21111 One surface
| 20000 | RESTORATION |
||
| 21000 | RESTORATIONS, AMALGAM |
||
| 21100 | RESTORATION, AMALGAM, PRIMARY TEETH |
||
| 21110 | Rertorations, Amalgam, Non-Bonded, Primary Teeth |
||
| 21111 | One surface | $101.55 | $101.55 |