42541 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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| 42540 | Grafts, Soft Tissue, Pedicle, With Free Graft Placed In Pedicle Donor Site |
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| 42541 | Per site | $1217.66 | $1217.66 |