12700 MEDICATION, CUSTOM APPLIANCE
| 10000 | PREVENTION |
||
| 12700 | MEDICATION, CUSTOM APPLIANCE | ||
| 12701 | Medication, Custom Appliance - Maxillary Arch |
74.0
+Lab Costs |
74.0
+Lab Costs |
| 12702 | Medication, Custom Appliance - Mandibular Arch |
74.0
+Lab Costs |
74.0
+Lab Costs |