Claim CLM-2026185003
$301.68
billed
$198.84
allowed
$0.00
paid
$0.00
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Encounter for check up (procedure) | 185349003 | $0.00 | $0.00 |
| topical application of fluoride varnish | D1206 | $185.21 | $0.00 |
| intraoral periapical each additional radiographic image | D0230 | $16.37 | $0.00 |
| periodic oral evaluation established patient | D0120 | $14.55 | $0.00 |
Denial risk — 15/99
Scored by the denial-risk model before adjudication. Advisory only — nothing blocks on a score; the factors below cite the adjudication history they came from.
| Factor | Weight |
|---|---|
| UnitedHealthcare denial history: 1318 of 8195 claims denied (16%) | +0.36 |
| Service D0120 (periodic oral evaluation established pa): 14 of 143 historically denied (10%) | -0.03 |