42621 Per site
| 40000 | PERIODONTICS |
||
| 42000 | PERIODONTAL SERVICES, SURGICAL |
||
| 42600 | PERIODONTAL SURGERY, FLAPS, GRAFTS, OSSEOUS TISSUE |
||
| 42620 | Grafts, Osseous, Allograft (Including Flap Entry and Closure) |
||
| 42621 | Per site |
$1111.75
+Material Expenses |
$1111.75
+Mater. Exp. |