91129 Each additional unit over three
| 90000 | GENERAL SERVICES |
||
| 91000 | UNCLASSIFIED TREATMENTS |
||
| 91100 | UNCLASSIFIED TREATMENT, DENTAL PAIN |
||
| 91120 | Emergency Services Not Othewise Specified In Guide |
||
| 91129 | Each additional unit over three | $113.65 | $113.65 |