23413 Three surfaces
| 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 |
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| 23410 | Retsorations, Tooth Colored, Primary, Anterior, Bonded Technique |
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| 23413 | Three surfaces | $184.02 | $184.02 |