| Item Number | Description | Schedule Fee |
|---|---|---|
| 75042 | Permanent dentition treatment—single arch (mandibular or maxillary) treatment (correction and alignment) using orthodontic fixed appliances or aligners, including supply of appliances and aligners—each subsequent 3 months of active treatment (including all adjustments and maintenance and removal of the appliances) after the initial three months of active treatment for a maximum of a further 33 months |
$242.10 |
| Total: | $242.10 | |