55.11 $66.12 $66.12 66729 $55.11 $66.12 $66.12 66731 L $427.35 $512.82 $512.82 66739 L $427.35 $512.82 $512.82 7.0 - Chirurgie buccale 71201 $122.26 $151.79 $151.79 $151.79 71209 $99.92 $124.30 $124.30 $124.30 72111 $122.26 $151.79 $151.79 72119 $99.92 $124.30 $124.30 72211 $182.73 $226.35 $226.35 72219 $148.55 $184.47 $184.47 72221 $256.40 $317.91 $317.91 72229 $222.18 $276.05 $276.05 72231 $272.12 $362.01 $362.01 72239 $237.95 $295.68 $295.68 72321 $94.66 $120.37 $120.37 72329 $77.63 $98.70 $98.70 72331 $161.23 $201.47 $201.47 72339 $148.41 $165.21 $165.21 72511 $55.22 $156.99 $156.99 72519 $42.07 $81.12 $81.12 72521 $185.39 $260.37 $260.37 72529 $153.81 $191.03 $191.03 72531 $268.20 $425.20 $425.20 72539 $249.80 $425.20 $425.20 72541 $281.16 $455.29 $455.29 72551 $303.65 $519.40 $519.40 72631 $219.55 $359.89 $359.89 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE B 5

72639 $148.55 $191.12 $191.12 72711 $168.28 $260.37 $260.37 72719 $141.96 $225.02 $225.02 73111 $60.47 $74.57 $74.57 73222 $211.93 $211.93 73223 $226.12 $376.80 $376.80 73231 $193.64 $193.64 $193.64 73241 $146.54 $146.54 $146.54 73411 $328.38 $328.38 73421 $388.58 $388.58 73431 $355.85 $355.85 73441 $372.86 $372.86 73451 $693.40 $693.40 73461 $693.40 $693.40 75401 $554.75 $554.75 75402 $605.76 $605.76 75403 $124.30 $124.30 75411 $699.95 $699.95 75412 I.C. I.C. 79311 $222.18 $302.21 $302.21 79312 $189.32 $425.20 $425.20 79321 $114.37 $151.79 $151.79 79322 $151.79 $151.79 79331 $189.32 $562.57 $562.57 79332 L $558.87 $558.87 79333 $195.90 $558.87 $558.87 79341 $497.15 $497.15 79342 L $595.28 $595.28 79343 $595.28 $595.28 8.0 - Orthodontie 80601 $31.56 $45.78 $45.78 80602 $49.97 $61.49 $61.49 80631 L $47.32 $66.74 $66.74 80632 L $94.66 $133.44 $133.44 80639 $47.32 $66.74 $66.74 80641 $55.11 $68.90 $68.90 80642 $110.21 $137.77 $137.77 80649 $55.11 $68.90 $68.90 80651 $47.32 $58.88 $58.88 80659 $47.32 $58.88 $58.88 80661 $47.32 $58.88 $58.88 80669 $47.32 $58.88 $58.88 80671 $47.32 $58.88 $58.88 80679 $47.32 $58.88 $58.88 81111 L $276.10 $342.77 $342.77 81112 L $276.10 $342.77 $342.77 81113 L $339.21 $421.29 $421.29 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE B 6

