14922 Two units
| 10000 | PREVENTION |
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| 14000 | APPLIANCES |
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| 14900 | APPLIANCES, INTRAORAL, TO TREAT MEDICALLY DIAGNOSED OBSTRUCTIVE SLEEP APNEA, |
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| 14920 | Appliance, Intraoral, For the Treatment of Obstructive Airway Disorders, Monitoring To include |
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| 14922 | Two units | $155.8 | $155.8 |