14721 Maxillary Appliance

10000	PREVENTION
14000	APPLIANCES
14700	APPLIANCES, TEMPOROMANDIBULAR JOINT
14720	Appliance, TMJ Intraoral Repositioning; includes impression, insertion and insertion adjustment (no post-insertion adjustments)
14721	Maxillary Appliance	$643.26 +Lab Costs	$643.26 +Lab Costs