23115 Five surfaces (maximum surfaces per tooth)
| 20000 | RESTORATION |
||
| 23000 | RESTORATIONS, TOOTH COLOURED/PLASTIC WITH/WITHOUT SILVER FILINGS |
||
| 23100 | RESTORATIONS, TOOTH COLOURED, PERMANENT ANTERIORS, NON BONDED TECHNIQUE |
||
| 23110 | Restorations, Permanent Anteriors, Bonded Technique |
||
| 23115 | Five surfaces (maximum surfaces per tooth) | $314.87 | $314.87 |