21240 Restorations, Amalgam, Bonded, Permanent Molars

20000

RESTORATION

21000

RESTORATIONS, AMALGAM

21200

RESTORATIONS, AMALGAM, PERMANENT TEETH

21240 Restorations, Amalgam, Bonded, Permanent Molars
21241

One surface

153.39 153.39
21242

Two surfaces

189.67 189.67
21243

Three surfaces

226.39 226.39
21244

Four surfaces

269.38 269.38
21245

Five surfaces or maximum surfaces per tooth

325.31 325.31
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