21215 Five surfaces or maximum surfaces per tooth
| 20000 | RESTORATION |
||
| 21000 | RESTORATIONS, AMALGAM |
||
| 21200 | RESTORATIONS, AMALGAM, PERMANENT TEETH |
||
| 21210 | Restorations, Amalgam, Non-Bonded, Permanent Bicuspids and Anteriors |
||
| 21215 | Five surfaces or maximum surfaces per tooth | $263.12 | $263.12 |