14739 Each additional unit over three
| 10000 | PREVENTION |
||
| 14000 | APPLIANCES |
||
| 14700 | APPLIANCES, TEMPOROMANDIBULAR JOINT |
||
| 14730 | Appliance, TMJ, Periodic Maintenance, Adjustments, Repairs |
||
| 14739 | Each additional unit over three |
$83.42
+Lab Costs |
$83.42
+Lab Costs |