21240 Restorations, Amalgam, Bonded, Permanent Molars
| 20000 | RESTORATION |
||
| 21000 | RESTORATIONS, AMALGAM |
||
| 21200 | RESTORATIONS, AMALGAM, PERMANENT TEETH |
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| 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 |