91113 Three units
| 90000 | GENERAL SERVICES |
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| 91000 | UNCLASSIFIED TREATMENTS |
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| 91100 | UNCLASSIFIED TREATMENT, DENTAL PAIN |
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| 91110 | Palliative (emergency) Treatment of Dental Pain, Minor Procedure |
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| 91113 | Three units | $323.95 | $323.95 |