13411 First tooth
| 10000 | PREVENTION |
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| 13000 | PREVENTIVE SERVICES, OTHER |
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| 13400 | SEALANTS, PIT AND FISSURE (Mechanical and/or chemical preparation included) |
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| 13410 | Preventive Restorative Resin (procedure that involves some preparation of the pits and/or fissures |
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| 13411 | First tooth | $75.74 | $75.74 |