| http://www.w3.org/ns/prov#value | - ral anesthesia - first 30 minutes Deep sedation/general anesthesia - each additional 15 minutes Intravenous conscious sedation/analgesic - first 30 minutes Intravenous conscious sedation/analgesic - each additional 15 minutes Consultation - diagnostic service provided by dentist or physician other than requesting dentist or physician Occlusal guards, by report Maximum Benefits $391 $408 $429 $423
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