21234 Four surfaces
20000 | RESTORATION |
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21000 | RESTORATIONS, AMALGAM |
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21200 | RESTORATIONS, AMALGAM, PERMANENT TEETH |
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21230 | Restorations, Amalgam, Bonded, Permanent Bicuspids and Anteriors |
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21234 | Four surfaces | $262.08 | $262.08 |