14712 Mandibular Appliance
| 10000 | PREVENTION |
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| 14000 | APPLIANCES |
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| 14700 | APPLIANCES, TEMPOROMANDIBULAR JOINT |
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| 14710 | Appliance, TMJ, Diagnostic and/or Therapeutic, includes impression, insertion and insertion |
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| 14712 | Mandibular Appliance |
$643.26
+Lab Costs |
$643.26
+Lab Costs |