No DIAGNOSA KODE ICD

1 Gangguan perkembangan dan erupsi gigi (Disorders of tooth K00

develompment and eruption)
2 Supernumerary teeth K00.1
3 Gangguan erupsi gigi (Disturbances in tooth eruption) K00.6
4 Gigi sulung tidak tanggal/ persistensi (Retained persistent primary K00.63
tooth). Persistensi gigi sulung
5 Gigi impaksi (Impacted teeth) K01.1
6 Molar rahang atas impaksi (Maxillary molar impacted) K01.16
7 Molar bawah impaksi (Mandibular molar impacted) K01.17
8 Karies gigi (Dental caries) K02
9 Karies terhenti (Arrested caries) K02.3
10 Karies gigi pada permukaan pit dan fissure (Dental caries on pit K02.5
and fissure surface)
11 Karies gigi pada permukaan pit dan fissure terbatas pada K02.51
lapisan email (Dental caries on pit and fissure surface limited to
enamel). Demineralisasi permukaan halus/ aproksimal karies dini
/ lesi putih / karies email tanpa kavitas
12 Karies gigi pada permukaan halus (Dental caries on smooth K02.6
Surface)
13 Karies gigi pada permukaan halus terbatas pada lapisan K02.61
Email (Dental caries on smooth surface limited to enamel)
14 Karies gigi pada permukaan halus mencapai dentin (Dental caries K02.62
on smooth surface penetrating into dentin)
15 Karies gigi, lainnya, ydt (Other specified dental caries) Karies K02.8
mencapai pulpa vital gigi sulung
16 Atrisi gigi berlebihan (Excessive attrition of teeth) K03.0

17 Abrasi gigi (Abrasion of teeth) K03.1

18 Erosi gigi (Erosion of teeth) K03.2
19 Resorbsi patologis K03.3
20 Endapan akresi pada gigi (Deposits accretions on teeth)/ OH K03.6
buruk
21 Perubahan warna pada mahkota eksterna (Posteruptive color K03.7
changes of dental hard tissues)
22 Dentin Hipersensitif (Sensitive dentine) K03.8
23 Penyakit jaringan pulpa dan periapikal (Diseases of pulp and K04
periapical tissue)
24 Hyperemia pulpa gigi tetap muda (Hyperaemia) K04.00
25 Iritasi pulpa gigi tetap muda K04.01
26 Irreversible pulpitis K04.02
27 Reversible pulpitis K04.03
28 Nekrosis pulpa (Necrosis of pulp) K04.1
29 Periodontitis apikalis akut (Acute apicalis periodontitis) K04.4
30 Periodontitis apikalis kronis (Chronic apicalis periodontitis) K04.5
31 Abses periapikal dengan sinus (Periapical abcess with sinus) K04.6
32 Abses periapikal dengan sinus (Periapical abcess without sinus) K04.7
33 Kista radikuler (Radicular cyst) K04.8
34 Gingivitis dan penyakit periodontal (Gingivitis and periodontal K05
disease)
35 Gingivitis akut (Acute gingivitis) K05.0
36 Gingivitis akut akibat plak (Acute gingivitis plaque induced) K05.00
37 Gingivitis kronis (Chronic gingivitis) K05.1
38 Periodontitis agresif (Agrressive periodontitis) K05.2
39 Abses periodontal (Agrressive periodontitis localized / periodontal K05.21
abcess)

