20120 Caries/Trauma/Pain Control
| 20000 | RESTORATION |
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| 20100 | CARIES, TRAUMA AND PAIN CONTROL |
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| 20120 | Caries/Trauma/Pain Control | ||
| Additional Information: | Add'l Info: | (removal of carious lesions or existing restorations or gingivally attached tooth fragment and |
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| 20121 | First tooth |
125.14 - 208.56 | 125.14 - 208.56 |
| 20129 | Each additional tooth same quadrant |
125.14 - 208.56 | 125.14 - 208.56 |