Anforderung Kostenvoranschlag
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PKM
TM
TV
B
BV
BM
T
E
SKM
STA
INL
VVK
H
K
KH
KM
KMH
KMO
KO
KV
KVH
KVO
PKM
TM
TV
B
BV
BM
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KO
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Versorgungsart
Regelversorgung
gleichartige Versorgung
andersartige Versorgung
Verblendmaterial
Kunststoff
Keramik
keram. Schulter
Legierung / Material
Hochgold
Goldreduziert
NEM
Zenotec
Zenostar
e-max
Galvano
PMMA
Sonstiges
Stützstift
Gesichtsbogen
Zentrikplatte
Implantatsystem
sonstiges
Datum/Uhrzeit(Zeitstempel wird automatisch eingefügt)
KVA bis (Datum):
(Uhrzeit):
