Dental Benefits Summary - Health Insurance Plans | …
Charges for crowns and bridgework are per unit. There will be additional charges for the actual cost for gold/high noble metal. ENDODONTICS D3110 Pulp Cap - Direct (excluding final restoration) No Charge D3120 Pulp Cap - Indirect (excluding final restoration) No Charge D3220 Therapeutic Pulpotomy (excluding final restoration) $55 ................
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