81291 Appliance, Maxillary, Impaction
| 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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| 81290 | Appliances, Fixed, Mechanical Eruption of Tooth/Teeth |
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| 81291 | Appliance, Maxillary, Impaction |
$349.31
+Lab Costs |
$349.31
+Lab Costs |