81111 Appliance, Maxillary, Unilateral
| 80000 | ORTHODONTICS |
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| 81000 | APPLIANCES, ACTIVE, FOR TOOTH GUIDANCE OR MINOR TOOTH MOVEMENT |
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| 81100 | APPLIANCES, REMOVABLE |
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| 81110 | Appliances, Removable, Space Regaining |
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| 81111 | Appliance, Maxillary, Unilateral |
$349.31
+Lab Costs |
$349.31
+Lab Costs |