42521 Per site
| 40000 | PERIODONTICS |
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| 42000 | PERIODONTAL SERVICES, SURGICAL |
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| 42500 | PERIODONTAL SURGERY, FLAPS, GRAFTS, SOFT TISSUE |
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| 42520 | Grafts, Soft Tissue, Pedicle (Coronally Positioned) |
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| 42521 | Per site | $667.05 | $667.05 |