81114 L $339.21 $421.29 $421.29 81115 L I.C. I.C. 81116 L I.C. 81121 L $286.61 $355.85 $355.85 81122 L $286.61 $355.85 $355.85 81123 L $393.11 $489.29 $489.29 81124 L $393.11 $489.29 $489.29 81131 L $289.23 $359.79 $359.79 81132 L $289.23 $359.79 $359.79 81133 L $358.91 $446.13 $446.13 81134 L $358.91 $446.13 $446.13 81135 L $412.80 $512.87 $512.87 81211 L $412.80 $512.87 $512.87 81212 L $412.80 $512.87 $512.87 81221 L $223.52 $277.36 $277.36 81222 L $223.52 $277.36 $277.36 81231 L $351.04 $436.96 $436.96 81232 L $351.04 $436.96 $436.96 81241 L $351.04 $436.96 $436.96 81242 L $351.04 $436.96 $436.96 81243 L $241.92 $300.92 $300.92 81251 L $483.82 $601.82 $601.82 81252 L $483.82 $601.82 $601.82 81253 L $483.82 $601.82 $601.82 81291 L $379.96 $472.28 $472.28 81292 L $379.96 $472.28 $472.28 81293 L $366.81 $456.62 $456.62 81294 L $366.81 $456.62 $456.62 83101 L $143.31 $177.93 $177.93 83102 L $143.31 $177.93 $177.93 83201 L $176.00 $214.56 $214.56 83202 L $176.00 $214.56 $214.56 9.0 - Services complémentaires 92212 $169.34 $169.34 92213 $210.29 $210.29 92214 $251.23 $251.23 92215 $292.18 $292.18 92216 $333.12 $333.12 92217 $374.06 $374.06 92218 $415.07 $415.07 92219 $46.62 $46.62 92222 $78.09 $78.09 92223 $114.77 $114.77 92224 $151.42 $151.42 92225 $188.07 $188.07 92226 $224.73 $224.73 92227 $261.41 $261.41 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE B 7

92228 $298.07 $298.07 92229 $41.38 $41.38 92301 $58.93 $58.93 $58.93 92302 $117.77 $117.77 $117.77 92303 $176.63 $176.63 $176.63 92304 $235.49 $235.49 $235.49 92305 $294.37 $294.37 $294.37 92306 $353.26 $353.26 $353.26 92307 $412.14 $412.14 $412.14 92308 $471.00 $471.00 $471.00 92309 $58.93 $58.93 $58.93 92411 $43.39 $53.64 $53.64 $53.64 92412 $65.72 $81.13 $81.13 $81.13 92413 $88.07 $108.62 $108.62 $108.62 92414 $110.42 $136.08 $136.08 $136.08 92415 $132.76 $163.55 $163.55 $163.55 92416 $155.11 $191.03 $191.03 $191.03 92417 $177.46 $218.51 $218.51 $218.51 92418 $199.79 $245.95 $245.95 $245.95 92419 $22.36 $27.49 $27.49 $27.49 92421 $47.32 $58.88 $58.88 $58.88 92431 $47.32 $58.88 $58.88 $58.88 92432 $94.66 $117.77 $117.77 $117.77 92433 $141.96 $176.63 $176.63 $176.63 92434 $189.31 $235.49 $235.49 $235.49 92435 $236.63 $294.37 $294.37 $294.37 92436 $283.96 $353.26 $353.26 $353.26 92437 $331.31 $412.14 $412.14 $412.14 92438 $378.61 $470.98 $470.98 $470.98 92439 $47.32 $58.88 $58.88 $58.88 92441 $47.32 $58.88 $58.88 $58.88 92442 $94.66 $117.77 $117.77 $117.77 92443 $141.96 $176.63 $176.63 $176.63 92444 $189.31 $235.49 $235.49 $235.49 92445 $236.63 $294.37 $294.37 $294.37 92446 $283.96 $353.26 $353.26 $353.26 92447 $331.31 $412.14 $412.14 $412.14 92448 $378.61 $470.98 $470.98 $470.98 92449 $47.32 $58.88 $58.88 $58.88 92451 I.C. $60.19 $60.19 $60.19 92452 I.C. $120.37 $120.37 $120.37 92453 I.C. $180.56 $180.56 $180.56 92454 I.C. $240.75 $240.75 $240.75 92455 I.C. $300.92 $300.92 $300.92 92456 I.C. $361.11 $361.11 $361.11 92457 I.C. $421.30 $421.30 $421.30 92458 I.C. $481.47 $481.47 $481.47 Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE B 8

92459 I.C. $60.19 $60.19 $60.19 94302 $60.47 $75.88 $75.88 $75.88 96201 $37.94 96202 $45.78 99111 I.C. I.C. 99222 I.C. I.C. I.C. I.C. I.C. I.C. 99333 I.C. I.C. Date en vigueur : 1er mars 2009 Nouveau-Brunswick - NOMENCLATURE B 9