21210 Restorations, Amalgam, Non-Bonded, Permanent Bicuspids and Anteriors

20000

RESTORATION

21000

RESTORATIONS, AMALGAM

21200

RESTORATIONS, AMALGAM, PERMANENT TEETH

21210 Restorations, Amalgam, Non-Bonded, Permanent Bicuspids and Anteriors
21211

One surface

111.99 111.99
21212

Two surfaces

139.98 139.98
21213

Three surfaces

196.54 196.54
21214

Four surfaces

241.62 241.62
21215

Five surfaces or maximum surfaces per tooth

263.12 263.12
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