Date:
Time:
First Name:
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Extraction

Tooth #s:

OTHER PROCEDURES
CONSULTATION
RADIOGRAPHS
Alveoplasty TMJ
Biopsy Implants
Incision & Drainage Orthognathic
Lesion Evaluation Pre-Prosthetic
Exposure
Hard Tissue
IMPLANTS
Infection
Expose and Bond
SURGICAL TEMPLATE
Soft Tissue
Frenectomy

 

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