23113 Three surfaces
| 20000 | RESTORATION |
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| 23000 | RESTORATIONS, TOOTH COLOURED/PLASTIC WITH/WITHOUT SILVER FILINGS |
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| 23100 | RESTORATIONS, TOOTH COLOURED, PERMANENT ANTERIORS, NON BONDED TECHNIQUE |
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| 23110 | Restorations, Permanent Anteriors, Bonded Technique |
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| 23113 | Three surfaces | $195.79 | $195.79 |