21242 Two surfaces
| 20000 | RESTORATION |
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| 21000 | RESTORATIONS, AMALGAM |
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| 21200 | RESTORATIONS, AMALGAM, PERMANENT TEETH |
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| 21240 | Restorations, Amalgam, Bonded, Permanent Molars |
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| 21242 | Two surfaces | $189.67 | $189.67 |