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FEMALE DENTOLOUS EDENTOLOUS NEW MEMBER

MALE DENTOLOUS EDENTOLOUS NEW MEMBER

Procedure Primary Permanent Maxilla Mandible

Restoration X 12,14, 33.38
Extraction X 13 41
Cosmetics
Prosthetics
*Tooth Prophylaxis (cleaning)

NAME: KRYSTYNE JOY MILLETTE ASUNCION AGE:18

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