25120 Inlays, Composite/Compomer, Indirect (Bonded)
| 20000 | RESTORATION |
||
| 25000 | RESTORATIONS, INLAYS, ONLAYS, PINS AND POSTS |
||
| 25100 | RESTORATIONS INLAYS |
||
| 25120 | Inlays, Composite/Compomer, Indirect (Bonded) | ||
| 25121 | One surface |
491.6
+Lab Costs |
491.6
+Lab Costs |
| 25122 | Two surfaces |
573.4
+Lab Costs |
573.4
+Lab Costs |
| 25123 | Three surfaces |
669.79
+Lab Costs |
669.79
+Lab Costs |
| 25124 | Three surfaces, modified |
861.59
+Lab Costs |
861.59
+Lab Costs |