42839 Each additional unit over four
| 40000 | PERIODONTICS |
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| 42000 | PERIODONTAL SERVICES, SURGICAL |
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| 42800 | PERIODONTAL SURGERY, MISCELLANEOUS PROCEDURES |
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| 42830 | Periodontal Abscess or Pericoronitis, May Include Any of The Following Procedures: Lancing, |
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| 42839 | Each additional unit over four | $83.42 | $83.42 |