91123 Three units
| 90000 | GENERAL SERVICES |
||
| 91000 | UNCLASSIFIED TREATMENTS |
||
| 91100 | UNCLASSIFIED TREATMENT, DENTAL PAIN |
||
| 91120 | Emergency Services Not Othewise Specified In Guide |
||
| 91123 | Three units | $340.95 | $340.95 |