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Anatomical loss or injury of the mouth, lips or tongue . ICD code: _____ Date of diagnosis: _____ Osteomyelitis or osteoradionecrosis of the mandible ICD code: _____ Date of diagnosis: _____ Oral neoplasm If checked, specify: _____ ICD code: _____ Date of diagnosis: _____ Periodontal disease . If this is the ONLY diagnosis checked, proceed to ... ................
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