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Clinical documentation should reflect the DSM-5 criteria used to establish dependence typically two or more of the eleven diagnostic criteria within a 12-month period to support medical necessity, particularly when tobacco cessation counseling services are being billed alongside this diagnosis

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Additionally, cigars contain a large amount of sugar inside that breaks down into acid when heated by combustion, leading to more damage in terms of tooth decay

Large quantities, even if intended as gifts, may attract additional scrutiny from Customs officers

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