42611 Per site
| 40000 | PERIODONTICS |
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| 42000 | PERIODONTAL SERVICES, SURGICAL |
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| 42600 | PERIODONTAL SURGERY, FLAPS, GRAFTS, OSSEOUS TISSUE |
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| 42610 | Grafts, Osseous, Autograft (Including Flap Entry, Closure and Donor Site) |
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| 42611 | Per site | $1111.75 | $1111.75 |