14912 Two units

10000

PREVENTION

14000

APPLIANCES

14900

APPLIANCES, INTRAORAL, TO TREAT MEDICALLY DIAGNOSED OBSTRUCTIVE SLEEP APNEA,
SNORING, UPPER AIRWAY RESISTANCE SYNDROM (UARS) WITH OR WITHOUT APNEA (Includes
models, gnathological determinants, appliance construction and insertion adjustment [no post-
insertion adjustments])

14910

Appliance, Intraoral, For the Treatment of Obstructive Airway Disorders, Periodic Maintenance,
Adjustment and Repairs

14912 Two units $171.35
+Lab Costs
$171.35
+Lab Costs
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