| Dental Appliances/Prostheses | Dental Appliances/Prostheses | Class I
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| Dental occlusal splint, custom-made | Dental occlusal splint, custom-made |
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| Orthodontic retainer | Orthodontic retainer |
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| Orthodontic clasp, metal, custom-made | Orthodontic clasp, metal, custom-made |
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| Orthodontic appliance system, progressive | Orthodontic appliance system, progressive |
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| Mandible-repositioning sleep-disordered breathing orthosis | Mandible-repositioning sleep-disordered breathing orthosis |
|
| Custom-made mouthguard | Custom-made mouthguard |
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| Orthodontic space maintainer | Orthodontic space maintainer |
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| Dental occlusal splint, customizable | Dental occlusal splint, customizable |
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| Orthodontic appliance system, adjustable | Orthodontic appliance system, adjustable |
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