23504 Four surfaces
| 20000 | RESTORATION |
||
| 23000 | RESTORATIONS, TOOTH COLOURED/PLASTIC WITH/WITHOUT SILVER FILINGS |
||
| 23500 | RESTORATIONS, TOOTH COLOURED/ PLASTIC WITH/WITHOUT SILVER FILINGS, PRIMARY, |
||
| 23504 | Four surfaces | $186.66 | $186.66 |