23502 Two surfaces
| 20000 | RESTORATION |
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| 23000 | RESTORATIONS, TOOTH COLOURED/PLASTIC WITH/WITHOUT SILVER FILINGS |
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| 23500 | RESTORATIONS, TOOTH COLOURED/ PLASTIC WITH/WITHOUT SILVER FILINGS, PRIMARY, |
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| 23502 | Two surfaces | $150.16 | $150.16 |