14611 Maxillary Appliance

10000	PREVENTION
14000	APPLIANCES
14600	APPLIANCES, PERIODONTAL
14610	Appliances, Periodontal (including bruxism appliance); Includes Impression, Insertion and Insertion Adjustment (no post-insertion adjustments)
14611	Maxillary Appliance	$436.94 +Lab Costs	$436.94 +Lab Costs