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["111110","1997-05-22",null,null,"Adult Prophylaxis","01110",30.00,null,null,null,"Y","EK","TO","1997-05-22"]
["111110","1997-05-22",null,null,"Periodic Oral Examination","00120",20.00,null,null,null,"Y","EK","TO","1997-05-22"]
["111111","1997-05-22",null,null,"Adult Prophylaxis","01110",30.00,null,null,null,"Y","EK","TO","1997-05-22"]
["111111","1997-05-22",null,null,"Periodic Oral Examination","00120",20.00,null,null,null,"Y","EK","TO","1997-05-22"]
["111111","1997-05-22",null,null,null,null,null,10.00,false,"2035","Y",null,null,"1997-05-22"]
["111112","1997-05-22",null,null,"Adult Prophylaxis","01110",30.00,null,null,null,"Y","EK","TO","1997-05-22"]
["111112","1997-05-22",null,null,"Periodic Oral Examination","00120",20.00,null,null,null,"Y","EK","TO","1997-05-22"]
["111112","1997-05-22",null,null,"Intra Oral Complete Series","00210",45.00,null,null,null,"Y","EK","TO","1997-05-22"]
["111112","1997-05-22","16","MDOL","3S Composite","02332",75.00,null,null,null,"Y","EK","TO","1997-05-22"]