91121 One unit of time
| 90000 | GENERAL SERVICES |
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| 91000 | UNCLASSIFIED TREATMENTS |
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| 91100 | UNCLASSIFIED TREATMENT, DENTAL PAIN |
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| 91120 | Emergency Services Not Othewise Specified In Guide |
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| 91121 | One unit of time | $113.65 | $113.65 |