Select Detachment HQ Det (Ft Worth) Det 1 Det 2 Det 3 Det 4 Det 5 (Houston) Select Provider Bierman Brant Brightman Corwin Dibelka Dickie Godbold Hibbs Hutson Kirkpatrick Kono Lee Matteoli McCann Morris Reeves Santoyo Schell Stephens Stokes Trammell X-Ray Tech Other Name of Provider if not listed:
Select Month January February March April May June July August September October November December Select Fiscal Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 ADA Code (For Reference Only) D0110 Initial Exam/ID Charting D0120 T-2 Exam D0140 T-3 Exam D0150 Comprehensive Exam D0220 Intraoral Film/Periapical D0230 Intraoral Film/Add D0270 Bitewing - Single Film D0272 Bitewings - Two Films D0330 Panorex D0460 Endodontic Dx Test D0999 Blood Pressure D1310 Nutritional Counseling D1320 Tobacco Counseling D1330 Oral Health Instruction D9310 Consultation D9310 Professional Consultaton D9920 Behavior Management D9973 Patient Handling Time Complete codes and fees.
Select Beneficiary Navy Reserve/Active (BEN 01) Marine Reserve/Active (BEN 02) Other Reserve/Active (BEN 05) USN/USMC Recruit Active Dependent (BEN 09) Dep of Ret/Deceased (BEN 10) All Retired (BEN 11) Humanitarian (BEN 12) Dep Child <17 /Unmarried (BEN 13) Unit Supported: Location:
Specific Date(s): Enter Number of Procedures Performed:
D0120 D0140 D0150 D0460 D0220 D0230
D0272 D0330 D1320 D1330 D9310 D9973
Additional procedures not listed:
These DIRS need to be entered Into DENCAS? Enter Into DENCAS: Yes Enter Into DENCAS: No
Comments:
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