15604 Removal of Fixed Space Maintainer Appliances by Second Dentist
| 10000 | PREVENTION |
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| 15000 | SPACE MAINTAINERS |
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| 15600 | SPACE MAINTAINERS, MAINTENANCE OF |
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| 15604 | Removal of Fixed Space Maintainer Appliances by Second Dentist | $81.78 | $81.78 |