97121 Maxillary Arch

90000	GENERAL SERVICES
97000	BLEACHING, VITAL
97120	Bleaching, Vital Home (Includes The Fabrication Of Bleaching Trays, Dispensing The System and Follow-up Care)
97121	Maxillary Arch	$250.29 +Lab Costs +Material Expenses	$250.29 +Lab Costs +Mater. Exp.