23221 One surface
| 20000 | RESTORATION |
||
| 23000 | RESTORATIONS, TOOTH COLOURED/PLASTIC WITH/WITHOUT SILVER FILINGS |
||
| 23200 | RESTORATIONS, TOOTH COLOURED/ PLASTIC WITH/WITHOUT SILVER FILINGS, PERMANENT |
||
| 23220 | Permanent Molars |
||
| 23221 | One surface | $125.14 | $125.14 |