81221 Appliance, Maxillary
| 80000 | ORTHODONTICS |
||
| 81000 | APPLIANCES, ACTIVE, FOR TOOTH GUIDANCE OR MINOR TOOTH MOVEMENT |
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| 81200 | APPLIANCES, FIXED OR CEMENTED |
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| 81220 | Appliance, Fixed, Spaces Regaining, Unilateral |
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| 81221 | Appliance, Maxillary |
$262.16
+Lab Costs |
$262.16
+Lab Costs |