22401 Primary Anterior
| 20000 | RESTORATION |
||
| 22000 | RESTORATIONS, PREFABRICATED, FULL COVERAGE |
||
| 22400 | RESTORATIONS PREFABRICATED, PLASTIC, PRIMARY TEETH |
||
| 22401 | Primary Anterior | $182.5 | $182.5 |
| 20000 | RESTORATION |
||
| 22000 | RESTORATIONS, PREFABRICATED, FULL COVERAGE |
||
| 22400 | RESTORATIONS PREFABRICATED, PLASTIC, PRIMARY TEETH |
||
| 22401 | Primary Anterior | $182.5 | $182.5 |