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r <br />,CDUL BENEFITS ANNA CA "'� <br />CITY OF SANTA ASIA <br />CLIENT #41 <br />PARTS BANDED CASE - ADULT 500.00 <br />PARTS BANDED CASE - CHILD 500.00 <br />C BAYMEN7 <br />PRO C <br />CODE <br />MEMBER LACES: <br />MEMBER PA'S'S. <br />ADUNCTIE GENERAL SERVICES: <br />09110 <br />PALLIATIVE (EMERGENCY) TREATMENT OF DENTAL PAID <br />MINOR PROCEDURES <br />NO CHARGE <br />09215 <br />LOCAL ANESTHESIA <br />NO CHARGE <br />CONSULTATION - PER SESSION <br />NO CHARGE <br />09440 <br />OFFICE VISIT - AFFER WORKING HOURS <br />NO CHARGE <br />BROKEN APPOINTMENT (LESS THAN 24-HOUR NOTICE) <br />NO CHARGE <br />ORTHODONTICS: <br />FULL. BANDED CASE - ADULT <br />1000.00 <br />08000 <br />FULL. BANDED CASE - CHILD <br />1000.00 <br />PARTS BANDED CASE - ADULT 500.00 <br />PARTS BANDED CASE - CHILD 500.00 <br />