Labial veneer (porcelain laminate), laboratory Reline complete or partial upper or lower denture, laboratory Reline complete or partial upper or lower denture, chairside Replace missing or broken teeth, complete denture, each tooth Upper or lower partial denture, cast metal base with resin saddlesĪdjust complete or partial upper or lower denture Upper or lower partial denture, resin base *member is responsible for copayment plus actual lab cost of gold Removal of impacted tooth, partially bony
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