23224 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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| 23220 | Permanent Molars |
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| 23224 | Four surfaces | $223.2 | $223.2 |