23210 Permanent Bicuspids
| 20000 | RESTORATION |
||
| 23000 | RESTORATIONS, TOOTH COLOURED/PLASTIC WITH/WITHOUT SILVER FILINGS |
||
| 23200 | RESTORATIONS, TOOTH COLOURED/ PLASTIC WITH/WITHOUT SILVER FILINGS, PERMANENT |
||
| 23210 | Permanent Bicuspids | ||
| 23211 | One surface |
114.7 | 114.7 |
| 23212 | Two surfaces |
145.99 | 145.99 |
| 23213 | Three surfaces |
183.54 | 183.54 |
| 23214 | Four surfaces |
221.11 | 221.11 |
| 23215 | Five surfaces or maximum surface per tooth |
232.57 | 232.57 |