72421 First tooth
| 70000 | ORAL MAXILLOFACIAL SURGERY |
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| 72000 | REMOVALS, (EXTRACTIONS), SURGICAL |
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| 72400 | ALVEOLAR BONE PRESERVATION |
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| 72420 | Alveolar Bone Preservation - Allograft |
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| 72421 | First tooth |
$318.03
+Material Expenses |
$318.03
+Mater. Exp. |