| 3/31/2024 | 90212100 | IMP-PFM-NS23#&Supreme regular metal rib porcelain teeth (with plastic impression sample made in the US and plaster jaw sample made in Vietnam but not included)#&VN | XXXXXXXXXX | 1 | UNIT | 33.8 | USA | NA |
| 3/31/2024 | 90212100 | IMP-PFM-NS33#&Supreme regular metal rib porcelain teeth (with plastic impression sample made in the US and plaster jaw sample made in Vietnam)#&VN | XXXXXXXXXX | 1 | UNIT | 29.8 | USA | NA |
| 3/31/2024 | 90212100 | IMP-ALL-LA23#&Zirconium rib porcelain teeth (with plastic impression sample made in the US and plaster jaw sample made in Vietnam but not included)#&VN | XXXXXXXXXX | 4 | UNIT | 94 | USA | NA |
| 3/31/2024 | 90212100 | IMP-ALL-LA33#&Zirconium rib porcelain teeth (with plastic impression sample made in the US and plaster jaw sample made in Vietnam)#&VN | XXXXXXXXXX | 8 | UNIT | 188 | USA | NA |
| 3/31/2024 | 90212100 | IOS-PFM-NS13#&Supreme IOS regular metal rib porcelain teeth (plastic jaw model available but not included)#&VN | XXXXXXXXXX | 24 | UNIT | 769.2 | USA | NA |
| 3/31/2024 | 90212100 | IMP-ALL-LA24#&Zirconia rib porcelain teeth (with plastic impression sample made in the US and plastic jaw sample made in Vietnam but not included)#&VN | XXXXXXXXXX | 1 | UNIT | 26.2 | USA | NA |
| 3/31/2024 | 90212100 | IOS-PFM-GO13#&IOS precious metal rib porcelain teeth (plastic jaw model available but not included)#&VN | XXXXXXXXXX | 6 | UNIT | 863.82 | USA | NA |
| 3/31/2024 | 90212100 | IOS-PFM-PL13#&IOS Platinum semi-precious metal rib porcelain teeth (plastic jaw model available but not included)#&VN | XXXXXXXXXX | 7 | UNIT | 372.54 | USA | NA |
| 3/31/2024 | 90212100 | IOS-PFM-PL03#&Platinum IOS semi-precious metal rib porcelain teeth (no plastic jaw model)#&VN | XXXXXXXXXX | 8 | UNIT | 479.3 | USA | NA |
| 3/31/2024 | 90212100 | IMP-PFM-PL33#&Platinum semi-precious metal rib porcelain teeth (with plastic impression sample made in the US and plaster jaw sample made in Vietnam)#&VN | XXXXXXXXXX | 24 | UNIT | 1450.7592 | USA | NA |