23313 Three surfaces
| 20000 | RESTORATION |
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| 23000 | RESTORATIONS, TOOTH COLOURED/PLASTIC WITH/WITHOUT SILVER FILINGS |
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| 23300 | RESTORATIONS, TOOTH COLORED, PERMANENT POSTERIORS - BONDED |
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| 23310 | Permanent Bicuspids |
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| 23313 | Three surfaces | $243.73 | $243.73 |