22611 Primary Posterior
| 20000 | RESTORATION |
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| 22000 | RESTORATIONS, PREFABRICATED, FULL COVERAGE |
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| 22600 | RESTORATIONS, PREFABRICATED, PORCELAIN/CERAMIC/POLYMER GLASS, PRIMARY TEETH |
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| 22611 | Primary Posterior | $254.21 | $254.21 |