23402 Two surfaces
| 20000 | RESTORATION |
||
| 23000 | RESTORATIONS, TOOTH COLOURED/PLASTIC WITH/WITHOUT SILVER FILINGS |
||
| 23400 | RESTORATIONS, TOOTH COLORED, PRIMARY, ANTERIOR, NON BONDED |
||
| 23402 | Two surfaces | $138.71 | $138.71 |