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Product	Price	Quantity	Subtotal	Remove
OTH-013 Oral Cavity Cover (OCC)	$55.00	OTH-013 Oral Cavity Cover (OCC) quantity	$55.00	×
OR-17I Mixed Dentition: Class III (Hard Base)	$96.50	OR-17I Mixed Dentition:Class III (Hard Base) quantity	$96.50	×
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Subtotal	$151.50
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State Tax	$10.99
Total	$162.49