CIGNA Dental Care Patient Charge Schedule
CIGNA Dental Care® Patient Charge Schedule (DC-07) Code Procedure Description Patient Coinsurance Restorative (Fillings) D2140 Amalgam – 1 Surface, Primary or Permanent $13.00 D2150 Amalgam – 2 Surfaces, Primary or Permanent $16.00 D2160 Amalgam – 3 Surfaces, Primary or Permanent $16.00
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