43220 Bonded, Interproximal Enamel Splint
| 40000 | PERIODONTICS |
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| 43000 | PERIODONTAL PROCEDURES, ADJUNCTIVE |
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| 43200 | PERIODONTAL SPLINTING OR LIGATION, EXTRA CORONAL |
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| 43220 | Bonded, Interproximal Enamel Splint | ||
| 43221 | Per joint |
79.45 | 79.45 |