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Phoenix Exam Imaging services
INDICATE PATIENT BLOOD PRESSURE BELOW
ALERT HYGIENIST IF SYSTOLIC IS OVER 160 OR DIASTOLIC IS OVER 90
SYSTOLIC
/
DIASTOLIC
HAVE YOU HAD YOUR WISDOM TEETH EXRACTION?
1 EXTRACTED
2 EXTRACTED
3 EXTRACTED
4 EXTRACTED
X-Ray Mount
xray mount
Complete Series- D0210
4 Bitewings- D0274
3 Bitewings- D0273
2 Bitewings- D0272
1 Bitewing- 0270
First Periapical- D0220
Panoramic Radiographic Image- D0330
NO XRAYS PERFORMED
How Many Periapical Images
Oral Scan
oral scan
Intraoral Video
3d Dental Surface Scan – Direct- D0801
3d Dental Surface Scan – Indirect- D0802
Intraoral Pictures
NO INTRAORAL SCANS TAKEN
gap
gap
Imaging Link Complete
Imaging Link is Complete
Click Submit Below
SUBMIT WHEN INDICATED
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