81211 Appliance, Maxillary
| 80000 | ORTHODONTICS |
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| 81000 | APPLIANCES, ACTIVE, FOR TOOTH GUIDANCE OR MINOR TOOTH MOVEMENT |
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| 81200 | APPLIANCES, FIXED OR CEMENTED |
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| 81210 | Appliance, Fixed, Space Regaining (e.g. lingual or labial arch with molar bands, tubes, locks) |
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| 81211 | Appliance, Maxillary |
$349.31
+Lab Costs |
$349.31
+Lab Costs |