14612 Mandibular Appliance
| 10000 | PREVENTION |
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| 14000 | APPLIANCES |
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| 14600 | APPLIANCES, PERIODONTAL |
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| 14610 | Appliances, Periodontal (including bruxism appliance); Includes Impression, Insertion and Insertion |
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| 14612 | Mandibular Appliance |
$436.95
+Lab Costs |
$436.95
+Lab Costs |