14202 Appliance, Mandibular
| 10000 | PREVENTION |
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| 14000 | APPLIANCES |
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| 14200 | APPLIANCES, FIXED/CEMENTED, CONTROL OF ORAL HABITS |
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| 14202 | Appliance, Mandibular |
$599.74
+Lab Costs |
$599.74
+Lab Costs |