14629 Each additional unit over three
| 10000 | PREVENTION |
||
| 14000 | APPLIANCES |
||
| 14600 | APPLIANCES, PERIODONTAL |
||
| 14620 | Appliances, Adjustment, Repair |
||
| 14629 | Each additional unit over three |
$79.45
+Lab Costs |
$79.45
+Lab Costs |