NO DIAGNOSA KODE ICD

40 Periodontitis kronis ringan dan sedang (Chronic periodontitis) K05.3
41 Resesi gingiva (Gingival recession) K06.0
42 Pembesaran gingiva (Enlargement gingiva) K06.1
43 Anomali dentofasial (Dentofacial anomalies) K07
44 Anomali hubungan antara lengkung gigi (Anomalies of dental K07.2
arch relationship)
45 Distoklusi (Disto Occlusion) K07.20
46 Mesioklusi (Mesio Occlusion) K07.21
47 Jarak gigit berlebihan ˗ Tumpang gigit horisontal (Overjet K07.22
excessive overjet ˗ horizontal overbite)
48 Tumpang gigit berlebihan ˗ Tumpang gigit vertikal (Overbite K07.23
excessive overbite ˗ vertical overbite)
49 Gigitan terbuka (Openbite) K07.25
50 Gigitan bersilang depan, belakang (Crossbite anterior or K07.26
posterior)
51 Oklusi lingual gigi posterior rahang bawah (Posterior lingual K07.27
occlusion of mandibular teeth)
52 Anomali letak gigi (Anomalies of tooth position) karena K07.3
kehilangan prematur gigi sulung
53 Kelainan fungsi dentofasial (Dentofacial functional abnormalities) K07.5
54 Maloklusi akibat kelainan menelan (Malocclusion due to K07.51
abnormal swallowing)
55 Maloklusi akibat kelainan menelan (Malocclusion due to mouth K07.54
breathing)
56 Maloklusi akibat kebiasaan buruk lidah, bibir atau jari tangan K07.55
(Malocclusion due to tongue, lip and finger habits)
57 Gangguan TMJ K07.6
58 Gangguan gigi dan jaringan pendukung lainnya (Other disorders K08
of teeth and supporting structures)
59 Seluruh gigi tanggal (Complete loss of teeth) K08.1
60 Seluruh gigi tanggal tanpa penyebab spesifik (Complete loss of K08.10
teeth unspecified cause)
61 Seluruh gigi tanggal akibat trauma (Complete loss of teeth due to K08.11
trauma)
62 Seluruh gigi tanggal akibat penyakit periodontal (Complete loss of K08.12
teeth due to periodontal disease)
63 Seluruh gigi tanggal akibat karies (Complete loss of teeth due to K08.13
caries)
64 Akar gigi tertinggal (Retained dental root) K08.3
65 Sebagian gigi tanggal (Partial loss of teeth) K08.4
66 Sebagian gigi tanggal tanpa penyebab spesifik (Partial loss of K08.40
teeth due unspecified cause)
67 Sebagian gigi tanggal akibat trauma (Partial loss of teeth duee to K08.41
trauma)
68 Sebagian gigi tanggal akibat penyakit periodontal (Partial loss of K08.42
teeth due to diseases)
69 Sebagian gigi tanggal akibat karies (Partial loss of teeth due to K08.43
caries)
70 Kista Odontogenik (Odontogenic cyst) K09.0
71 Granuloma K10.1
72 Abses kelenjar ludah K11.3
73 Sialothiasis K11.5
74 Gangguan sekresi saliva K11.7
75 Stomatitis dan lesilesi yang berhubungan (Stomatitis and related K12
lesions)
76 Afte mulut rekuren (Recurrent oral apthae) K12.0
77 Afte minor kambuhan (Recurrent aphthous ulcer) K12.00
78 Luka traumatik (Traumatic ulcer) K12.04
79 Selulitis dan abses mulut K12.2
80 Penyakit bibir dan mukosa mulut lainya K13
81 Angular cheilitis K13.01
82 Eritema multiformis (Erythema multiforme) L51
83 Eritema multiformis non bulosa L51.0
84 Eritema multiformis bulosa L51.1
85 Eritema multiformis non bulosa manisfestasi di mulut L51.0X
86 Eritema multiformis bulosa manisfestasi di mulut L51.1X
87 Facial pain no otherwise specified (Nyeri orofasial) R51
88 Fraktur tengkorak dan tulang muka (Fracture of skull and facial S02
bones)
89 Fraktur gigi (Fracture of tooth) S02.5
90 Fraktur email gigi (Fracture of enamel of tooth only) S02.50
91 Fraktur mahkota gigi tanpa mengenai pulpa (Fracture of crown of S02.51
tooth without pulpal involvement)
92 Infeksi spiroketal lainnya (Other spirochaetal infection) A69
93 Infeksi Vincent lainnya (Other Vincent’s infection) A69.1
94 Gingivitis ulseratif nekrotik akut (ANUG) A69.10
95 Infeksi virus hespes simplex (Herpes simplex infection) B00
96 Dermatitis virus herpes vesikuler (Herpesviral vesicular B00.1
dermatitis)
97 Herpes simplex labialis B00.11
98 Gingivostomatitis dan faringotonsilitis virus herpes (Herpesviral B00.2
gingivostomatitis and pharyngotonsilitis)
99 Primary herpetic gingivostomatitis, Recurrent intra oral herpes/ B00.2X
stomatitis herpetika
100 Infeksi virus dengan lesi pada kulit dan selaput lendir lainnya B08
(Other viral infection characterized by skin and mucous
membrane lesions not elsewhere classified)
101 Stomatitis vesikular enterovirus dengan ruam, Hand foot and B08.4
mouth disease/ flu singapura (Enteroviral vesicular stomatitis
with exanthem)
102 Mumps (Parotitis epidemika) B26
103 Mumps tanpa komplikasi B26. 9
104 Mumps manifestasi di rongga mulut B26. 9X
105 Kandidiasis (Candidiasis) B37
106 Kandida stomatitis (Candidal stomatitis) B37.0
107 Kandida stomatitis pseudomembran akut (Acute B37.00
pseudomembranous candidal stomatitis)
108 Candida stomatitis atrofik kronis (Denture stomatitis due to B37.03
candidal infection)
POLI GIGI PUSKESMAS BETUN ˍˍedited by drg. Maria M S.
Nogo Masa, MMR