14829 Each additional unit over three
| 10000 | PREVENTION |
||
| 14000 | APPLIANCES |
||
| 14800 | APPLIANCES, MYOFACIAL PAIN DYSFUNCTION SYNDROME |
||
| 14820 | Appliance, Myofacial Pain Dysfunction Syndrome, Periodic Maintenance, Adjustment and Repairs |
||
| 14829 | Each additional unit over three |
$83.42
+Lab Costs |
$83.42
+Lab Costs |