13213 Three units
| 10000 | PREVENTION |
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| 13000 | PREVENTIVE SERVICES, OTHER |
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| 13200 | ORAL HYGIENE INSTRUCTION/PLAQUE CONTROL |
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| 13210 | Individual Instruction (One Instructor To One Patient) - Excluding Audio-Visual Time |
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| 13213 | Three units | $222.04 | $222.04 |