23214 Four surfaces
20000 | RESTORATION |
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23000 | RESTORATIONS, TOOTH COLOURED/PLASTIC WITH/WITHOUT SILVER FILINGS |
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23200 | RESTORATIONS, TOOTH COLOURED/ PLASTIC WITH/WITHOUT SILVER FILINGS, PERMANENT |
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23210 | Permanent Bicuspids |
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23214 | Four surfaces | $221.11 | $221.11 |