05104 Four units
| 00000 | DIAGNOSTIC |
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| 05000 | CASE PRESENTATION/TREATMENT PLANNING |
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| 05100 | TREATMENT PLANNING |
||
| 05104 | Four units | $311.62 | $311.62 |
| 00000 | DIAGNOSTIC |
||
| 05000 | CASE PRESENTATION/TREATMENT PLANNING |
||
| 05100 | TREATMENT PLANNING |
||
| 05104 | Four units | $311.62 | $311.62 |