22400 RESTORATIONS PREFABRICATED, PLASTIC, PRIMARY TEETH
| 20000 | RESTORATION |
||
| 22000 | RESTORATIONS, PREFABRICATED, FULL COVERAGE |
||
| 22400 | RESTORATIONS PREFABRICATED, PLASTIC, PRIMARY TEETH | ||
| 22401 | Primary Anterior |
182.5 | 182.5 |
| 22411 | Primary Posterior |
182.5 | 182.5 |