13401 First tooth
| 10000 | PREVENTION |
||
| 13000 | PREVENTIVE SERVICES, OTHER |
||
| 13400 | SEALANTS, PIT AND FISSURE (Mechanical and/or chemical preparation included) |
||
| 13401 | First tooth | $34.06 | $34.06 |
| 10000 | PREVENTION |
||
| 13000 | PREVENTIVE SERVICES, OTHER |
||
| 13400 | SEALANTS, PIT AND FISSURE (Mechanical and/or chemical preparation included) |
||
| 13401 | First tooth | $34.06 | $34.06 |