04722 Two units
| 00000 | DIAGNOSTIC |
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| 04000 | TEST/ANALYSIS/LABORATORY PROCEDURES/INTERPRETATION AND/OR REPORTS |
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| 04700 | SUPPLEMENTARY DIAGNOSTIC PROCEDURES (INTERPRETATION ONLY) |
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| 04720 | Wax-up, Diagnostic (To Evaluate Cosmetic And/Or Preparation Design And/Or Occlusal |
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| 04722 | Two units |
$155.8
+Lab Costs |
$155.8
+Lab Costs |