42823 Three units
| 40000 | PERIODONTICS |
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| 42000 | PERIODONTAL SERVICES, SURGICAL |
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| 42800 | PERIODONTAL SURGERY, MISCELLANEOUS PROCEDURES |
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| 42820 | Post Surgical Periodontal Treatment Visit Per Dressing Change |
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| 42823 | Three units | $238.38 | $238.38 |