23400 RESTORATIONS, TOOTH COLORED, PRIMARY, ANTERIOR, NON BONDED
| 20000 | RESTORATION |
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| 23000 | RESTORATIONS, TOOTH COLOURED/PLASTIC WITH/WITHOUT SILVER FILINGS |
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| 23400 | RESTORATIONS, TOOTH COLORED, PRIMARY, ANTERIOR, NON BONDED | ||
| 23401 | One surface |
112.62 | 112.62 |
| 23402 | Two surfaces |
138.71 | 138.71 |
| 23403 | Three surfaces |
162.69 | 162.69 |
| 23404 | Four surfaces |
205.45 | 205.45 |
| 23405 | Five surfaces (maximum surfaces per tooth) |
250.28 | 250.28 |
| 23410 | Retsorations, Tooth Colored, Primary, Anterior, Bonded Technique |