14822 Two units
| 10000 | PREVENTION |
||
| 14000 | APPLIANCES |
||
| 14800 | APPLIANCES, MYOFACIAL PAIN DYSFUNCTION SYNDROME |
||
| 14820 | Appliance, Myofacial Pain Dysfunction Syndrome, Periodic Maintenance, Adjustment and Repairs |
||
| 14822 | Two units |
$166.84
+Lab Costs |
$166.84
+Lab Costs |