21220 Restorations, Amalgam, Non-Bonded, Permanent Molars

20000

RESTORATION

21000

RESTORATIONS, AMALGAM

21200

RESTORATIONS, AMALGAM, PERMANENT TEETH

21220 Restorations, Amalgam, Non-Bonded, Permanent Molars
21221

One surface

118.25 118.25
21222

Two surfaces

146.93 146.93
21223

Three surfaces

200.71 200.71
21224

Four surfaces

253.1 253.1
21225

Five surfaces or maximum surfaces per tooth

282.95 282.95
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