13239 Each additional unit over two
| 10000 | PREVENTION |
||
| 13000 | PREVENTIVE SERVICES, OTHER |
||
| 13200 | ORAL HYGIENE INSTRUCTION/PLAQUE CONTROL |
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| 13230 | Re-Instruction (Within 6 Months) - Excluding Audio-Visual Time |
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| 13239 | Each additional unit over two | $74.0 | $74.0 |