Dental Services

Service Maximum
ID Insurance Code Date Benefit Billed
OP0001 CompDent D0120 1/5/2021 $125.00 $135.00
OP0002 SIP D1110 1/18/2021 $185.00 $135.00
OP0003 CompDent D2751 1/31/2021 $235.00 $250.00
OP0004 Westville D2751 2/13/2021 $135.00 $100.00
OP0005 CompDent D1110 2/26/2021 $245.00 $185.00
OP0006 SIP D1110 3/11/2021 $275.00 $100.00
OP0007 SIP D1110 3/24/2021 $325.00 $425.00
OP0008 Westville D0120 4/6/2021 $175.00 $125.00
OP0009 BlueDent D0120 4/19/2021 $195.00 $145.00
OP0010 BlueDent D1110 5/2/2021 $200.00 $225.00
OP0011 BlueDent D1110 5/15/2021 $225.00 $235.00
OP0012 SIP D1110 5/28/2021 $200.00 $185.00
OP0013 CompDent D2751 6/10/2021 $475.00 $325.00
OP0014 SIP D1110 6/23/2021 $235.00 $235.00
OP0015 SIP D1110 7/6/2021 $235.00 $245.00
OP0016 BlueDent D1110 1/31/2021 $225.00 $200.00
OP0017 BlueDent D0120 2/13/2021 $185.00 $175.00
OP0018 Westville D0120 7/19/2021 $195.00 $150.00
OP0019 Westville D1110 8/1/2021 $225.00 $125.00
OP0020 CompDent D2751 8/14/2021 $375.00 $500.00
OP0021 CompDent D2330 8/27/2021 $325.00 $400.00
OP0022 Westville D2751 9/9/2021 $450.00 $400.00
OP0023 Westville D0120 9/22/2021 $325.00 $300.00
OP0024 SIP D0210 10/5/2021 $500.00 $550.00
OP0025 SIP D0120 10/18/2021 $250.00 $250.00
OP0026 BlueDent D2751 10/31/2021 $125.00 $115.00
OP0027 CompDent D0120 11/13/2021 $325.00 $300.00
OP0028 Westville D2330 11/26/2021 $275.00 $250.00
OP0029 SIP D2751 12/9/2021 $200.00 $235.00
OP0030 BlueDent D1110 12/22/2021 $185.00 $175.00
OP0031 CompDent D2330 2/26/2021 $225.00 $235.00
 Dental Services

Service Maximum
ID Insurance Code Date Benefit Billed
OP0032 BlueDent D1110 2/2/2022 $225.00 $200.00
OP0033 BlueDent D0120 2/14/2022 $185.00 $175.00
OP0034 Westville D0120 2/26/2022 $195.00 $150.00
OP0035 Westville D1110 3/9/2022 $225.00 $125.00
OP0036 CompDent D2751 3/21/2022 $375.00 $500.00
OP0037 CompDent D2330 4/2/2022 $325.00 $400.00
OP0038 Westville D2751 4/14/2022 $450.00 $400.00
OP0039 Westville D0120 4/26/2022 $325.00 $300.00
OP0040 SIP D0210 5/8/2022 $500.00 $550.00
OP0041 SIP D0120 5/20/2022 $250.00 $250.00
OP0042 BlueDent D2751 6/1/2022 $125.00 $115.00
OP0043 CompDent D2751 6/13/2022 $475.00 $325.00
OP0044 SIP D1110 6/25/2022 $235.00 $235.00
OP0045 SIP D1110 7/7/2022 $235.00 $245.00
OP0046 BlueDent D1110 7/19/2022 $225.00 $200.00
OP0047 BlueDent D0120 7/31/2022 $185.00 $175.00
OP0048 Westville D0120 8/12/2022 $195.00 $150.00
OP0049 CompDent D0120 8/24/2022 $125.00 $135.00
OP0050 SIP D1110 9/5/2022 $185.00 $135.00
OP0051 CompDent D2751 9/17/2022 $235.00 $250.00
OP0052 Westville D2751 9/29/2022 $135.00 $100.00
OP0053 CompDent D1110 10/11/2022 $245.00 $185.00
OP0054 SIP D1110 10/23/2022 $275.00 $100.00
OP0055 SIP D1110 11/4/2022 $325.00 $425.00
OP0056 Westville D0120 11/16/2022 $175.00 $125.00
OP0057 BlueDent D0120 11/28/2022 $195.00 $145.00
OP0058 BlueDent D1110 12/10/2022 $200.00 $225.00
OP0059 BlueDent D1110 12/22/2022 $225.00 $235.00
OP0060 Westville D120 12/23/2022 $250.00 $325.00